799 



Metabolism in Athreptic Infants 



Although repeated attacks of diarrhea are one of the most frequent 

 causes of athrepsia, the condition may occur independently of any gastro- 

 intestinal disturbance. It is seen in infants who have been underfed for 

 long periods of time or in those suffering from chronic infections. It is 

 especially frequent in infants born prematurely and in those living under 

 unhygienic conditions. The condition of athrepsia may be properly con- 

 sidered as the end result of a period of partial starvation continued for 

 long periods of time. The term "starvation" is used in the sense of a 

 cellular starvation and may result even when considerable amounts of 

 food are given by mouth, as far as calories are concerned, but food which 

 is lacking in certain essential constituents. The condition also occurs 

 when the presence of infection increases the consumption of food beyond 

 the intake or when infections or constitutional anomalies prevent the 

 utilization of absorbed food. 



The protein metabolism in the early stages of the condition is not 

 greatly affected. Nitrogen absorption and retention is practically normal. 

 Only during periods of diarrhea is there a decreased absorption of pro- 

 tein (Bendix, L. F. Meyer (c) (<7), Freund(a), Courtney). Even here the 

 loss of nitrogen is not sufficiently great to seriously threaten the nitrogen 

 balance. When the condition of athrepsia is fully developed, however, 

 there may be a negative nitrogen balance. L. F. Meyer (c) (d) has shown 

 that the loss of nitrogen is chiefly by way of the urine. In a typical case 

 Meyer found the following nitrogen balance: 



Intake Urine Stools Balance 



5.5419 grams N 4.7158 grams N 1.2555 grams N" 0.4294 gram N 



Such findings are indicative of destruction of body tissue. As might 

 be expected the mineral salt balance is also negative. This has been 

 shown by L. F. Meyer (a), by Jundell and by Steinitz. The loss is chiefly 

 of sodium, potassium and chlorin, a very considerable proportion of the 

 loss being by way of the urine. 



This negative nitrogen and mineral salt balance occurs at the time 

 when the infant's weight has been reduced to the lowest point compatible 

 with life. The negative nitrogen balance is quite comparable with the 

 premortal rise of nitrogen excretion observed in starving individuals. 

 It represents a stage where the stores of carbohydrate and fat in the body 

 have been exhausted and the metabolic requirements are met by consump- 

 tion of body proptoplasm. The excess of nitrogen and salts in the urine 

 represents the unutilizable debris resulting from tissue destruction. The 

 ammonia coefficient in the urine of these infants is often high. This has 

 been explained by Pfaundler as a failure of liver function in that urea is 



