Kwashiorkor in North America

The controversy regarding the relative importance of protein vs energy deficiency in the genesis of kwashiorkor has not been resolved by studies of protein-energy malnutrition (PEM) in developing countries. Cases of edematous PEM (n = 29) in North America on the other hand provide clear indications that protein deficiency is an essential prerequisite for the development of kwashiorkor and marasmic kwashiorkor. Energy intakes may vary from low to high and the main source of energy may be carbohydrate or fat. These findings are in keeping with experimental evidence that a low ratio of protein to energy disrupts the usual hypometabolic response to dietary deficiency and leads to hypoalbuminemia and consequent edema. Protein supplements should be a part of programs aimed at preventing kwashiorkor.     

Masked clozapine-induced cardiomyopathy.

A 33-year-old Latin-American woman with a history of psychosis and mood disorder, but no cardiac history or risk factors, presented with heart failure after 6 weeks of clozapine and olanzapine therapy. Her presentation was ambiguous and further complicated by a highly suggestible nature, which delayed the proper diagnosis and treatment. After discontinuing the antipsychotic agents and completing an otherwise negative comprehensive work-up, her heart function significantly improved (left ventricular ejection fraction increased from 38% to 53%). A literature search showed that cardiomyopathy secondary to antipsychotics has been reported but remains poorly understood. This is the second documented case report of clozapine-induced cardiomyopathy in a Latin-American woman.     

Amino Acids in Plasma and Urine in Kwashiorkor

Children with kwashiorkor were found to have an aminoaciduria. Also ethanolamine and beta-aminoisobutyric acid were found in the urine. The latter two substances disappeared upon feeding an adequate diet.     

Evaluation of clinical and biological parameters in marastic Kwashiorkor children treated by parenteral nutrition

Reduction of hospital stay and mortality rate due to dehydration and electrolyte imbalance in children suffering from severe marasmic Kwashiorkor was attempted. A program of parenteral nutrition providing 70 to 100 milliliters water, 30 to 40 kilocalories, and 3 to 4 grams amino acids per kilogram daily was given. Seventy-seven African children suffering from protein deficiency and calorie deficiency were given an intravenous perfusion of casein hydrolysate or cristalloid amino acids for a mean period of 6 days. An oral supplement of tea and sugar, boiled rice, and palm oil was also given. The total mortality has not been modified in comparison with that in children given an oral diet (semi-liquid) consisting of low fat milk and locally available proteins. In more than half of the cases, the parenteral nutrition has favored water and salt retention and the development of cardiac failure possibly due to adynamic circulatory state. Weight curve, serum albumins, serum and urine amino acids were followed closely for 1 month. In eleven patients, nitrogen balance studies were done. All were positive independently of the coexisting infectious pathology. Correlating the increase in serum proteins with the cumulative nitrogen balance allowed us to consider casein hydrolysate as particularly useful for hepatic protein synthesis while cristalloid amino acids seem to favor muscular protein synthesis. The introduction of parenteral nutrition as a therapeutic regimen for standard use in the malnourished child seems less favorable than oral realimentation programs and does not seem desirable in developing countries.