Serum-ionized calcium in mexican protein-energy malnourished children.

BACKGROUND: Hypocalcemia occurring in children with severe primary protein-energy malnutrition (PEM) has previously been shown to merely reflect a reduction in the protein-bound fraction of serum calcium. On the other hand, ultrafilterable, i.e., nonprotein bound calcium (Ca(U)), remains unaffected. The aim of the present investigation was to test the hypothesis that in infantile PEM, ionized calcium, which represents the major and physiologically most important component of Ca(U), is also kept within a normal concentration, whatever the total serum calcium levels. METHODS: Three milliliters of peripheral venous blood were obtained on admission and periodically afterward from 18 fasting marasmic infants and 6 children with the edematous form of PEM (kwashiorkor). Ionized calcium was determined in 125 microL aliquots of blood serum with ion-selective electrodes. The measurement of related elements and molecules was carried out with customary laboratory procedures. RESULTS: On admission, as well as during the ensuing stages of nutritional recovery, ionized serum calcium exhibited a normal concentration, with the exception of two initial samples. Total calcium, total protein, albumin, and inorganic phosphate concentrations were decreased in a variable degree according to the clinical type, ascending to normal levels during recovery. CONCLUSIONS: Ionized calcium serum concentration remains within normal limits in severe infantile PEM.

Increasing frequency of staphylococcal infective endocarditis. Experience at a university hospital, 1981 through 1988.

To determine the characteristics of infective endocarditis in our hospital, we reviewed all patients with that diagnosis at the University of Massachusetts Medical Center, Worcester, between 1981 and 1988. Of 113 patients with infective endocarditis, 56 (50%) had staphylococcal endocarditis. Despite aggressive medical and surgical therapy, in-hospital mortality was 25%. Forty-five (80%) of the 56 cases of staphylococcal endocarditis involved Staphylococcus aureus with a mortality of 28% vs 9% in the non-S aureus group. Mortality was higher in patients with congestive heart failure (35%), atrioventricular block (45%), atrial fibrillation (42%), and prosthetic valve endocarditis (50%). Seventy-six percent of the patients with congestive heart failure required surgery. Patients with congestive heart failure and S aureus infection had a mortality of 45%. Thirty-six patients (64%) were alive at late follow-up (mean, 28.6 months). Mortality was highest (23%) during the first 3 months following diagnosis of staphylococcal endocarditis. Staphylococcal endocarditis represents an increasingly large proportion of patients with infectious endocarditis. Mortality rates remain high despite aggressive management of the patient's condition.