Malnutrition causes a reduction in alveolar epithelial sodium and chloride transport which predisposes to death from lung injury.
BACKGROUND
All forms of malnutrition have been associated with increased severity of pneumonia, an increased pneumonia associated mortality and an increased risk of pulmonary fluid overload. Malnutrition was found to be associated with increased sweat sodium and chloride concentrations. A reduction of systemic sodium and chloride transport reflected in sweat sodium and chloride levels has been linked to increased severity of pulmonary edema in children with septicemia.


OBJECTIVE
Malnutrition causes a reduction in alveolar epithelial sodium and chloride transport which predisposes to death from lung injury. SUPPORTING EVIDENCE FOR THE HYPOTHESIS: Malnutrition caused reduced pulmonary fluid clearance in the rat model. Amiloride insensitive pulmonary fluid clearance in malnourished rats was reduced. The reduction in fluid clearance was reversible by beta agonists which increases epithelial sodium and chloride transport.


CONCLUSIONS
Reduction of alveolar ion and fluid transport capacity explains the predisposition to death from pulmonary edema associated with intravenous fluids and blood transfusions in inpatients with malnutrition. Reduced alveolar epithelial ion transport impairs absorption of intra-alveolar inflammatory exudate in pneumonia leading to a increased severity of respiratory compromise and increased mortality. MEANS TO TEST THE HYPOTHESIS: Nasal potential difference measurements could compare airway epithelial sodium and chloride transport in patients with and without malnutrition and malnutrition associated lung disease. Sweat sodium and chloride concentrations could be compared in patients with and without respiratory disease associated with malnutrition and correlated with the severity of respiratory compromise.
Eisenhut
Michael
M
University of Liverpool, Institute of Child Health, Eaton Road, Liverpool, L12 2AP, United Kingdom. michael_eisenhut@yahoo.com
D001692:Biological Transport; D002712:Chlorides / Q000378:metabolism*; D006801:Humans; D008171:Lung Diseases / Q000401:mortality / Q000503:physiopathology; D055370:Lung Injury; D044342:Malnutrition / Q000503:physiopathology*; D011650:Pulmonary Alveoli / Q000503:physiopathology*; D020545:Respiratory Mucosa / Q000503:physiopathology*; D012964:Sodium / Q000378:metabolism*
D002712:Chlorides; D012964:Sodium