Transperitoneal Calcium Mass Transfer using Dialv Sate with a Low Calcium Concentration (1.0 mM)

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 467-470 ◽  
Author(s):  
Thomas Weinreich ◽  
A. Colombi ◽  
H.H. Echterhoff ◽  
G. Mielke ◽  
M. Nebel ◽  
...  
Keyword(s):  
Mass Transfer ◽  
Calcium Concentration ◽  
Phosphate Binders ◽  
Total Serum ◽  
Vitamin D Metabolites ◽  
Low Calcium ◽  
Total Serum Calcium ◽  
Before And After ◽  
To Receive ◽  
Dialysate Calcium

Lower dialysate calcium concentrations were recently proposed to overcome the risk of hypercalcemia In continuous ambulatory peritoneal dialysis (CAPD) patients on calcium containing phosphate binders and/or vitamin D metabolites using the standard dialysate calcium concentration (sCa) of 1.75 mM. To assess transperitoneal calcium mass transfer (CaMT) in CAPD patients using a dialysate with a low calcium concentration (LCa, 1.00 mM), 18 stable patients were randomly allocated to receive either LCa or SCa. CaMT was assessed over 4 hours using 2L dialysate bags with three different dialysate glucose concentrations (1.5%, 2.3%, 4.25%). Total serum calcium (tCa), Ionized calcium (iCa), and the exact dialysate volume were measured before and after the 4-hour dwell. A sample of the drained dialysate was obtained to measure the dialysate calcium concentration. The tCa and iCa levels were not significantly different In both groups prior to and did not change throughout the test. CaMT (median/range) was .0.64 mmol/exchange (0.35 –1.29 mmol/exchange) using LCa with 1.5% glucose compared to 0.23 mmol (.0.18 -0.87 mmol) with SCa (p<0.0001). CaMT was negatively correlated to ICa and ultrafiltration volume [4.25%: LCa -1.22 (.0.84 -1.9); SCa .0.43 (-1.35 -0.13); p<0.001]. In summary, LCa results in a loss of calcium into the dialysate even at low ultrafiltration volumes and serum ICa levels. This might facilitate the prevention and therapy of renal osteodystrophy with calclum-containing phosphate binders and calcitriol. However, patients using LCa must be carefully monitored for calcium homeostasis and bone turnover.

The Influence of Dialysate Calcium Concentration on the Pth Level in Children Undergoing Capd

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 567-569 ◽  
Author(s):  
Maria Sieniawska ◽  
Maria Roszkowska-Blaim ◽  
Beata Wojciechowska
Keyword(s):  
Mass Transfer ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Dwell Time ◽  
Calcium Concentration ◽  
Vitamin D Metabolites ◽  
Intact Parathyroid Hormone ◽  
Gland Function ◽  
Dialysate Calcium ◽  
Pth Level

In 12 children aged four-and-a-half to 18 years (mean 11 ±4.2) undergoing continuous ambulatory peritoneal dialysis (CAPO), serum intact parathyroid hormone (iPTH), ionized calcium (iCa) levels, and calcium mass transfer (CaMT) were measured on three consecutive days: day 1, after a four-hour interval between dialyses; on day 2, after four hours dwell time with peritoneal dialysis (PD) Ca 3.5 mEq/L; and on day 3, after four hours dwell time with PD Ca 2.5 mEq/L. A significantly more negative CaMT was found when PD Ca 2.5 mEq/L was used, as compared with values obtained using PD Ca 3.5 mEq/L. Significantly lower parathyroid hormone (PTH) values were found after the interval between exchanges. We conclude that in order to properly evaluate parathyroid gland function and to decide whether or not to give vitamin D metabolites, a protocol for determining PTH should be standardized.

Calcium Concentration in the Capd Dialysate: What is Optimal and is There a Need to Individualize?

1997 ◽  
Vol 17 (6) ◽  
pp. 554-559 ◽  
Author(s):  
Susanne Bro ◽  
Lisbet Brandi ◽  
Henrik Daugaard ◽  
Klaus Olgaard
Keyword(s):  
Vitamin D ◽  
Calcium Carbonate ◽  
Calcium Concentration ◽  
Phosphate Binders ◽  
Vitamin D Metabolites ◽  
Plasma Phosphate ◽  
Study Selection ◽  
Initial Decrease ◽  
Stable Plasma ◽  
Dialysate Calcium

Objective To evaluate risk/benefit of various continuous ambulatory peritoneal dialysis (CAPD) dialysate calcium concentrations. Data Sources A review of the literature on the effects of various CAPD dialysate Ca concentrations on plasma Ca, plasma phosphate, plasma parathyroid hormone (PTH), doses of calcium carbonate, doses of vitamin D analogs, and requirements of aluminum-containing phosphate binders. Study Selection Eleven studies of nonselected CAPD patients, and 13 studies of CAPD patients with hypercalcemia were reviewed. Results In nonselected CAPD patients, treatment with a reduced dialysate Ca concentration (1.00, 1.25, or 1.35 mmol/L) improved the tolerance to calcium carbonate and/or vitamin D metabolites and reduced the need for Al-containing phosphate binders. When using dialysate Ca 1.25 or 1.35 mmol/L, the initial decrease of plasma Ca and increase of PTH could easily be reversed with an immediate adjustment of the treatment. After 3 months, stable plasma Ca and PTH levels could be maintained using only monthly investigations. In patients with hypercalcemia and elevated PTH levels, treatment with dialysate Ca concentrations below 1.25 mmol/L implied a considerable risk for the progression of secondary hyperparathyroidism. When hypercalcemia was present in combination with suppressed PTH levels, a controlled increase of PTH could be obtained with a temporary discontinuation of vitamin D and/or a reduction of calcium carbonate treatment in combination with a dialysate Ca concentration of 1.25 or 1.35 mmol/L. Conclusion Most CAPD patients can be treated effectively and safely with a reduced dialysate Ca concentration of 1.35 or 1.25 mmol/L. Treatment with dialysate Ca concentrations below 1.25 mmol/L should not be used. A small fraction of patients with persistent hypocalcemia need treatment with high dialysate Ca, such as 1.75 mmol/L.

Neurologic Sequelae Associated with Foscarnet Therapy

1994 ◽  
Vol 28 (9) ◽  
pp. 1035-1037 ◽  
Author(s):  
Edward Lor ◽  
Yong Qing Liu
Keyword(s):  
Adverse Effect ◽  
Adverse Effects ◽  
Calcium Concentration ◽  
Total Serum ◽  
Cns Involvement ◽  
Serum Calcium Concentration ◽  
Total Serum Calcium ◽  
Neurologic Sequelae ◽  
History Of ◽  
Cns Lesions

OBJECTIVE: To report three cases of possible foscarnet-induced neurologic sequelae. CASE SUMMARY: We report two cases of seizures and one case of hand cramping and finger paresthesia after starting foscarnet therapy with no evidence of predisposing risk factors, such as serum laboratory abnormalities, renal dysfunction, or known central nervous system (CNS) involvement. All three patients had stable laboratory values during therapy and when the neurologic adverse effects occurred. All patients were receiving appropriate dosages of foscarnet. DISCUSSION: The incidence of seizures in AIDS patients was reviewed. A history of CNS lesions, infections, and/or AIDS per se may increase the risk of a neurologic adverse effect while receiving foscarnet therapy. Acute ionized hypocalcemia may cause these neurologic adverse effects. Ionized hypocalcemia is transitory, is related to the rate of foscarnet infusion, and may not be reflected as a change in total serum calcium concentration. CONCLUSIONS: Foscarnet probably contributed to the neurologic adverse effects reported here. Foscarnet may need to be administered at a slower rate than is recommended by the manufacturer. Electrolytes must be monitored closely; however, a neurologic adverse effect may not be foreseen.

Renal Osteodystrophy and the Status of Aluminum and Other Trace Metals in CAPD Patients: A Panel Review

1984 ◽  
Vol 4 (3) ◽  
pp. 129-136 ◽  
Author(s):  
Vito Campese ◽  
Ronald E. Easterling ◽  
Fred Finkelstein ◽  
William Mattern ◽  
David A. Ogden ◽  
...  
Keyword(s):  
Vitamin D ◽  
Bone Disease ◽  
Phosphorus Removal ◽  
Aluminum Toxicity ◽  
Phosphate Binders ◽  
Total Serum ◽  
Hypertonic Solutions ◽  
Total Serum Calcium ◽  
Control Serum ◽  
Panel Review

Most reports indicate that in patients on CAPD, hyperparathyroid bone disease progresses, while osteomalacia improves. With 1.5g% Dianeal, and when dialysate Ca is 7mg%, peritoneal mass transfer of calcium is positive, i.e., it is absorbed from the solution, while with hypertonic solutions it is less positive or even negative. Daily phosphorus removal by CAPD is insufficient to control serum phosphorus, hence CAPD patients require phosphate binders and/or phosphate restriction. Peritoneal phosphorus removal is greater with hypertonic than with isotonic solutions. In patients on CAPD, the loss of substantial amounts of D-binding protein and 25(OH)DJ into the dialysate, produces a gradual decrease in plasma 25(OH)D levels. Similarly, these patients have low 1,25(OH)D2 DJ levels and, hence, should receive vitamin D or its analogues. Unlike hemodialysis, CAPD results in a significant removal of PTH, with a peritoneal clearance of 1.5 ml/min. However, despite an estimated daily loss of 13.5% of the circulating PTH, there probably is not a significant effect on plasma PTH levels, which usually respond to changes in serum Ca. Levels of the intact PTH molecule provide a better index of hyperparathyroidism than do levels of its COOH-terminal fragment. With regard to investigation and treatment, one should measure serum ionic calcium rather than total calcium, even if the latter is corrected for total protein. The minimal dialysate calcium should be 7 mg/dl and for hypertonic solutions, perhaps it should be higher (7.5–8.0 mg%). Total serum calcium should be maintained at 10.2–10.7 mg/dl (ionized calcium of 5.1–5.5 mg/dl); adjunctive use of active forms of vitamin D and prevention of aluminum intoxication may prevent progressive bone disease in CAPD, and existing bone disease may heal. Whereas there are enough data supporting the connection of aluminum toxicity and osteomalacia in hemodialysis patients, data concerning the incidence of osteomalacia and its relationship to aluminum in CAPD patients are scarce. Apparently CAPD removes aluminum more efficiently than hemodialysis. CAPD patients are less likely to develop osteomalacia because the dialysate aluminum content is low and these patients tend to require lower doses of phosphate binder. There are no extensive studies on trace element deficiencies or excess in patients on CAPD. These patients may be more susceptible to deficiencies of trace elements which are protein bound. Desferoxamine may be effectively used for the treatment of patients with either aluminum or iron overload.

A Membrane Ultrafiltration Procedure for Determining Diffusible Calcium in Serum

1970 ◽  
Vol 16 (3) ◽  
pp. 226-228 ◽  
Author(s):  
Genevieve Farese ◽  
Milton Mager ◽  
William F Blatt
Keyword(s):  
Serum Calcium ◽  
Calcium Concentration ◽  
Simple Procedure ◽  
Total Serum ◽  
High Flux ◽  
Ultrafiltration Membranes ◽  
Serum Calcium Concentration ◽  
Normal Value ◽  
Total Serum Calcium ◽  
The Mean

Abstract A rapid, simple procedure is described for separating diffusible from proteinbound serum calcium by centrifugation through high-flux ultrafiltration membranes. The mean normal value for ultrafilterable calcium was 57.1% (range 52 to 61%) of the total serum calcium concentration.

Secretion of calcium by rat submandibular gland

1959 ◽  
Vol 196 (3) ◽  
pp. 645-648 ◽  
Author(s):  
Robert H. Dreisbach
Keyword(s):  
Submandibular Gland ◽  
Calcium Concentration ◽  
Total Serum ◽  
Transient Phase ◽  
Secretory Rate ◽  
Total Serum Calcium ◽  
The Mean ◽  
Rat Submandibular Gland ◽  
Calcium Loss ◽  
Mean Concentration

The mean concentration of calcium in rat submandibular gland saliva after maximal pilocarpine stimulation was initially 3.2 µEq/gm and gradually fell during the 1st hour to 0.93 µEq/gm. The final concentration was approximately 30% of the concentration of calcium in the serum ultrafiltrate whether the total serum calcium was normal or elevated threefold by the infusion of calcium chloride. At the end of the transient phase, the gland calcium concentration was from 28 to 57% less than the initial gland concentration depending upon the type of anesthesia used. The calcium loss from the gland correlated well with the excess calcium secreted in the saliva during the transient phase. After the initial transient phase was ended, the saliva calcium concentration bore an inverse relationship to the secretory rate and was directly proportional to the serum ultrafiltrate calcium concentration.

scholarly journals Restless legs syndrome in patients with distal diabetic polyneuropathy

2018 ◽  
Vol 146 (9-10) ◽  
pp. 512-515 ◽  
Author(s):  
Tatjana Smiljkovic ◽  
Svetlana Kostic-Dedic ◽  
Vesna Nikolic ◽  
Andjela Gavrilovic ◽  
Sanja Jevdjic
Keyword(s):  
Risk Factors ◽  
Serum Calcium ◽  
Restless Legs Syndrome ◽  
Calcium Concentration ◽  
Diabetic Polyneuropathy ◽  
Total Serum ◽  
Serum Calcium Concentration ◽  
Restless Legs ◽  
Total Serum Calcium ◽  
Distal Symmetrical Polyneuropathy

Introduction/Objective. An association between restless legs syndrome (RLS) and etiologically different polyneuropathies is well established. However, the investigations about the prevalence of RLS in diabetic polyneuropathy (DP) have led to controversy. Our study objective was to determine the frequency of RLS in patients with distal symmetrical polyneuropathy in patients with diabetes and identify possible risk factors for its occurrence in this group of patients. Method. We investigated 101 consecutive patients with distal DP. RLS was diagnosed according to the International RLS Study Group diagnostic criteria. The distal symmetrical polyneuropathy was confirmed by the electromyoneurographic study performed in each patient. Results. Overall RLS was present in 27 (26.73%) patients. The comparison between patients with and without RLS revealed that the RLS+ group included more women than men (14.85/9.90% vs. 35.64/37.62%, non-significant), patients were significantly younger (60.58 ? 10.54 vs. 65.57 ? 10.94 years, p ? 0.05), sensory polyneuropathy was significantly more common (17/27 vs. 34/74, p ? 0.05); the average level of the total serum calcium concentration was higher in the RLS + group than in non-RLS (2.43 ? 0.26 vs. 2.28 ? 0.39; p ? 0.05). However, multivariate logistic regression analysis did not demonstrate these as significant independent risk factors for RLS in DP. Conclusions. RLS is common in DP and occurs in more than a quarter of these patients. Though sensory forms and higher total serum calcium concentration were associated with RLS, neither of these has been identified as a significant single risk factor for the development of RLS in DP.

Effects of metabolic acidosis on PTH and 1,25(OH)2D3 response to low calcium diet

1982 ◽  
Vol 243 (6) ◽  
pp. F570-F575 ◽  
Author(s):  
D. A. Bushinsky ◽  
M. J. Favus ◽  
A. B. Schneider ◽  
P. K. Sen ◽  
L. M. Sherwood ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Ionized Calcium ◽  
Total Serum ◽  
Dihydroxyvitamin D3 ◽  
Calcium Diet ◽  
Low Calcium Diet ◽  
Low Calcium ◽  
Total Serum Calcium ◽  
Camp Generation ◽  
Immunoreactive Parathyroid Hormone

To study the effects of chronic metabolic acidosis on the metabolism of 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] rats were given either a low calcium diet (LCD) (0.002% calcium) or chow (1.2% calcium); ammonium chloride (NH4Cl) was added (1 or 1.5%) to the drinking water of some rats eating LCD or chow while others served as nonacidotic controls. LCD increased circulating 1,25(OH)2D3 levels from 46 +/- 14 to 204 +/- 24 pg/ml (P less than 0.001) in the absence of NH4Cl; 1.5% NH4Cl prevented the increase in 1,25(OH)2D3 (25 +/- 6 vs. 27 +/- 8 pg/ml (P, NS) but 1% NH4Cl did not (50 +/- 12 vs. 161 +/- 23 pg/ml; P less than 0.001). Acidosis suppressed neither serum immunoreactive parathyroid hormone (PTH) nor urine cAMP response to LCD. Although total serum calcium and phosphorus showed no regular changes with NH4Cl, acidosis raised blood ionized calcium in rats fed either chow or LCD, and serum 1,25(OH)2D3 levels were inversely correlated with ionized calcium (r = 0.714; P less than 0.001) during LCD. Chronic NH4Cl acidosis prevented serum 1,25(OH)2D3 from rising during LCD, independent of changes in PTH secretion, cAMP generation, or serum phosphorus. The absence of a 1,25(OH)2D3 response may be due to increased ionized calcium produced by acidosis.

scholarly journals Phototherapy and serum calcium levels in full term neonates with hyperbilirubinemia

2021 ◽  
Vol 61 (1) ◽  
pp. 8-11
Author(s):  
Carissa Lidia ◽  
I Made Kardana ◽  
Gusti Ayu Putu Nilawati ◽  
Ida Bagus Subanada ◽  
I Gusti Agung Ngurah Sugitha Adnyana ◽  
...  
Keyword(s):  
Serum Calcium ◽  
T Test ◽  
Full Term ◽  
Total Serum ◽  
Term Neonates ◽  
Total Serum Calcium ◽  
Before And After ◽  
Total Serum Calcium Level ◽  
Severe Hyperbilirubinemia ◽  
Paired T Test

Background Hyperbilirubinemia is one of the most common problems in newborns. Severe hyperbilirubinemia, known as kernicterus, can suppress O2 consumption and oxidative phosphorylation, as well as damage brain cells, resulting in neuronal dysfunction and encephalopathy. Phototherapy is a common therapy for neonatal hyperbilirubinemia, but may rarely lead to the adverse effect of hypocalcemia. Objective To investigate serum calcium levels in full term neonates with hyperbilirubinemia, before and after phototherapy. Methods This cohort study compared total serum calcium level before and after phototherapy in full term neonates with hyperbilirubinemia. Subjects were full term neonates aged 2-14 days with high total serum bilirubin levels, according to the Bhutani curve, and were treated with phototherapy at Sanglah Hospital, Denpasar, Bali, Indonesia. Paired T-test was used to compare serum calcium levels before and after phototherapy. Results There were 35 subjects in this study. Paired T-test revealed that subjects’ serum calcium significantly decreased after phototherapy [before: 9.47 mg/dL vs. after: 9.23 mg/dL; mean difference 0.24; (95%CI 0.03 to 0.46; P=0.025)]. None of our subjects had hypocalcemia after phototherapy. Conclusion Full term neonates with hyperbilirubinemia have reduced serum calcium levels after phototherapy.

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