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Blood volume (51Cr) in severe protein-calorie malnutrition
Insights
Protein-calorie malnutrition in Shi children leads to reduced blood volumes, specifically lower red cell volume and plasma volume. Albumin levels correlate with these changes, highlighting risks in using weight for assessing malnutrition.
Area of Science:
- Pediatric Nutrition
- Hematology
- Clinical Physiology
Background:
- Protein-calorie malnutrition is a significant health issue in children.
- Understanding intravascular volume status is crucial for managing malnutrition.
- Previous studies have not fully elucidated volume changes in malnourished populations.
Purpose of the Study:
- To determine intravascular volumes in protein-calorie-depleted Shi children.
- To correlate these volumes with anthropometric measurements and plasma albumin levels.
- To assess the reliability of anthropometric parameters in evaluating malnutrition-related volume deficits.
Main Methods:
- Radiochromium technique used to measure red cell volume (RCV).
- Total blood volume (TBV) and plasma volume (PV) derived from RCV measurements.
- Total circulating albumin (TCA) measured; values related to body size and correlated with albuminemia and weight deviation.
Main Results:
- Malnourished Shi children exhibited hypovolemia relative to body size.
- Low TBV resulted from decreased RCV and potentially reduced PV.
- TCA decreased proportionally with albuminemia; RCV and TBV correlated with albuminemia but not weight deviation.
Conclusions:
- Protein-calorie malnutrition significantly impacts intravascular volumes in children.
- Albuminemia is a relevant correlate of RCV and TBV.
- Anthropometric parameters alone may be unreliable for assessing intravascular volumes in severe malnutrition (marasmic kwashiorkor).
Abstract:
The intravascular volumes were determined in 42 protein-calorie-depleted Shi children, and in 14 healthy patients. The red cell volume (RCV) was determined by a radiochromium technique; the total blood volume (TBV), the plasma volume (PV), and the total circulating albumin (TCA) were derived. The values were related to weight without edema, to expected weight for height, and to body surface area. Related values were averaged and were correlated with both the weight deviation and the plasma albumin level. Figures for healthy Shi children were comparable with American normal standards. Malnourished children were hypovolemic relative to their body size measurements; low TBV was the consequence of an absolute decrease in RCV and of a possible reduction of PV; TCA was lowered in the same proportion as albuminemia. RCV and TBV correlated well with albuminemia, but did not correlate with the weight deviation; the relationship between PV and albuminemia was not linear. Despite some quantitative discrepancies, similar results were obtained with each kind of related values. In a discussion of the results, stress is laid on risks of misinterpretation resulting from the use of anthropometric parameters as a basis of reference when studying intravascular volumes in marasmic kwashiorkor.