Hypophosphatemia and Metabolic Bone Disease Associated With the Use of Elemental Formula: Case Report and Review

2021 ◽  
pp. 097321792110653
Author(s):  
Sirisha Kusuma Boddu ◽  
Vijay Kumar Thota Venkata
Keyword(s):  
Bone Disease ◽  
Milk Protein ◽  
Metabolic Bone Disease ◽  
Very Low Birth Weight ◽  
Poor Growth ◽  
Elemental Formula ◽  
Metabolic Bone ◽  
Wide Range ◽  
Low Birth Weight Babies ◽  
Interesting Correlation

A small percentage of infants and children develop cow’s milk protein allergy which is usually treated with exclusive breastfeeding or extensively hydrolyzed formulas. Some children might still be reactive to hydrolyzed formulas and would need elemental amino acid-based formulas. Elemental formulas are also frequently employed in treating very low birth weight babies with significant intolerance to regular preterm formulas and the resulting poor growth. All pediatric formulas are usually prepared as per international guidelines to fulfill the macro- and micronutrient requirements of growing children across a wide range of volume intakes. However, an interesting correlation is being reported recently, between the use of a specific elemental formula and the development of hypophosphatemia and significant metabolic bone disease. We discuss this phenomenon by exploring the available evidence and report 2 similar cases that we managed in our practice.

Metabolic bone disease in low birth weight babies between 1500 and 2000 g on exclusive breast feeding

Astrocyte ◽  
2014 ◽  
Vol 1 (2) ◽  
pp. 75
Author(s):  
HarishKumar Chellani ◽  
Neelam Roy ◽  
Shobha Sharma ◽  
Sanjay Siddhartha ◽  
Sugandha Arya
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Breast Feeding ◽  
Bone Disease ◽  
Metabolic Bone Disease ◽  
Exclusive Breast Feeding ◽  
Metabolic Bone ◽  
Low Birth Weight Babies

scholarly journals Case report of a possible familial predisposition to metabolic bone disease in juvenile rhesus macaques

2003 ◽  
Vol 37 (2) ◽  
pp. 139-144 ◽  
Author(s):  
S. E. Wolfensohn
Keyword(s):  
Vitamin D ◽  
Bone Disease ◽  
Metabolic Bone Disease ◽  
Rhesus Macaques ◽  
Clinical Manifestations ◽  
Clinical Problem ◽  
Poor Growth ◽  
Familial Predisposition ◽  
Nutritional Deficit ◽  
Metabolic Bone

Deficiencies of dietary calcium and/or vitamin D will cause hypocalcaemia, leading to metabolic bone disease. The disease commonly affects young rapidly growing animals and this is a report of the condition in a colony of rhesus macaques ( Macaca mulatta). A clinical problem of metabolic bone disease was seen in 1993, when it was treated and resolved satisfactorily. However it recurred in 1999 following changes in management and husbandry of the colony, at which time the clinical manifestations were more serious. The animals had bowed tibia, fibula, radius and ulna and enlarged epiphyses, were reluctant to climb and jump, had a 'hopping' gait and poor growth. The syndrome had a multifactorial aetiology involving a combination of staff and management changes, a borderline nutritional deficit, a lack of daylight for production of vitamin D, and a possible familial predisposition.

Comparison of Intact Parathyroid Hormone, Alkaline Phosphatase, Phosphate Levels for Diagnosing Severe Metabolic Bone Disease in Infants with Severe Bronchopulmonary Dysplasia

2017 ◽  
Vol 34 (12) ◽  
pp. 1199-1204 ◽  
Author(s):  
Erin Tkach ◽  
Ammie White ◽  
Kevin Dysart ◽  
Brenda Waber ◽  
Ursula Nawab ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Parathyroid Hormone ◽  
Bronchopulmonary Dysplasia ◽  
Bone Disease ◽  
Metabolic Bone Disease ◽  
Very Low Birth Weight ◽  
Area Under The Curve ◽  
Intact Parathyroid Hormone ◽  
Vlbw Infants ◽  
Metabolic Bone

Objective We compared the accuracy of serum intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), and phosphate (phos) levels for diagnosing severe metabolic bone disease (MBD) in very low-birth-weight (VLBW) infants with severe bronchopulmonary dysplasia (BPD). Study Design Retrospective analysis of VLBW infants with severe BPD admitted between 2010 and 2012 and with ≥ 1 iPTH, ALP, and phos level collected within a similar 72-hour period. MBD severity was classified by serial radiography. Results Laboratory values were available for 65 infants, of whom 24 (36.9%) developed severe MBD. A maximum ALP > 660 IU/L was the most accurate for diagnosing severe MBD (area under the curve: 88.4%; 95% confidence interval [CI]: 77.2–94.5%). Maximum iPTH was the least accurate (optimal cut point > 130 pg/mL; area under the curve: 70.5%; 95% CI: 58.2–81.4). Conclusion Maximum ALP was more accurate than iPTH or phos for diagnosing severe MBD among preterm infants with severe BPD.

Prevalence of Metabolic Bone Disease in Tube-Fed Children Receiving Elemental Formula

2018 ◽  
Vol 90 (5) ◽  
pp. 291-298 ◽  
Author(s):  
Ana L. Creo ◽  
Lisa M. Epp ◽  
Julie A. Buchholtz ◽  
Peter J. Tebben
Keyword(s):  
Bone Disease ◽  
Incomplete Data ◽  
Metabolic Bone Disease ◽  
Monitoring Data ◽  
Suspected Case ◽  
Radiographic Evidence ◽  
Elemental Formula ◽  
Metabolic Bone ◽  
Review Period ◽  
Multicenter Survey

Background: Previous studies suggest normal mineral status in children receiving elemental formula. However, a recent multicenter survey described 51 children who developed hypophosphatemia and bone disease while receiving elemental formula. Our aim is to determine the prevalence of metabolic bone disease in children receiving extensively hydrolyzed or amino acid-based formula. Methods: We established a retrospective cohort using an institutional database of tube-fed children. We defined a “confirmed case” as a child with biochemical and radiographic evidence of bone disease (rickets and/or low-trauma fractures). We defined a “suspected case” as a child who had biochemical evidence and/or radiographic evidence of bone disease but with incomplete data during the review period. Results: A total of 102 tube-fed children receiving elemental or semi-elemental formula were identified. The four elemental and semi-elemental formulas evaluated were Neocate®, EleCare®, Pregestimil®, and Alimentum®. Not all children had complete monitoring data performed during the review period. Of the children receiving Neocate who had monitoring data (46%), 23% developed hypophosphatemia and radiographic abnormalities (fractures or rickets), which resolved with phosphorus supplementation and/or change in the formula brand. Conclusions: We estimate that at least 11% and up to 23% of all tube-fed children receiving Neocate develop metabolic bone disease. Based upon the estimated prevalence, we recommend cautious use of this formula with monitoring for evolving bone disease in this population.

Sign in / Sign up

Export Citation Format

Share Document