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

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Abstract
The extent of clinical edema in 200 Jamaican cases of infantile protein malnutrition was compared with the levels of serum proteins and serum pseudocholinesterase activity and with the degree of hepatomegaly. Two separate analyses were made, edema being assessed clinically and by the amount of initial weight loss during recovery. In both analyses there was significant correlation between the degree of edema and the values of serum albumin and total protein. Cases with severe edema consistently had low serum proteins, but only about half of the cases with very low proteins had severe edema. Both hepatomegaly and low serum pseudocholinesterase activity were significantly related to severe edema. On the other hand there was no evidence of correlation between liver dysfunction and liver size except in the largest livers. Mortality was highest in cases with severe edema and very low serum proteins. Liver enlargement and very low serum pseudocholinesterase levels were more constant features of fatal cases, with or without edema. The possible mechanisms of edema in kwashiorkor, and the significance of the fatty liver, are briefly discussed.