Plasma free iron: a possible cause of oedema in kwashiorkor.

Background: Oedema is a sine qua non for the diagnosis of kwashiorkor yet the mechanisms leading to oedema remain ill defined.

Aims: To relate the plasma concentration of radical promoting 'free' iron to the degree of oedema in patients with kwashiorkor.

Setting: University teaching hospital.

Patients: Fifteen children with kwashiorkor, nine of whom had severe and six of whom had a moderate degree of oedema.

Methods: Plasma 'free' iron was measured as bleomycin detectable iron (BDI) and related to severity of oedema and plasma albumin concentration.

Results: BDI was significantly higher in the patients with severe oedema (20.5 v 6.75 mumol/l) whereas the albumin concentrations were similar (16 v 17 g/l). BDI was no longer present in any patients 30 days after admission.

Conclusions: 'Free' circulating iron may contribute to the oedema of kwashiorkor, and its sequestration could hasten recovery and decrease morbidity and mortality.