Serum colloidal osmotic pressure in the development of kwashiorkor and in recovery: its relationship to albumin and globulin concentrations and oedema

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Abstract
1. Serum colloidal osmotic pressure was measured in children ‘at risk’ to kwashiorkor, in others with frank signs of the disease and during recovery. Simultaneous estimations of serum albumin and globulin concentrations and assessments of the extent of oedema were also made.2. During the development of kwashiorkor, serum colloidal osmotic pressure did not decrease significantly until albumin concentration was 25.1–27.5 g/l. Above 30.0 g/l, colloidal osmotic pressure was maintained at normal levels during which time a significant reciprocal relationship existed between albumin and globulin concentrations. These findings provide support for suggestions that there may be an oncotic regulation of albumin synthesis.3. Low albumin concentrations were mainly responsible for the low colloidal osmotic pressures found in children with kwashiorkor and in agreement with previous findings the threshold for the formation of oncotic oedema was found to be about 2.35–2.65 kN/m2.4. Values for colloidal osmotic pressure calculated from serum albumin and gobulin concentrations using empirical formulas did not agree well with measured values and no constant correction factor suitable over the whole range of albumin concentrations found in rural Ugandan children could be devised. In many hypoalbuminaemic children only direct measurement of serum colloidal osmotic pressure will indicate the true extent of risk to an episode of oedema.