NUTRITIONAL EDEMA. OBSERVATIONS ON THE RELATION OF THE SERUM PROTEINS TO THE OCCURRENCE OF EDEMA AND TO THE EFFECT OF CERTAIN INORGANIC SALTS

Abstract

In patients with nutritional edema, studied during the active and convalescent stages, edema was never observed when the level of serum albumin was greater than 2.9 gm. per 100 cc; when the level fell below 2.5 gm. per 100 cc, edema was invariably present. The correlation with total serum protein, although not so close, was sufficient to indicate a critical level for edema close to 5 gm. per 100 cc. Serum globulin was exceedingly variable; decreased, normal and increased values all were found in association with edema. Decreased globulin generally occurred only when the albumin was also decreased and thus was usually present in association with edema. No relation of cause and effect was considered, however, to exist between lowered globulin and edema. In 2 patients the combined administration of NaCl and NaHCO3 led to rapid gain in weight, marked increase in edema and depression of chloride excretion in the urine. In 1 of the patients these effects could not be reproduced after feeding of an adequate diet had resulted in a return to normal of the serum protein. The impossibility of offering an exact explanation of all the effects observed is pointed out, although it is stated that the results are in harmony with the view that the cation Na is more intimately related to the causation of edema than the anion Cl.