Blood and Extracellular Fluid Studies in Chronic Malnutrition in Infancy 12

Abstract

One problem facing the Italian Medical Nutrition Mission in 1945-46 was the great number of infants and children suffering from severe and chronic malnutrition. Through lack of sanitation, milk control and proper food, cases of severe inanition were encountered quite frequently in southern Italy.The obvious dehydration of these emaciated infants on one hand and the poor results obtained with intravenous fluid therapy on the other hand suggested that there existed a severe disturbance of the distribution of body water rather than a simple deficiency in body fluids. Studies under the actual conditions of a war-torn and povertystricken country seemed therefore to be desirable. METHODS AND MATERIAL Clinical materialTwenty-three cases of severe marasmus in infancy and six cases of chronic malnutrition in older children were examined and 55 observations were made. Prior to being admitted to the Annunziata Hospital in Naples these infants had suffered generally from several attacks of gastro-intestinal disturbances, particularly diarrhea and vomiting, which presumably caused their initial loss of 1The present studies are a part of the work of the Italian Medical Nutrition Mission, 1945-46. This Mis-sion was sponsored by the Unitarian Service Committee,

Plasma and blood volumes in severely malnourished Jamaican children.

“…The assumption also that the ratio of whole body haematocrit to peripheral venous haematocrit holds true for malnourished children was not validated in this study. Several workers have reported on the increased plasma volume occurring in malnutrition, irrespective of the methods used (Gollan, 1948;Gomez, Ramos Galvan, Cravioto Muno6z, and Bienvenui, 1950;Cohen and Hansen, 1962;Picou, 1963). Gomez et al (1950) used Evans Blue and found a mean value for plasma volume of 83 ml./kg.…”

An example of cellular hyperosmolarity

“…A chronically increased cellular osmolar concentration would be a plausible mechanism for the occurrence of hypernatremia in certain cerebral disorders (13,14). Likewise, a chronically decreased cellular osmolar concentration might be the original defect in those instances of hyponatremia frequently observed among patients with pulmonary tuberculosis and other debilitated states (15)(16)(17)(18). These so-called "saltwasting syndromes" may not represent a deple-tion of sodium in any true sense.…”

Serum complement and immunoconglutinin in malnutrition.

“…The failure to show Phe data of electrophoretically altered C3 components in some rrelation be-children with raised IK may be due to the limiting tion and the factor of C3 concentration needed for clear delinea-Moreover, tion of the precipitin arcs. mobilized to Other possible explanations of low complement bodies to the activity need mention, though they are not signifi- (Gollan, 1948;Gomez et al, 1950) and suggested in addition by the presence of hyponatraemia (Garrow and Pike, 1967) possibly due to an inappropriate secretion of antidiuretic hormone. Loss through the gastrointestinal tract is another possible avenue of complement depletion; in protein-calorie malnutrition, the intestinal mucosa is flattened (Ramalingaswami, 1964) which may lead to protein-losing gastroenteropathy.…”