Blood Keto-acids in Kwashiorkor

Abstract

DURING desalting in an electrolytic desalter (Shandon Scientific Co. Ltd., London) of urines from kwashiorkor patients, it was observed that a considerable amount of a black mercury amalgam was invariably formed. Estimation of the concentration of ammonia in these urines confirmed that the amalgam formation was due to a high ammonia content. This was in agreement with a report made earlier by Platt and Heard that ammonia excretion was increased in protein malnutrition. It was suspected at the time that this increased ammonia output may be the result of an acidification defect due to reduced hydrogen ion excretion by the renal tubules or else to the excretion of increased amounts of organic acids. Afterwards, while measuring serum transaminase-levels by the spectrophotometric method¹ it was noted that on the addition of malic or lactic dehydrogenase and reduced diphosphopyridine nucleotide to the buffered serum, the specimens from cases of kwashiorkor consumed more reduced diphosphopydrine nuleotide than normal serum. In many instances more than 30 min. were required to produce equilibrium conditions and in most cases extra reduced diphosphopyridine nucleotide would have to be added in order to produce a steady state and a high enough initial spectrophotometric reading. With normal serum on the other hand, equilibrium was usually attained in less than 10 min. and it is unusual for extra reduced diphosphopyridine nucleotide to be required. This observation pointed to the probability that ketoacids which are substrates for malic dehydrogenase and lactic dehydrogenase must accumulate in the blood in kwashiorkor.