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PubMed1975

Chemically defined diet in the treatment of kwashiorkor.

Kwashkorkor is associated with malabsorption of energy and nutrients. Standard diets often initiate diarrhea and a high mortality is still prevalent. A synthetic monomolecular formula has been evaluated and compared with a standard diet in the early rehabilitation phase of 21 children with kwashiorkor. The formula group had significantly less vomiting and reached minimum weight faster than the group on standard diet. Weight gain and diarrhea were similar. The rise of albumin and BUN was faster on standard diet. A significant increase in haemoglobin was seen only in the formula group. A rise in body temperature after a meal was evident in most patients and significantly more pronounced in the formula group. The lower total nitrogen content of the formula may explain the observed slower rise in albumin and BUN but the ready utilization was indicated by the favourable weight changes as well as the rise in rectal temperature. As high energy per volume was desirable the formula was not diluted to isoosmolality. However, the high glucose concentration in the experimental diet probably caused some negative effects.

Blood Glucose↗
PubMed1975

Disseminated intravascular clotting in kwashiorkor.

The role of disseminated intravascular clotting (DIC) in the pathogenesis of the bleeding diathesis kwashiorkor was investigated in 22 patients. According to the severity of the clinical and haematological findings, two grades of DIC were observed. A severe grade of DIC was shown in 6 cases (5 fatal) presenting with thrombocytopenia, hypofibinogenaemia, and multiple coagulation defects, and with abnormally prolonged partial thromboplastin,prothombin, and thrombin times]. A second goups of 16 patients (7 fatal) showed a less severe grade of DIC manifested by thrombocytopenia, low fibringoen level, and a clotting factor defect shown by rpolonged prothrombin and thrombin times.

Blood Cell Count↗
PubMed1988

Effect of kwashiorkor on the cardiovascular system.

In kwashiorkor the heart is clinically and radiologically small. This study utilises echocardiography, a tool not previously used in this disease, to show that this is due to decreased muscle mass.

Child, Preschool↗
PubMed1991

Computed tomography of the brain in kwashiorkor: a follow up study.

Computed tomography of the brain was performed initially and after nutritional rehabilitation on 12 children with kwashiorkor. The severe cerebral shrinkage evident initially resolved after nutritional rehabilitation. The mechanism and significance of this reversible abnormality remains to be determined.

Atrophy↗
PubMed1960

Serum transaminases and isocitric dehydrogenase in kwashiorkor.

Serum glutamic oxalacetic transaminase (G-OT), glutamic-pyruvic transaminase (G-PT), and isocitric dehydrogenase (ICD) have been estimated in six groups of subjects, namely, normal British adults, normal Nigerian adults, undernourished Nigerian adults and children, Nigerian children with florid protein malnutrition (kwashiorkor), and cases of protein malnutrition after treatment. The normal range in Nigerian adults was apparently slightly lower than in European adults.A marked increase in serum enzyme activity was found in florid malnutrition, and a slight rise in undernutrition. In all cases serum G-PT showed lesser changes than G-OT and ICD. The causes of these abnormalities are discussed. The increased serum enzyme activity is thought to be derived primarily from the liver and possibly also from voluntary muscle. Estimation of serum enzymes is recommended in the investigation of protein malnutrition.

Humans↗
PubMedDate not supplied

Evaluation of clinical and biological parameters in marastic Kwashiorkor children treated by parenteral nutrition.

Reduction of hospital stay and mortality rate due to dehydration and electrolyte imbalance in children suffering from severe marasmic Kwashiorkor was attempted. A program of parenteral nutrition providing 70 to 100 milliliters water, 30 to 40 kilocalories, and 3 to 4 grams amino acids per kilogram daily was given. Seventy-seven African children suffering from protein deficiency and calorie deficiency were given an intravenous perfusion of casein hydrolysate or cristalloid amino acids for a mean period of 6 days. An oral supplement of tea and sugar, boiled rice, and palm oil was also given. The total mortality has not been modified in comparison with that in children given an oral diet (semi-liquid) consisting of low fat milk and locally available proteins. In more than half of the cases, the parenteral nutrition has favored water and salt retention and the development of cardiac failure possibly due to adynamic circulatory state. Weight curve, serum albumins, serum and urine amino acids were followed closely for 1 month. In eleven patients, nitrogen balance studies were done. All were positive independently of the coexisting infectious pathology. Correlating the increase in serum proteins with the cumulative nitrogen balance allowed us to consider casein hydrolysate as particularly useful for hepatic protein synthesis while cristalloid amino acids seem to favor muscular protein synthesis. The introduction of parenteral nutrition as a therapeutic regimen for standard use in the malnourished child seems less favorable than oral realimentation programs and does not seem desirable in developing countries.

Adult↗
PubMed1990

The long-term effects of early kwashiorkor compared with marasmus. IV. Performance on the national high school entrance examination.

This is one of a series of studies on the long-term effects of early childhood malnutrition in Barbadian school children. This is the first report of the relationship between early malnutrition and later performance on a national examination administered to all 11-y-old children in Barbados to assign high school seats. We compared scores achieved on the 11-plus examination by 103 boys and girls with histories of marasmus or kwashiorkor with those obtained by 63 healthy comparison children and also with scores obtained by the total island population of children during the same years. We report that children with histories of either type of malnutrition confined to infancy had significantly lower scores on the national high school examination than healthy comparison children. Reduced 11-plus scores were closely associated with teacher reports of attention deficits in the classroom documented when the children were as young as 5 to 8 y of age and also with IQ and academic performance. Early malnutrition had independent effects on performance on the 11-plus examination even when home environmental conditions were controlled for. These findings have important implications for future opportunities available to children with histories of infantile malnutrition.

Barbados↗
PubMed2001

[Kwashiorkor as a symptom of abuse and neglect in Barcelona].

Child abuse can take various forms and the presenting signs and symptoms can sometimes lead to diagnostic error. Faced with a malnourished child physicians should not forget that one of the possible causes of the malnutrition could be abuse. Because of rising immigration, forms of child abuse uncommon among the Spanish industrialized population may increase.An African girl, who had been resident in Spain for several years, presented with symptoms of kwashiorkor disease. This, combined with observation of the child's social environment and her own account, led to a diagnosis of neglect. This is a rare clinical presentation of abuse in our socio-economic milieu.

Child Abuse↗
PubMed1975

[Kwashiorkor. Dermatological and clinical aspects (Analysis of 100 cases)].

The Authors study 100 children with "kwashiorkor", treated at Municipal Hospital Jesus (Rio de Janeiro). The children came from prolitic families of low economical resources. Their age is between 4 months and 8 years, 53% of them beiney halfbreed, 32% white people and 15% negroes. Diagnosis was based on alimentary deficiency in high caloric value proteins (100%), oedema (100%), muco-cutaneous alterations (78%), capillary changes (65%), apathy (75%), muco-cutaneous pallox (67%), and complementary examinations (total and fraction proteins, sodium, potassium hemoglobin). They emphasize the role of intercurrent infections (verminosis, pneumopathies, virosis, otitis, etc.). Treatment was carried out through correction of desnutrition, hydro-electrolytical troubles and infectious diseases.

Brazil↗
PubMed1991

Electron microscopy of herpes simplex hepatitis with hepatocyte pulmonary embolization in kwashiorkor.

We report a case of herpes simplex hepatitis in a child with edematous malnutrition. Electron microscopy showed virus in parenchymal cells, with pulmonary embolization of necrotic, infected hepatic cell fragments. Systemic dissemination of herpes simplex may be related both to the profound immunoincompetence associated with kwashiorkor and to a reduction in the circulating and fixed polyanions that normally inhibit viral attachment to cells.

Capillaries↗
PubMed1990

Kwashiorkor and marasmus: changing hospital incidence of syndromic presentation (1957-88).

This clinico-epidemiological study was undertaken to substantiate the impression that the pattern of clinical presentation of protein-energy malnutrition causing kwashiorkor-marasmus syndrome (KMS) is changing over time. An analysis of data for the period 1964-88, obtained from the specialised Pediatric Clinic of the Calcutta School of Tropical Medicine serving mostly the city slums showed decrease (p less than 0.01) in the incidence of chronic edematous forms of severe KMS, less decrease (p less than 0.05) in the incidence of mild-moderate KMS and increase (p less than 0.01) in the incidence of nutritional marasmus and of chronic very severe forms of KMS characterised by extreme retardation in growth and development. Incidentally, a rising incidence of rickets was observed. In the hospitalised cases (1957-88) these observations were corroborated. Data for 1985-88 of NRS Medical College Hospital, Calcutta, a general hospital serving the city as well as the neighbouring rural areas, showed that among the hospitalised city children edematous KMS was proportionately fewer than marasmus. The situation was reverse in the children from the rural areas. The observations suggested that the syndromic presentation of KMS is changing over the last three decades with some rural-urban differences for which only some recent data could be available.

Child↗
PubMed1990

[Evaluation of bone age in patients with kwashiorkor].

The present work is the result of a multicentric study performed at Hoima and Kitgum Hospitals in Uganda on a group of 20 children with Kwashiorkor. Bone age was evaluated on the X-ray film of the children's left hand and wrist, according to Tanner and to De Roo, by 2 different evaluators. The final results were compared. Eighty-five % of the patients presented delayed bone maturation: such a result confirms the importance of malnutrition on skeletal development. The data reported by other authors are also discussed.

Age Determination by Skeleton↗
PubMed1975

Bicarbonate excretion in kwashiorkor.

Children with kwashiorkor have an impairment of bicarbonate excretion which may result in the inappropriate production of acid urine in the presence of systemic alkalosis. This defect has resolved after 2 weeks of treatment.

Bicarbonates↗
PubMedDate not supplied

[Kwashiorkor in an adult with alcoholic hepatic cirrhosis].

Multifactorial malnutrition is common in alcoholic cirrhosis. We report a case dominated by Kwashiorkor due to malabsorption related to infestation with Giardia Lamblia. Malnutrition deserves a complete investigation in order to detect treatable causes.

Adult↗
PubMed1988

[Kwashiorkor syndrome in exudative enteropathy].

We report on a case of a 45 years old man suffering from ulcerative colitis accompanied by a protein-loosing-syndrome (hypoalbuminaemia). The significant decrease of cholinesterase (CHE) and quick level, edemas of the legs and forearms, pleural effusion and ascites had been misinterpreted as signs of liver insufficiency. Low protein diet was given and, thus, the full picture of kwashiorkor developed soon as a logical consequence. Liver-induced fluid dysbalance was assumed and the low-protein diet continued. We describe the difficulties of treatment and the favourable outcome of the disease.

Biopsy↗
PubMed1979

Isoniazid pharmacokinetics in kwashiorkor.

Isoniazid plasma half-life and clearance rates were studied in children with kwashiorkor before and after nutritional rehabilitation. Isoniazid half-life rates fell and clearance increased with nutritional rehabilitation. The changes documented in this report are not an indication that isoniazid therapy should be altered in malnourished children, but may indicate that this should be done in malnourished adults.

Half-Life↗
PubMed1983

[Initiation of a cure for kwashiorkor patients using a whey milk product. A comparison with cows milk].

Whey milk, a side-product of cheese production, is not utilized for human nutrition. Whey protein is of good nutritional quality with a high biological value, exceeding that of whole-milk protein. A whey milk product consisting of liquid whey milk 60%, whole cow's milk 40% and skimmed milk powder 0.5% was mixed, spray-dried and prepared in instant form. After reconstitution with water, it was compared with sterilized whole cow's milk for the initiation of cure in 30 acute kwashiorkor patients randomly allocated to the two feeds. The diets were given for 3 weeks. There were no statistically significant differences between the two diets with regard to weight gain or levels of serum albumin, globulin, calcium, phosphorus, alkaline phosphatase, sodium, potassium, chloride, bicarbonate, urea or haemoglobin. Judging from this limited investigation, whey milk deserves consideration for human utilization. Should economical production be possible, it could contribute towards preventing and treating protein energy malnutrition.

Animals↗