Harry Husdan

Metabolic studies in prolonged fasting

Abstract Thirteen obese females were studied during 14 periods of fasting, lasting 2 to 4 weeks, in which they consumed only noncaloric fluids. This paper concerns itself primarily with changes in weight, in fluid-electrolyte and acid-base balance and in kidney function. The 11 patients who underwent 3 weeks of fasting lost an average of 12.7 pounds in the first week, 6.8 pounds in the second and 5.6 pounds in the third. The decreasing rate of weight loss with time could be related to decreases in urine output, basal metabolism and in activity of the patients. Urine sodium decreased gradually to about 20 mEq./day after 1 week of starvation. During early refeeding, urine sodium almost disappeared regardless of sodium intake and weight gain paralleled sodium retention. Urine chloride paralleled urine sodium whereas urine potassium fell more slowly although progressively. In 1 subject the aldosterone secretion rate which doubled after 1 week of fasting rose to its highest level during refeeding. Mild metabolic acidosis predominated in the first 2 weeks of fasting, a tendency to respiratory alkalosis in the third and metabolic alkalosis during refeeding. The clearances of urea and endogenous creatinine decreased during fasting. Data on urine pH, titratable acidity, ammonia, phosphorus and nitrogen are shown.

A Possible Role of Vitamin D in the Genesis of Parenteral-Nutrition-Induced Metabolic Bone Disease

Patients receiving long term parenteral nutrition may develop metabolic bone disease. In all 11 patients studied, histologic studies of bone showed excessive unmineralized bone tissue despite normal plasma 25-hydroxyvitamin D levels. Three patients also had bone pain and fractures and severe urinary loss of calcium and phosphate. Withdrawal of vitamin D from parenteral nutrition solutions was associated with improved histologic findings of bone in all patients, shown by a decrease in osteoid tissue and an increase in tetracycline uptake. In the three patients with symptoms, bone pain subsided, fractures healed, and urinary loss of calcium and phosphate decreased. Thus, vitamin D may be a factor in the genesis of parenteral nutrition-induced metabolic bone disease.

Reappraisal of Protein Losses in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Dialysate effluent protein content was measured in 22 patients undergoing continuous ambulatory peritoneal dialysis (9 with and 13 without previous peritonitis). The average amount of protein in those patients without peritonitis was 1.3 g/2 liters exchanged over a 6-hour period, while that of patients with previous peritonitis was 2.6 g/2 liters exchanged over the same period. 71% of protein found in the dialysate of 2 patients was albumin. Despite the difference in the amount of protein lost between those without and those with peritonitis, there was no significant difference in their mean serum albumin levels (3.2 and 3.4 g%, respectively) which were only slightly below the normal range. The previously reported high protein losses in patients undergoing CAPD are probably the result of frequent episodes of peritonitis and a higher number (five) of daily exchanges.

• Periosteal New Bone Formation (Periosteal Neostosis) in Renal Osteodystrophy Relationship to Osteosclerosis, Osteitis Fibrosa, and Osteoid Excess!

Radiologic skeletal surveys in 117 patients with severe chronic renal disease revealed periosteal neostosis (periosteal new bone formation) in 10 patients (8.5%). Periosteal neostosis occurred in varied locations and was always accompanied by subperiosteal resorption in finger bones, and in 9 of 10 cases by osteosclerotic changes in the central skeleton. The most common finding in iliac crest biopsies, obtained from 8 patients, was osteoid excess (osteomalacia). The combination of periosteal neostosis, subperiosteal resorption, osteosclerosis, and osteoid excess may be a manifestation of secondary hyperparathyroidism, with high bone turnover and sustained ability to produce mineralized bone.

Study of Calcium Crystals in Patients with Kidney Stones

An important factor in the formation of calcium-containing kidney stones is the supersaturation of urine with calcium salts. However, we have been unable to find any difference in the saturation of calcium oxalate between stone-formers and normals, whereas the saturation of octocalcium phosphate was indeed higher in the stone formers although there was a considerable overlap1.

A Comparison of Extracorporeal and Travenol Coils for the Conduct of Short Haemodialysis: a Consumer Report

A cross-over study carried out over a 24 week period during 1975-76 was designed to test the relative merits of Extracorporeal versus Travenol coils for thrice weekly short periods of haemodialysis for patients with end-stage renal failure. Predictability of and capacity for ultrafiltration were excellent and equally good for both products. Leak rates in Travenol coils were 9.3% as compared to 4.3% for Extracorporeal coils. Dialysances of BUN, creatinine, and phosphate were significantly higher with Travenol coils than with Extracorporeal coils, but this increase was not as great as might be expected from the greater surface area of the Travenol coil. Despite the greater functional efficiency of the Travenol coils we could detect no difference in the degree of biochemical control of the patients as judged by standard pre and post dialysis blood chemistries. Residual blood volumes averaged 9 mls for the Travenol coils as compared to 1.6 mls for Extracorporeal coils.