The Problem of Oedema in Infantile Malnutrition

Abstract

I n contrast to its great frequency in semistarved adults oedema is rather exceptional in wasted infants. Among 380 cases we observed oedema only 8 times, CHOREMIS (5) in 3.1 % of his 450 wasted infants. It thus seems evident that wasting of the body is in itself by no means necessarily linked with the occurrence of oedema.Infantile malnutrition is, however, a syndrome of inhomogeneous aetiology.There are certain types showing a conspicuous tendency to oedema, such as 1) Czerny and Kellers "Mehlniihrschaden". 2 ) "wartime malnutrition" of infants (2, 7). 3) Tropical forms of malnutrition. 4) Leiner's disease (erythroderma desquamativum). Hence the aetiology of malnutrition has a bearing on the appearance of oedema. I n this paper we endeavour to analyse why oedema is exceptional in spite of severe wasting, in infantile hospital material, as contrasted with semistarved adults and "special" types of infantile malnutrition as enumerated above. We felt that the pathogenic significance of factors generally believed to promote hunger oedema might be tested by their presence in the "oedematous" or by their absence in the "dry" type of infantile malnutrition. We hoped that the relationships between wasting of the body and occurrence of oedema might be further clarified by such comparative work. This task is facilitated by summarizing some recent brilliant descriptions of oedema in semistarvation (2, 10, 13, 20, 21, 23). Briefly it seems that extensive hypoalbuminaemia doubtless promotes severe, universal oedema. So does elevated venous pressure accompanying hard work, infections or imprudent hypercalorisation. The mechanism of oedema in the latter cases seems to be due to overburdening the wasted heart by rising cardiac output. All this agrees with the classical knowledge on oedema formation (3, 6, 9, 22, 26, 29, 30).On the other hand, however, oedema has been observed in a great number of semistarved adults even in the absence of important hypoproteinaemia or high venous pressure. The appearance and disappearance of oedema in such cases is clearly linked with posture. The essential departure from the normal Received 28.8. 1952. D e p r t m e n t of Pediatrics University of PBcs PBcs. Hungary.

The Effects of Malnutrition on Inpatient Outcomes in Patients With Gastroparesis: A Nationwide Analysis

“…Vitamin and mineral deficiencies have been linked to mortality in hospitalized patients and patients undergoing major surgeries [22]. Malnutrition may also increase mortality through other mechanisms, such as hypoglycemia and hypothermia [23,24]. Patients with malnutrition who cannot tolerate oral feeding should receive alternative forms of enteral nutrition to improve outcomes [25].…”

The Chemical Structure of the Body

“…Undernutrition leads to a loss of fat, and it has been known for some long time to increase the percentage of water in the body as well. The work carried out during the Second World War established that the increase was largely extracellular, and it niay be very extensive, even in the absence of any visible cedema [Kerpel-Fronius and Kovach, 1948;Widdowson and McCance, 1951;Kerpel-Fronius and Varga, 1953].…”