Diarrhoea of Acute Kwashiorkor

Children with kwashiorkor almost invariably have diarrhoea which may be severe and prolonged. The exact cause is often obscure and the management unsatisfactory (Brock et al., 1955; Trowell, 1958; Pretorius and Smit, 1958). Recently Bowie, Brinkman, and Hansen (1965), and Bowie, Barbezat, and Hansen (1967) found that the majority of their kwashiorkor patients with severe diarrhoea responded with a dramatic reduction in daily stool weights on a lactose-free diet, with or without added glucose. The diarrhoea was related to lactose malabsorption as a result of intestinal lactase deficiency. Other disaccharidases were much less affected, and absorption tests for sucrose and maltose were normal. In Uganda, Wharton (1968) found intolerance to disaccharides and glucose in kwashiorkor patients, and he was able to control the diarrhoea with a diet containing fructose as the only carbohydrate. The present investigation was undertaken to evaluate further the effect of different sugars on the diarrhoea of kwashiorkor in an area where life-threatening diarrhoea is less frequently encountered than reported from other centres (Pretorius, Wehmeyer, and Mey, 1964; Wharton, 1968).