Nutritional oedema in children in Egypt.

Oedema developing in the course of gastro-intestinal disorders of infancy has been noted in America by Maver (1920) and in Egypt by Shawki. It was of the same character as that which developed in adults during times of war and famine, as in Poland during the Great War, when the food available was of low caloric value (1200-1400 cal. per day) and no meat was obtained for months. The oedema, though resembling that of kidney disease, was not associated with any renal damage. Eighteen cases of gastro-intestinal disorder with oedema have been collected. All had previously been submitted to a prolonged period of starvation on medical or lay advice before attending the hospital because of some gastro-intestinal trouble and a variable fever. Food had been restricted to anisi or karaway and boiled barley or rice water. After a period varying from three days to two months, with an average of three weeks, during which the patients lost considerable weight and became pale and flabby, oedema appeared first in the eyelids, then in the hands and legs and lastly in the peritoneal cavity as ascites. No cardiac or renal disease was found to account for the oedema. The blood and oedema fluid of these cases were examined for their protein, chlorides, cholesterol and calcium content and the blood picture noted. The results are shown in the table. The table shows certain features which will be dealt with more in detail later. In all except three cases the total serum protein was 4-5 per cent. or less, reaching the 'critical level' as in experimental oedema (Weech, Snelling and Goettsch, 1933). The reduction was mostly in the albumin fraction. The chlorides, instead of being only 50 mgm. per cent. higher in the cellular spaces, showed an increase of at least 120 mgm. per cent. and reached as much as 482 mgm. per cent. difference between the blood and oedema fluids in one of the cases. All cases showed a severe hypochromic anaemia with a low reticulocyte count. The cholesterol content of the blood was always low. The anaemia and general weakness tended to persist after the oedema had disappeared. From the table two facts stand out: (1) the almost constantly present hypo-proteinaemia; and (2) the increased chloride content of the oedema fluid. 254