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The safety and efficacy of a rice-based oral rehydration salt (ORS) solution for the treatment of acute diarrhea in infants <6 months of age was compared to those of a standard glucose-based ORS solution. A total of 97 infants aged 1–6 months who had a history of acute diarrhea for 120 h or less and showed signs of mild to moderate dehydration and no complications was recruited. Subjects were assigned to two treatment groups and received either standard glucose-based ORS solution or rice-based ORS solution until cessation of diarrhea. There was no significant difference between the two treatment groups with regard to the main outcome variables, including total stool output {84 [95 confidence interval (CI), 56–126] vs. 106 (95 CI, 76–148) g/kg}, total ORS solution intake [171 (95 CI, 149–197) vs. 187 (95 CI, 161–218) ml/kg], or duration of diarrhea (35 ± 31 vs 38 ± 32 h). In addition, the fact that there was no difference between treatment groups in the presence of reducing substances in the stools suggests that rice was digested and absorbed by these infants. The results of our study support the conclusion that for infants <6 months of age, rice-based ORS solution is safe and as efficacious as standard glucose-based ORS solution in the treatment of acute diarrhea.

The case of a 13-year-old boy with the advanced clinical picture of the idiopa thic DeToni-Debré-Fanconi syndrome is described, on whom acute studies of proximal tubular functions and of the effect of furosemide thereon were performed. Sodium bicarbonate loading corrected the hyperchloremic acidosis, but induced an increase of urinary bicarbonate loss of over 20 % of the filtered amount. Furosemide corrected bicarbonate reabsorption in spite of the presence of metabolic alkalosis. The urinary excretion of alpha-amino nitrogen, glucose, and phosphates decreased and tubular reabsorption of the two latter increased under furosemide. On a chronic treatment with furosemide and dietary sodium chloride restriction, correction of hyperchloremic acidosis, hypophosphatemia and rickets was achieved.

AFTER having treated a large number of cases affected with third-degree malnutrition, where so-called deficiency lesions were seen, such as edema, pellegra, ariboflavinosis, xerosis, various bone lesions, changes in color and texture of the hair, follicular hyperkeratosis, perifolliculitis, emotional changes, psychic deviations, backwardness, persistent anorexia, muscular flaccidity, and autophagia in varying degrees, all cured only by giving adequate amounts both in quantity and in quality of nutritional elements and, specifically, without the addition of commercial vitamins, we thought it interesting to report these facts.Actually, for several years we treated children complaining of serious malnutrition according to classic ideas, adding all kinds of vitamin preparations to adequate diets, but the favorable progress in many cases which were treated differently has made us change our older therapeutic methods.The results obtained following our new ideas in treating the above-named disorders are the reason for this preliminary report. MATERIAL A study was

SINCE Galesesio and Slantineano, in 1909, reported moderate anemia in patients affected with pellagra,1 the great majority of authors who have studied this problem agree on the presence of anemia in persons suffering from malnutrition. From the morphologic point of view, anemias have been reported as macrocytic, microcytic, and dimorphic, and, in relation with infantile malnutrition, the morphologic type most frequently found has been the normochromic normocytic.2Morphologic classification of anemias, as determined by measurement of factors such as the mean corpuscular volume, the mean corpuscular hemoglobin, and the mean corpuscular concentration of hemoglobin and by the examination of blood slides, has a great value, especially in the study and nature of erythropoiesis, but such morphologic classification is of less importance in the investigation of the etiologic and pathologic factors involved in the production of anemias.From a review of works on anemias in undernourished children, two clear

The activity of the enzyme pyruvic kinase in leukocytes isolated from severely malnourished children was markedly decresed, while those of lactic and malic dehydrogenases were unchanged compared to those in leukocytes from the control, well-nourished children. The progressive linear decrement of ATP and the increment of ADP expected in leukocytes during normal growth of infants from 8 to 24 months was disturbed in leukocytes of severely malnourished children; ATP levels were low initially and remained so. The data suggest an aberration of energy metabolism in the leukocytes of severely malnourished children which is similar to that previously observed in muscle of children with protein-calorie malnutrition.

So far, most studies on renal function in children with advanced protein-energy malnutrition have shown an impairment of glomerular filtration rate and renal plasma flow, as well as diminished ability to excrete an acid load and a concentrated urine. Investigation of these functions in eight marasmic infants and eight children with kwashiorkor once they were free of obvious infections and acute electrolyte disturbances has shown a practically normal renal performance.