The Relation of Oedema to Serum Protein and Pseudocholinesterase Levels in the Malnourished Infant.

The cause of fluid retention in kwashiorkor is unknown. Of various possible factors, one of the few for which there is positive evidence is hypoproteinaemia (Trowell, 1944). Its importance in oedema formation in this condition has been questioned on the grounds that the level of serum protein or albumin in the individual case may fail to correlate with the degree of clinical oedema (Jelliffe, Bras and Stuart, 1954; Hansen, 1956; Waterlow, Cravioto and Stephen, 1960). There are now detailed reports of the serum protein pattern in malnourished infants from many parts of the world, but few of them deal specifically with this relation (Anderson and Altmann, 1951; Edozien, 1960; Hellyer and Went, 1960; MacDonald, 1960; Potgieter, Smythe and Kench, 1960; Kulkarni, Satoskar and Chitre, 1960). It is indeed difficult to do so, for clinical oedema is not readily quantitated, and an excess of total body water is common to all types of infantile malnutrition with or without detectable oedema (Schnieden, Hendrickse and Haigh, 1958; Smith, 1960). In the present study an attempt has been made to compare the degree of oedema with the serum protein levels in 200 infants admitted consecutively to this unit with a primary diagnosis of protein malnutrition. Both factors were also compared with the degree of liver enlargement and with liver function as indicated by the level of serum pseudocholinesterase activity. Two separate analyses were made, oedema being estimated (a) by clinical assessment on an arbitrary scale, and (b) by the initial weight loss after the commenceinent of treatmient. In each analysis the cases were divided into three groups according to the estimated severity of oedema. Fatal cases were