HYPOINSULINEMIA HAS AN IMPORTANT ROLE IN THE DEVELOPMENT OF EDEMA ANDHEPATOMEGALY DURING MALNUTRITION

Various alterations in hormonal levels have been suggested to contribu te to the development of nutritional oedema and fatty liver in childre n 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 an d hypoglycaemia before feeds. During this phase, although the weight g ain 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 t he 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), hypoprealbumina emia (0.1 g/l), oedema, hepatomegaly, and dermatosis. This case demons trates clearly the important role of defective insulin secretion in th e development of nutritional oedema and hepatomegaly.