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Journal of Tropical Pediatrics 1996 42(5):297-299; doi:10.1093/tropej/42.5.297
© 1996 by Oxford University Press
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brief-report

Hypoinsulinaemia has an Important Role in the Development of Oedema and Hepatomegaly During Malnutrition

Ashraf T. Soliman, MD*,, Issa Alsalmi, MD** and Maurice Asfour, MD

*Department of Pediatrics, Royal Hospital Muscat, Oman
**Department of Endocrinology, Royal Hospital Muscat, Oman

Correspondence: Ashraf T. Soliman, Pediatric Endocrinology, Royal Hospital, Seeb 1331, Muscat code 111, Oman. Fax: (968)591530

Various alterations in hormonal levels have been suggested to contribute to the development of nutritional oedema and fatty liver in children with kwashiorkor.1–4 We present an infant who underwent near-total pancreatectomy at the age of 4 weeks and developed kwashiorkor after 11 weeks. The sequence of events following surgery can be divided into two phases. The first phase was characterized by hyperinsulinaemia and hypoglycaemia before feeds. During this phase, although the weight gain was slow (10 g/day) serum albumin (32 g/l) and prealbumin (0.23 g/l) concentrations were maintained with no oedema or hepatomegaly. In the second phase, insulin deficiency prevailed and he was receiving the same amount of milk (protein)/day (enriched with starch). During that phase he rapidly developed hypoalbuminaemia (18 g/l), hypoprealbuminaemia (0.1 g/l), oedema, hepatomegaly, and dermatosis. This case demonstrates clearly the important role of defective insulin secretion in the development of nutritional oedema and hepatomegaly.


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