Cardiac Failure in Kwashiorkor

Wharton, B A; Howells, G.R.; McCance, R. A.

doi:10.1016/s0140-6736(67)92006-5

Cited by 65 publications

(34 citation statements)

References 10 publications

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“…These rates are incomparable because anticipated mortality may vary widely from centre to centre depending upon the severity of the malnutrition, associated de®ciencies, endemic or epidemic infection, admission policy, treatment regimen and the quality of care. The prognosis of severely malnourished children depends on anthropometric status (Gomez et al, 1956;Dramaix et al, 1993;Kahn, 1959), the presence of oedema (Dramaix et al, 1993) micro-nutrient de®ciencies (McLaren et al, 1969;Golden & Ramdath, 1987), electrolyte imbalance (Gomez et al, 1956;Kahn, 1959), hepatic dysfunction (McLaren et al, 1969;McLean, 1962) or associated infections (Gomez et al, 1956;Laditan, 1976) as well as the treatment protocol used (Wharton et al, 1967). Although reduction in mortality depends upon identi®cation of the reasons for observed differences between centres and regimens, they are usually ascribed to inherent features of the malnutrition; this impedes the evaluation of a centre's ef®cacy and attempts to reduce mortality.…”

Section: Introductionmentioning

confidence: 99%

A model to standardise mortality of severely malnourished children using nutritional status on admission to therapeutic feeding centres

et al. 1997

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Objective: To determine a simple model to calculate the number of deaths which could be expected in a therapeutic feeding centre from the height, weight and oedema of children on admission. Design: Admission weight, height, presence of oedema of the children and outcome were prospectively recorded. Setting: Data were recorded in 18 feeding centres set-up during emergency operations in Africa. Ten of the feeding centres were selected, a priori, as reference centres and eight centres as test centres. Subjects: Data for 3858 children were recorded. 837 children absconded from the centres and were excluded from the analysis. Analysis was performed on data from 2753 children who left the centre after recovery and 268 children who died during treatment. Interventions: The relation between the risk of death and, anthropometric measurements and presence of oedema has been determined in a previous paper. The maximum likelihood estimate of the constant of the model was determined from global analysis of the data of the reference centres. The model was applied to the data of the reference and test centres. Results: The model to predict the individual probability of death was:The predicted number of deaths was close to the recorded number of deaths for each reference centre. For three of the eight test centres there was a signi®cant excess of observed deaths over predicted. Conclusion: This model can be easily used by the supervisor of a centre to assess the expected number of deaths during treatment of malnutrition from simple measurements on children that are routinely taken on admission and thus help to determine the nature of variation in observed mortality rates.

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Section: Introductionmentioning

confidence: 99%

A model to standardise mortality of severely malnourished children using nutritional status on admission to therapeutic feeding centres

et al. 1997

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“…During treatment the sodium pump is stimulated, large amounts of intracellular sodium comes out of the cells, potassium enters the cells, the circulating blood volume increases and the hemoglobin drops from dilutional anemia. The children are at risk of acute heart failure (92)(93)(94)(95)(96) and sudden death (97).…”

Section: The First Phase Of Treatmentmentioning

confidence: 99%

Evolution of nutritional management of acute malnutrition

Golden

2010

Indian Pediatr

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“…This was due to concerns that ‘children with bilateral pitting oedema typically have high intracellular sodium and are therefore inclined to retain fluids’ and ‘are prone to fluid retention and susceptible to fluid changes’, thereby predisposing the child to fluid overload and heart failure 6 . Whilst this was suggested by Wharton et al , who reported an excess of heart failure in children receiving a high energy milk to which sodium was added 13 , apparently to improve acceptability in all children (including those without diarrhoea) the sodium content was probably higher and the milk given over a longer period of time than they would have received if they were only being rehydrated. Thus, this cannot be extrapolated to inform management of rehydration in children with SAM.…”

Section: Introductionmentioning

confidence: 97%

“…The current concern is based on an old paper from Uganda reporting an excess of heart failure in children receiving a high energy milk to which sodium was added, apparently to improve acceptability (See: Wharton et al, 1967 3 ). It can be argued that the quantity of sodium given to these children was presumably higher than those receiving low osmolarity ORS, also that these children received this high sodium milk for much longer that ORS is given, and also they had a high sodium intake in absence of diarrhoea, which means these findings cannot be extrapolated to children with diarrhoea, but this paper should be quoted.…”

mentioning

confidence: 99%

Oral rehydration of malnourished children with diarrhoea and dehydration: A systematic review

Houston¹,

Gibb²,

Maitland³

2017

Wellcome Open Res

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Background: Diarrhoea complicates over half of admissions to hospital with severe acute malnutrition (SAM). World Health Organization (WHO) guidelines for the management of dehydration recommend the use of oral rehydration with ReSoMal (an oral rehydration solution (ORS) for SAM), which has lower sodium (45mmols/l) and higher potassium (40mmols/l) content than old WHO ORS. The composition of ReSoMal was designed specifically to address theoretical risks of sodium overload and potential under-treatment of severe hypokalaemia with rehydration using standard ORS. In African children, severe hyponatraemia at admission is a major risk factor for poor outcome in children with SAM complicated by diarrhoea. We therefore reviewed the evidence for oral rehydration therapy in children with SAM. Methods: We conducted a systematic review of randomised controlled trials (RCTs) on 18 th July 2017 comparing different oral rehydration solutions in severely malnourished children with diarrhoea and dehydration, using standard search terms. The author assessed papers for inclusion. The primary endpoint was frequency of hyponatraemia during rehydration. Results: Six RCTs were identified, all published in English and conducted in low resource settings in Asia. A range of ORS were evaluated in these studies, including old WHO ORS, standard hypo-osmolar WHO ORS and ReSoMal. Hyponatraemia was observed in two trials evaluating ReSoMal, three children developed severe hyponatraemia with one experiencing convulsions. Hypo-osmolar ORS was found to have benefits in time to rehydration, reduction of stool output and duration of diarrhoea. No trials reported over-hydration or fatalities. Conclusions: Current WHO guidelines strongly recommend the use of ReSoMal based on low quality of evidence. Studies indicate a significant risk of hyponatraemia on ReSoMal in Asian children, none have been conducted in Africa, where SAM mortality remains high. Further research should be conducted in Africa to evaluate optimal ORS for children with SAM and to generate evidence based, practical guidelines

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Cardiac Failure in Kwashiorkor

Cited by 65 publications

References 10 publications

A model to standardise mortality of severely malnourished children using nutritional status on admission to therapeutic feeding centres

A model to standardise mortality of severely malnourished children using nutritional status on admission to therapeutic feeding centres

Evolution of nutritional management of acute malnutrition

Oral rehydration of malnourished children with diarrhoea and dehydration: A systematic review

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