Free and total triiodothyronine and thyroxine in malnourished Jamaican infants. The effect of diet on plasma levels of thyroid hormones, insulin and glucose during recovery

Plasma concentrations of free triiodothyronine (FT3), total triiodothyronine (TT3) and total thyroxine (TT4) were reduced to 63.0, 37.7, 61.7 per cent of controls respectively in protein-energy malnutrition (PEM), while free thyroxine (FT4) was elevated by 23 per cent. There was a gradual increase of both TT4 and TT3 during recovery. The ratio of free to bound hormones was high in malnutrition and declined with recovery, indicating a deficiency of thyroid-hormone binding in malnutrition. The observation of a significant reduction (P<0.05) in T3/T4 ratios, which occurred in malnutrition and was induced during recovery after 3 d on a low energy maintenance diet, suggested depressed conversion of T4 to T3 due to energy restriction. Energy restriction also significantly (P<0.001) depressed plasma insulin concentrations in the presence of nearly constant glucose levels. (AU)

The ankle jerk in severe protein energy malnutrition (PEM) - abstract

Although muscular atrophy is a cardinal feature of severe PEM, there are little data on neuromuscular function. We therefore measured the ankle jerk in 16 severely malnourished children (age range 6 - 60 months, median 11.5 months) on admission, daily for the first week and then weekly until discharge. The results were compared with those from 9 healthy Jamaican children (age range 5 - 28 months median 14 months). The angle jerk was elicited by electrically stimulating the sciatic nerve in the popliteal fossa. Movement of the foot was recorded on an oscilloscope via a transducer attached to the left great toe. Measurement of latency period, contraction, plateau and relaxation times were made from photographs of the oscilloscope tracings. At all times and with all variables, the malnourished children had a wide range of measurements. Compared with the controls, there was no difference in the latency period (26ñ5 msecs vs 25ñ3). The contraction time was significantly slower on admission (162ñ10 msecs vs 130ñ5) but at 30 days post admission was significantly faster (106ñ4 msecs vs 130ñ5 msecs). The relaxation times showed a tendency to be slower on admission and faster after recovery but the differences were significant. The plateau time was also of a similar pattern with the recovery value being significantly shorter (33ñ3 msecs vs 46ñ4 msecs). Thus in all variables, on admission, there was a wide range with the times being slower than normal attaining normality at about 2 weeks after admission and thereafter being faster. In 3 children tested 1 month after discharge the angle jerk remained faster than controls. Thyroid function tests were all normal. The fact that the latency period was unchanged suggests that these changes are distal to the sarcoplasmic reticulum. They may be related to the supply of energy to the muscles during rapid growth or to the order in which the different muscle fibre types are repleted during recovery from severe PEM (AU)

A sterile scalded skin syndrome in children recovering from malnutrition

Three children who developed skin lesions resembling the Scalded Skin Syndrome during recovery from kwashiorkor are described. The lesions were sterile and the children showed no constitutional upset. The aetiology of these lesions is obscure (AU)