Alkaline phosphatase activity of the serum in kwashiorkor.

There are few reports of alkaline phosphatase activity in the serum of children suffering from kwashiorkor. The values quoted are somewhat conflicting: Waterlow (1948) found an average level of 19.7 .King-Armstrong units in eight cases of "fatty liver disease " in Jamaica, and Jaya-sekera, de Mel, and Cullumbine (1951) reported an average value of 15.8 units in 40 children with kwashiorkor investigated in Ceylon. Both values fall within the normal range of 15 to 20 King-Armstrong units quoted by Behrendt (1949). In Kampala the average of 23 estimations in children newly admitted for treatment of acute kwashiorkor was 11.8 units with a range of 4.7 to 23.1 units (Dean and Schwartz, 1953). Workers in Cape-town, Johannesburg, and Gautemala City have also found low values (Hansen, Bersohn, and Behar, personal communications). Low activities have been reported for most of the blood and tissue enzymes investigated in kwash-iorkor. In the Kampala investigation already mentioned the activity of three serum enzymes (amylase, non-specific esterase, and pseudocholin-esterase) was low when the children were admitted , and rose after two to three weeks of treatment to levels approaching, and often exceeding, those that were considered normal for healthy children. Enzymes in duodenal juice (amylase, lipase, and trypsin) showed similar alterations. The pattern for alkaline phosphatase was different: in about half the children investigated the levels fell so that by the eighth day the average value was 9.5 units. Subsequently there was a steady rise in activity up to the time when the children were discharged, usually about 30 days after admission. Bersohn (personal communication) also frequently found a fall in alkaline phosphatase activity in Johannesburg children. As at Kampala, the fall did not occur in all cases, but it was frequent enough to merit attention.