Sindrom Diare Pada Malnutrisi PDF

TIlE
A5IERI(AN
Vo).
JOURNAL
22, No.
2,
OF
CLINICAL
Febrirry,
Irinled
in
NUTRITION
1969, pp.
t3I-I46
U.S.A.
Dehydration
Syndrome
Iranian
SADRE,
MAHIN
HAtsIts
M.D.,1
ZARRINDOKHT
of
ONE-THIRD
the
been
simown
intercttrrent
of
infections
rheal
t!isease
should
1)e
in
eveti
to
dition
anti
hospital
diar-
cases
diagnosis
child
disease
produces
that
does
tion
not
that
are
in
dren,
hospitalized
many
Imas
in various
(1,
that
understooti
in
and
It
has
tion
as
fering
are
been
it
ortr
aim
in
the
our
points
out
total
therapeutic
study
Iranian
different
will
malnutrition,
permit
Time
clinical
eyes,
decreased
of
rational
first
sufprotein-
step
that
approach
to
its
treatment.
In
1
Food
Iran.
an(I
of
Healtim
we
Nutrition
Professor
University
World
paper,
of
Teheran.
present
the
Iimstitute
Pediatrics,
of
Medical
results
Iran,
Pahlavi
con-
as
seen
to
the
i.IETHOI)S
of
Nutritionist,
139
clinic
of Paimlavi
Hospital
during
time summer
of
Teheran)
for
selecting
evidence
of
elasticity
infection,
and
or
no
of
by
imcpatomegaly
was
classified
as
aimd
not
occur
to
standardize
solution
(1/6
plasnma,
serunm
disduring
of kwaslmiorkor
edema
accompanied
aimd
skin
lesions.
edema
and
No
various
whole
did
was
of
use
nmade
treatment
pimysicians.
others)
not
lesions
attempt
solution,
aibunmin,
patient
was
skin
metimods
(among
Ringer
Time
when
responsible
isi)
iimfectious
received
was
included
solution,
DO
and
A diagnosis
conconmitalmtiy.
time
cimild;
nose,
timere
marasmic
the
depressed
ear,
Specific
hepatonmegaly
by
(Sunken
time skin,
therapy
episode.
patients
mucous
nmembranes);
and vomiting
in the
of
parenteral
when
given
our
dehydration
48 hr
in a malnourisimed
Signs
of
pulmonary,
sates.
Organization.
montims
of age,
fronm timose con-
premious
obvious
rows
Hospital,
were
criteria
treatnmemmts
Teheran,
2-36
chosen
clmildren,
and
dryness
of
of acute
diarrhea
enmployed
timis
time
adimitted
fontanel,
a imistory
was
dehydra-
children
forms
as
a niore
of
1967.
eases:
meas-
26
outpatient
time present
to
were
AND
They
were:
preseimt
calorie
of
studied.
timroat
is poorly
inadequate.
occurs
from
the
de-
30-50%
including
clearly
malnutrition
that
employed
from
at
world,
This
dehydration
chil-
suffering
of the
3-6).
nor-
Mortality
estimated
timey
Also,
patients,
Material
sultimmg time
(University
hydrain
(2).
them
been
parts
country
A
was
malnourished
of
hydration,
the
adequate
patients
after
at
prior
and!
is reporte(i.
Clinical
pa-
syndrome
to
treatment.
discimarged
MATERIAI.S
malnourished
respond
nourished
rates
the
disease
atlmission
time
from
diarrhea!
timeir
mtiscle
is not
time
dehydration
readily
measures
mally
in
anti
suffering
It
it
in
blood
of
parenteral
of
nialnutrition
many
any
of
6 montims
lower
summer.
that
in
as
or
and
file.
Diarrhea!
mires
of
upper
because
moment
an
winter
of
children
delmydration
but
M.D.,
M.D.
analyses
malnourisimed
time
rather
GHARIIS,
DoNoso,
bioclietnical
of
(1).
However,
time cause
as
out,
timat
eimtered
tients
severe
in
spring
pointed
common
from
admission,
disease,
respiratory
to
have
MOHAMMAD
GONZALO
AND
These
of:
Dar-
a Ringer-lactate
blood
ammd protein
transfusions,
lmydroly-
Downloaded from ajcn.nutrition.org by guest on November 18, 2012
or
PH.D.,1
Teheran
tn lion
is rarely
M.D.,1
HEDAYAT,
acimitted
in
suffering
tnalnu
such
as
consultatioll
children
be
Children
GHAVAM,
wart!s
to
lmrotein-cl0rie
malnutrition
is so
time
pediatric
in Malnourished
Sadre
140
et
al.
TABLE
Sone
clinical
characteristics
in 26 malnourished
patients
Per-
Case
number
Age,
months
Name
\Vt,
centage
ideal
wt
kg
CX
ASA
2.4
48
3.5
44
42
18
F
F
2.8
ZB
ZE
sP
5.5
50
AMA
18
4.0
35
RH
11
4.5
47
Dehydration
Pallor
++
++
++
+++
++
+
+
++
+
+++
+++
++
suffering
dehydrati
im
Dis-
Hepa-
Skin
lesions
from
Edema,
local
tomegaly
Edema,
general
Other
Death
after
days
No
+
+
++
++
1 day
No
No
26
No
1 day
No
8 hr
in-
Skin
16
fection
I)
4-4
59
12
3.3
34
27
6.0
46
+
++
++
+
+
++
++
++
++
+
+
+++
+
+++
No
++
5 days
No
9 days
34
Kerato-
mnalacia
10
AMI
39
46
11
MP
5-9
67
12
MK
2.9
46
13
KB
1.9
36
14
A4AI()
14
6.0
58
15
FS
2.6
51
it)
AN
36
3-4
23
17
MSA
10
4.5
49
17
5.5
50
3-4
46
+
+
++
+++
++
+++
+
+
++
+++
No
J aundice
3 hr
No
No
++
9 days
Otitis
days
14
miedia
18
MSA
19
20
AT
16
5.6
52
21
MO
24
4.0
32
+
+++
++
++
++
+++
+++
++
+
+++
++
+
++
++
+
+
No
13
No
21
No
No
No
++
+++
+++
3 days
1 day
13
No
12
Eye
+++
in-
3 days
fection
22
ASO
11
5.9
59
23
FA
11
4.7
50
24
AK
11
5.8,
61
25
i)A
24
M,
4.0
32
26
MB
10
3.8
41
Chemical
+++
+++
++
++
+++
samples
tained
withmin
and muscle
1 hr of admission
carried
(7), sodium
globin
photometry
in
an
calcium
(8),
cimloride
phorus
(11),
total
proteins,
mg)
toid
were
muscle.
and
in
and
timen
in
(9),
keto
extracted
a platinum
and
(by
flame
bicarbonate
(12),
The
with
dish
light
dry,
at
dried
petroleum
defatted
450
C,
in
a small
up
to
a known
were
flame
pimotometry.
cal
ashes
was
shows
12
No
No
7
2 days
quantity
of
volume.
in
the
characteristics
In
sium,
(as
our
their
ii
hematocrit,
calcium,
Time
(14),
of
Table
pyruvic),
serum
age,
weight
hemoglobin,
C
were
11
determined
idea!
mission.
del-
100
ether
tissue
the
up
Table
phos-
the
at
+
+
tassium
No
++
made
centage
(150-
from
were
+++
++
++
No
nitric
acid
Sodium
the
and
and
ash
po-
liquor
by
RESULTS
serum
biopsies
surgically
samples
The
(10),
total
+++
taken
hemoflame
photometer),
acids
(13).
obtained
a micro-Soxhiet.
ashed
EEL
albumin
The
the jugular
determina-
out:
Hematocrit
and
potassium
were
+++
+++
biopsies
were
oband prior
to any
timerapy.
Blood
was withdrawn
from
or femoral
vein
and
time following
500
+++
Determinations
Blood
tions
++
+
++
+++
+++
proteins,
sodium
phosphorus,
per-
other
clini-
patients
blood
on
total
are
potassium
ad-
values
for
potas-
keto
acids
bicarbonate,
albumin
and
weight,
and
sodium,
chloride,
and
sex,
total
given.
content
AB
AG
AH
Dehydration
in
Malnourished
TABLE
Blood
levels
in
12 marasmic-
Death
Case
Number
Type
within
4 days
3
5
8
10
12
13
15
17
21
23
+
+
+
+
sium,
mEq/
mEq/
liter
liter
children
Bicar-
Phosphorus,
mEq/
mg/tOO
Calcium, Chloride, bonate,

niEq/
mEq/
liter
liter
liter
5.6
64
13.3
4.7
3.8
6.6
80
6.0
4.5
0.95
6.9
3.5
46
7.5
136
2.7
6.6
17.0
2.4
0.33
6.6
3.4
47
14.0
146
13.2
68
0.0
3.1
0.72
6.6
33
9.0
156
3.7
1 .6
100
6.0
2.2
0.17
4.8
2.7
50
13.5
154
5.6
3.6
6.0
3-5
0.28
6.6
4.5
32
8.9
136
3.5
2.8
100
17.0
8.6
0.46
7.2
3.8
17
5.2
152
6.0
3.0
82
18.0
8.5
0.16
6.3
3.3
27
9.4
152
6.0
3.0
42.0
3.8
32
10.6
158
4.6
7.0
36
11.0
125
2.5
5.0
38
12.0
136
4.2
9.8
144.4
9.1
2.5
2.6
0.73
5.8
6.8
0.46
7.5
2.0
5.7
0.41
7.2
82
18.1
5.4
0.34
6.6
5.0
96
9.7
5.7
0.46
6.6
3.4
4.9
4.6
84.0
12.9
5.1
0.44
6.6
3.6
10.4
2.9
1 .8
13.90
11.1
2. 1
0.23
0.67
0.46
3.0
4.90
0.83
0.51
122
3.8
5-9
54
21
5.5
122
5.8
3.6
31
8.1
130
4-9
4-9
23
6.6
154
3.2
11.9
31
7.8
138
3.7
4-9
28
9.1
144
3.8
3.0
38
11.0
144
4-3
5.0
23
8.1
158
2.3
8.0
31
9-4
156
2.6
9.2
118
6.0
32
9.0
133
3-4
2.5
81
25
7.7
122
4. 1
1.7
42
12.2
139
2.9
5.0
144
2.6
41
11.5
136
2.0
29.8
8.6
138.7
SD
7.2
2.1
12.2
SEM
2.0
0.58
3.3
0.25
0.58
1 .75
1 .28
1 .28
2.07
0.25
9
11
14
16
18
19
20
22
24
25
26
Avg
P
a
N.S.a
N.S.
not
(mEq/100
five
from
Table
cimarged
visit
of
biopsies,
in Table
3.2
0.61
0.07
0.19
2.2
0.22
3.0
84
6.0
4-7
0.21
4.7
76
27.0
4.0
1.18
4.2
90
6.0
3.2
0.32
4.8
6.0
6.2
0.34
3.6
12.0
5.3
0.36
4.8
1.6
10.0
5.6
0.69
4.8
1.8
16.0
3.2
0.36
4.6
2.4
5.1
0.24
3.9
1.8
23.0
4.6
0.54
45
2.9
101
7.7
1.9
0.70
102
15.5
1.4
5.0
95
18.0
5. 1
6.7
90
13.1
3-4
0.32
3.6
3-5
4.8
91.
12.2
4.0
0.46
4.2
1.9
0.96
2.2
16.5
4.8
1.5
0.26
0.55
0.46
4.98
1.3
0.39
0.10
0.15
0.12
0.96
0. 19
1.52
0.12
102
N.S.
N.S.
mmmitteti
to
time hospital.
cimarge
anti
N.S.
defatted,
five
dry
from
nonedematous
tissue)
edematous
patients,
in
and
at
0.14
1
2.0
1.2
3.9
1.8
4.5
2.0
4.2
1.5
,
10.6
1.8
9.6
0.001
N.S.
N.S.
The
time imoimme visit
0.001
weights
on
are
given.
also
dis-
is shown
DISCUSSION
iii.
iv simows
patients,
made
34
4.0
0.05
N.S.
N.S.
3.8
1
significant.
muscle
4.0
3.2
136
5.6
6.4
146
8.2
21
Serum
albumm,
g/l0O
ml
8.4
SEM
K
K
K
K
K
K
K
K
K
K
K
K
K
K
Total
serum
proteinj
g/iOO
ml
35
SD
ml
Total
keto
acids,
mliq/
liter
34
35-5
Avg
Potas-
Sodium,
g/
ml
100
II
14 kwashiorkor-dehydrated
the
as
months
condition
recorded
after
of
from
they
the
dis-
a home
were
ad-
Dehydration
tient
sucim
can
as
in
be
due
the
to
bronclmopneumonia,
malnourished
a
pa-
parenteral
but
disease,
it
is nmuch
M
M
M
M
M
M
M
M
M
M
M
M
Hb,
Hct,
and
141
Children
Sadre
142
TABLE
Sodiutim
10
aimd
muscle
iim
biopsies
immalmmourished
nmEq
Patient
lit
potassium
dehydrated
100
et
dry,
number
of
There
is
merits
of
malnourished
fat-free
19
hyper-
24.8
22
25.4
12
27
23.0
13
43
28.6
17
26
20.6
27.4
24.4
or
(22)
of
of
22
18.0
24
27.0
way,
14
42
6.5
16
28
31.3
18
44
14.5
32.0
19.4
oim
six
discharge
and
dehydrated
after
nmaltmourished
children
Wt
on
admissionkVt
on
\Vt after
discharge
of
6 months
aelmission
Per-
been
two
extremes
Per-
Perkg
centage
ideal
wt
2.8
44
3.0
47
Died
4.5
47
5.4
56
6.0
54
6.0
46
6.2
47
6.4
45
not
3.4
23
4.4
30
4.5
29
(Table
19
3.4
46
3.5
20
5.7
52
7.0
47
64
Died
Died
the
comimmon
sents
such
an
so difficult
stood1, but
thought
tribution
per
(2,
of
body
the
(17);
dlepletion
sium
(18);
in
(!isutrbances
of
preand
is
surface
alteration
that
magnesium
in
area
in
supply
and
time excretion
Otimers
in
us-
hyponatremic
is possible
that
are
early
the
energy
potas-
of
more
due
to
the
marasmic
In this
weaning
to
in
the
spectrum
such
as
have
any
the
findings
simply
The
age
nine
the
cases
of
by
Chilean
the
of
the
the
South
authors
malnutrition
and
present
died
prognosis
agreement
Mexican
in
within
finding
African
authors
(31),
acweight.
other
with
the notable
did
not
show
with
the outcome
similar
our
does
of ideal
child
on
in
in
is in
percentage
that
on
classify
was
mission.
malnutrition
observation
who
characteristics,
of drowsiness,
relationship
However,
of
bearing
anemia
some influence
of dehydration
child.
type
This
to
less
damage,
and
to have
picture
the
cording
the
liver
hypoalbuminemia,
i).
late
con-
the
mal-
(29),
by
common
to
of
malnourished
ported
with
protein
exist
between
protein-calorie
reported
Drowsiness
abnormal
disbody
compart-
larger
It
with
with
diar-
clearly
underfactors
have
been
weight;
processes
Died
Died
prognosis
in
of
in
and
that
material,
is not
following
16);
Died
dehydration
be responsible:
water
in the
15.
biocimemical
coimsequence
correct
time
of
unit
reason
unfavorable
to
to
ments
as
Time
of
(21)
involved
discrepancies
could
be thought
the biochemical
centage
ideal
svt
disease.
the
areas
of
tropical
Africa
(27,
28).
The
differences
nutrition
kg
more
therapy
patients.
to be
have
centagel
ideal
vt
rheal
risks
of kwashiorkor
or
the
material
studied.
seems
urbanized
America
kg
16
on
treatment
authors
other
hand,
kwashiorkor,
to a diet very low in
edema,
Patient
number
time
Some
patients.
high
marasmus,
tent,
IV
adnmission,
imm
in
bacteriologically
contaminated
diet of poor
nutritional
value,
is by far the predominant
type in subtropical
countries
(23-26).
On the
weaning
nmonths
20);
clinical
exception
a clear-cut
(Table
seven
4
has
of
days
of
been
i).
time
adre-
workers
(30) and
who
term
dehy-
dration
with
drowsiness
as toxicosis
consider
it to be a very bad prognosis.
Seventeen
of the 26 patients
studied
and
were
Weight
the
the
(19,
disagreement
hyponatremic
warn
some
kidney
success
with
the use
hypotonic
solution
ing
hydration
malnourished
Kwashiorkor
TABLE
some
the
hydration
patients.
predominance
patients
in
Meamm
by
claim
considerable
a multielectrolyte
Potassium
Marasmus
Mean
water
and
solutes
anti time like.
children,
Sodium
a!.
Dehydration
1 year
of age
or
nmore
to
predominance
time
immaimmutrition
in
prescimool
developing
only
time
type
of
malnutrition
was
Imiglmer
in
for
hemoglobin
albunmin
hypoalbuminemia
ilmg
imm kwasimiorkor
are
in
seem
to play
for
survival
liter,
was
present
natremia,
in
with
liter
seen
was
the
sodium
sign
have
of
bad
abnornmal
sodium
sistently
crit
Patients
muscle,
ii
and
only
tient
35).
In
no
worse
a
our
than
the
conImypo-
exception
of
potassium
levels,
than
marasmic
However,
low
for
in
time level
number
but
both
serum
possibly
of
muscle
present
in
only
in
two
because
biopsies.
kwa-
five
marasmic
together
with
a very
low
anti
muscle.
seen
is
(36)
found
nmuscle
mal
Fig.
with
in
about
in
than
nor-
timese
two
more
tmmarasmus,
given
The
content
higher
itm
wimich
timose
from
time serum.
probably
1 in
de-
judgeti
potassititmm
in
time
as
outr
results
by
in
can
be
are
Dubois
et
for normal
cimildren.
Timese
authors
no marked
loss of potassium
in the
of dehydrateti
patietmts
witim nor-
nutritioimal
It
be
in
altereti,
demon-
potassium
potassium
pattertm
tlman
frotmm
compared
lower
mal(2).
those
time
cannot
Time
potas-
be
with
of
simoweti
kwasimiorkor
al.
serum
extent
bi-
of
ammd
timis element
sodiumlm
electrolytes
de-
imours
agonic
could
sodium
biopsies
and
of
with
autimors
relation
muscle
of
muscle
nmal
and
hyperpotassemia
was found
marasmic
patients.
The
very
high
content
(13.5
mEq/iiter)
in pa-
5 occurret!
in
had
patients
(Tables
time difference
was
serum,
was
cases
pietion
levels
in
by otimer
time
Time
imigh
recorded
between
muscle.
of
kwashiorkor
Such
been
consistent
in
muscle
and
imo deternminable
patient
died
a few
patients
levels
in
Comparison
(36).
imave
No
Normal
children.
admission.
imourishied
Na
ammd potassium
value
The
strated
hemato-
suggest
values
sium
KJ
Kwashiorkor
malnourished
after
presented
witimin
was not
Na
1. Sodium
chloride
carbonate.
as
increased
from
Hypopotassemia
simiorkor
nornmal
especially
that
possible
suffering
significant
cimildren,
imm four
potassium
mEq/
reported
would
time
Fic.
hydrated
ii).
III).
time
as
witim
case 10 (Table
lower
with
such
voleimmia,
serum,
did
Nal
Alterations
sodium
levels
Hypernatremia
associated
values,
of
values
mm). Hyhypo-
(22,
15
10
their
mEq/
time children
with
range.
in
130
been
prognosis
imowever,
timose
imormal
of
9
N
patients,
role
and
patients.
Marasmus
cases
four
content
ilyponatremia,
series,
six
g/
152
under
in
over
values
20
C)
find-
i and
figures
-1
anemia,
of our
(Tables
in the
than
any
anemia
less
four
25
re-
a constant
of
present
with
been
-0-
but
Severe
levels
30
0
signifi-
whereas
levels
have
(34).
>
(Table
lmemoglobin
not
pernatremia,
the
patients,
33),
was
chances
in
and
imemoglobin
100 ml,
but diti
,40
35
all
statistically
(32,
and
with
marasmic
not
values
chiltl
the
hypo-
in
and
norlnal
nmarasmic
of
is not
the
status.
clear
muscle
by
to
us
if time clmammges
electrolytes
deimydration,
are
or
wimetimer
founti
brougimt
delmy-
ported
time
was
present
kwashiorkor
was
Near
45
in
consistent
from
time
time difference
cant.
areas
sign
whicim
Hematocrit
were
143
I,
suffering
it).
that
urban
Children
oimce
malignant
over
lime
Malnourisimed
points
of
biochemical
aibuminemia,
patients
This
time infant
child
in
countries.
Time
with
younger.
in
Sadre
144
dration
simply
aggravates
abtmormaiit.
ported
here
children
imave
sumfferi
Also.
decreased
aimtI
an
been
ng
to
in
exist
in
Disturbances
in
porteti
imm immalmmutrition
responsible
cell,
andi
explainimmg
of our
of
time
calcenmia,
tetanv.
is
increases
can
time
Time
in
many
otmr
sible
that
least
timis
imm part,
to
significantly
of
eigimt
age,
i.e.,
in
deterimmined
normmmal
found
be
related,
in
at
keto
that
found
in
of
versus
was
frequent
may
be
per
biunour
in
alterations
sucim
as
sign
some
of
Timus,
imad
cimlorenmias
sui-vivet!,
of
levels
ms-ere
less
patieimts
level
in
in
progmmostic
all
eigimt
of
less
of
95
than
time
sanme
figures
serum
in
the
cimildren
70
way:
or
that
higher
presented
prognosis
seven
above
pathat
of
17
the
number
therapy,
at
present
a probable
but
of $5/patient-day,
$85. The
doubtful
can be seen from
shown
patients
imospitai
that
and
before
after
in
were
could
those
on
small
and
Timeir
even
if
of
the
imigh
time higim
as soon
of
m and
eight
and
for
witimout
to
the
us
that
treatment
a definite
their
hospitalizabeds,
in
iv).
the
is
episode
(Tables
for inmproving
it should
Centers
for
Nutritional
(40), wimere costs can be
facilities
of
patient
recovery
rather
development
(39).
for
no
survival
survive
cost
as imis acute
peras bat!
to be
demand
malnourisimed
witim practically
tritional
state
their
chances
pimysical
and
intellectual
could
be considerably
impaired
and
the
had
con-
nearly
did
six
6 months
from
they
of
from
three
appear
dis17
of
Out
alive
was
would
is
nutritional
be
weight,
(iiscimarge.
adulthood
The
to
as jut!ged
of ideal
into
iv.
discharged
be located,
found
admission,
that
average
Table
6 months.
of
more
mEq/liter
larger
timan
patient-days.
At a cost
each
success
represents
value
of timese successes
in time hospital.
It appears
Bicarbonate
d!ied!.
with
our
saved
child
an
deimydrate(I
be
far
from
point
of
proposition.
Because
the
was
value
timree
associated
ms-itim
time
mEq/liter
all
wimereas
figures
unproven
cimargeti
cimloride
tients.
directed
tion
pro-
laboratory
In our
series,
each
chargeti
alive
represents
similar
encountered
this
still
as
in
somewimat
can
in-
This
existent
is justifiable
the
each
considered.
if
timis
centage
com-
0.32
the
patients
dition
did
be
46%.
It
survival
in
view
died
acids.
compounds
should
can
patient.
improve
that
are
economic
time figures
the
pos-
coma.
Time
or
appeared
children
with
metabolic
diial)etic
It
con-
of
acids
(as pyruvic)
with
very
low
lmigh amounts
of
Acidosis
cimaracteristics
sum
0.07
anions
material.
serum
showeti
from
0.02 mEq
total
keto
liter.
Hypocimloremia
cari)onate
levels
and
time
the
timese
0.45
calcium,
of
atm increase
mmot differ
series
ionic
could
gap
which
sign.
cations.
time level
of
patients
However,
parable
acidosis,
of this
between
the
and
of
to
found
increasing
whim
very
evidence
timat
lack
gap
anions
had
composition
of
siderable
studied
mmone showed
acid-base
found
to
and
nursing
facilities
adequate.
From
time
of
percentage
for
time
time changes
possible
account
outside
patients.
children
but
It
sotiium
thereby
in time nmuscle
low
time
directed
case
inde-
child
patient
disturbance
means
p0-
from
therapy
tiividual
could
keeps
metabolic
perform-
that
work
malnourished
considerably
rates,
re-
These
time
The
tieath
rate
in our series
was
would
seem
timat to obtain
better
been
aim inadequate
ostimotic
inside
Some
(17).
in
from
that
imave
the
dis-
is over,
his
nu-
A cimance
be
provided
Rehabilitation
mutch
lower
without
of
improvement
at
timan
proper
dehytiration,
in
time
tassiunm
cell
showed
vary
mechanisms
time
for
jim time
suffering
that
been
(38).
time
to
imydration
potassium
have
patieimts
energy
(37).
of
timree
Time results
shown
in Table
mmclearly
dicate
that
the biochemical
picture
in
marasmic
sodhum
kwashiorkor
supply
ance
in
re-
dehydration
concentration
mmcommlpl i ca ted
be
as
found
from
surviveti,
and
all
lowest
levels died.
preexisting
alterations
increase
simowtm
Similar
a!.
et
Dehydration
nutritional
is
status
returned
ciency
of
time
his
patient
and
malnourished
money
spent
continue
he
the
effi-
each
to be very
treating
child,
for
Malnourished
before
environment,
Imospitalizing
dehydrated
in
of
to
in
full
measured
2.
will
low.
A study
was
biochemical
tion
consecutive
occurred
2-36
to
26
exist
between
ritie,
the
the
serum
sium
were
tients
type
than
in
of
hemo-
keto
3.
in
5.
potas6.
bad
prognosis
cally,
low
levels
were
sign
was
drowsiness.
bicarbonate
and
low
with
associated
intrahospital
with
50%.
Of
could
be
the
patients
traced
lmospital,
three
tlmree
did
timeir
point
nutritional
to time
treating
tients
9.
Dr.
R.
p2mticnts.
Surgical
Our
Ward
I)ms.
Mir,
Zeidi
M.
muscle
Nevisi,
for
for
Mir
A.
YouSefi,
in the
tO.
the
the
other
facts
of
pa-
11.
the
Dr.
J.
tmospitalization
care
to the
Hospital,
and
H.
Ahrari
We
thank
staff
of
especially
for
Misses
ammd P. Hamedi,
of
the
13.
and
determinations.
the
to
14.
9:
FRENK,
J.
J.
El
Mortality
I.
malnutrition.
0.
MELLANDER
Nutritioml
5,
B.
AND
Unit-an
the
in
3:
Ethio-
Field
of
Health.
1966.
sindrome
desnutrido.
Rev.
de
deshidratacion
5Iex.
Pediat.
for
Nutrition
ed).
DIEHL,
H.,
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disodium
Chem.
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II.
ternmination
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of
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375,
H. J.,
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and
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AND
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ical
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A.
that
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help
any
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A.
poor
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economic
present
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FERREIRO.
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alive
after
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under
We
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time
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F.
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M.
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pian
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183, 1960.
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To
J.
chlo-
and
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kwashiorkor
and
shown
total
the
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be
Significantly,
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of the
(5)
it
chil-
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proteins,
Muscle
J.
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total
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Iranian
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by
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clinical
of dehydra-
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bicarbonate
exhibited
of the
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IV. Development
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some
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No
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H., M.
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R.
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et

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