James N. Etteldorf

The purpose of this paper is to report the fatty acid distributon in subcutaneous fat and in the cho- lesterol-triglyceride fraction of serum (C-TG) of four groups of infants, each of whom received a different test diet during the first 2 months of life. The major variables in the test diets were: linoleic acid content (approximately 1.2 to 39.2 per cent of dietary fat) ; percentage of total calories de- rived from fat (approximately 35 to 50 per cent); main source of dietary protein (cow milk and soybean) ; and percentage of total calories derived from protein (approximately 9 to 19 per cent). The protein and lipoprotein electrophoretic patterns, total protein, total lipid, and fractional lipid concentrations in the sera of these same groups of infants were subjects of previous reports (1, 2).

WHILE studying renal function in children we have obtained evidence of some rather unusual and heretofore unreported alterations of renal hemodynamics in patients with sickle cell anemia. Glomerular filtration rate (mannitol clearance), effective renal plasma flow (paraaminohippurate [PAH] clearance), and tubular excretory capacity for PAH were determined in eight children between the ages of 4 and 11 years with sickle cell anemia. To our knowledge there are no reported data on these clearances (mannitol and PAH) in children with this disease. Calcagno and co-workers,¹using the thiosulfate clearance method, found a reduction in the glomerular filtration rate in five children with sickle cell anemia. Two patients with sickle cell trait were observed to have glomerular filtration rates within normal limits. They, however, report one case of secondary anemia in which the glomerular filtration rate was in the higher limits of normal (144.5 cc. a minute per 1.73 square meters).

We studied the efficacy of low-dose (0.1 U/kg/h) and high-dose (1..0 U/kg/h) insulin, given randomly to children with diabetic ketoacidosis (DKA) by continuous intravenous infusion without a loading dose. Plasma glucose reached 250 mg/dl in 3.4 +/- 0.4 h with the high-dose insulin group compared with 5.4 +/- 0.5 h with the low-dose insulin group (P < 0.01). During the first 12 h of therapy, plasma glucose fell below 100 mg/dl in 2 of 16 in the low-dose compared with 12 of 16 in the high-dose patients. The decrement of ketone bodies, cortisol, and glucagon was similar in both groups. The number of hours required for HCO3(-) greater than or equal to meq/l and arterial blood pH greater than or equal to 7.30 were not significantly different in the two groups. Hypokalemia (K < 3.4 meq/L) occurred in 3 of 16 low-dose and 10 of 16 high-dose patients. The data show that low-dose insulin, with a slower rate of glucose decrease, is as effective as a high dose for the treatment of DKA in children with less incidence of hypokalemia and decreased potential for hypoglycemia.