Intracellular Composition and Homeostatic Mechanisms in Severe Chronic Infantile Malnutrition

Abstract

IN SPITE of recent progress in the study of severe malnutrition of dietary origin, the mortality still is very high. In the 733 cases studied by Gómez et al. the over-all mortality was 35%. The majority of deaths occurred during the first 48 hours after admission to the hospital, and the outstanding features were electrolyte disturbances associated with diarrhea and/or bronchopneumonia. Similar observations have been reported from other areas of the world. Although the ultimate goal in the solution of the problems of malnutrition, as in any other disease, lies in prevention, or at least in earliest treatment, not enough emphasis has been given to the study of those factors responsible for the high mortality observed in this condition. Actually very little is known about the homeostatic mechanisms of children affected with severe chronic malnutrition. Water and electrolyte imbalances occurring in malnourished infants, such as attend superimposed diarrheal dehydration, usually are evaluated according to concepts derived from studies on well-nourished infants, without taking into consideration the fact that the chronically malnourished child has been abnormal for a long time before an episode of severe dehydration necessitates hospitalization. A great variety of environmental factors play a role in chronic malnutrition but, in general, the course of the disease is more or less constant. The chronically underfed child apparently becomes adapted to his metabolic status by slowing or almost complete cessation of growth, but suffers bouts of mild diarrhea which persist for a week or two, then disappear for a period of 8 to 10 days only to reappear with increased severity. Frequently the first bout coincides with convalescence from one of the infantile exanthematous diseases.