High 1,25-Dihydroxyvitamin D and Low 25-Hydroxyvitamin D Concentrations in Plasma in Patients Receiving Antiepileptic Drugs

Abstract: Plasma 25-hydroxyvitamin D (25-OH D), 1,25-dihydroxy vitamin D (1,25-(OH)₂ D) and parathyroid hormone (PTH) concentrations were determined in 30 outpatients receiving various antiepileptic drugs (AED). None of the patients exhibited high plasma PTH levels. The plasma 1,25-(OH) ₂ D levels were normal or high, a'though in a third of the patients the 25-OH D levels were reduced. There was a corre'ation between the 25-OH D and serum calcium levels. These findings suggest that the low plasma concentrations of 25-OH D, not 1,25-(OH)₂ D, might play an important part in the occurrence of AED-induced disturbances of bone metabolism.     

Resolution of severe oncogenic hypophosphatemic osteomalacia after resection of a deeply located soft-tissue tumour

Oncogenic osteomalacia is a rare metabolic bone disease characterized by phosphate leakage from the kidney and subsequent hypophosphatemia. It is caused by a phosphaturic factor produced by certain tumours. Removal of such tumours can completely cure the condition. Here, we report the case of a patient who was crippled with oncogenic osteomalacia. Extensive study revealed a tumour deeply located in the pelvis; removal of the tumour resulted in complete recovery. The tumour was identified as a mesenchymal tumour (mixed connective-tissue variant). The diagnostic evaluation, differential diagnosis, and treatment are discussed.     

X-linked hypophosphatemic rickets without “rickets”

Wrist and knee radiographs from children with X-linked hypophosphatemic rickets were analyzed and compared with those from normal children and children with established rickets to assess whether radiographically apparent rickets is a consistent abnormality in X-linked hypophosphatemia. The absence or presence of rickets was correctly identified in 94.8% of wrist and knee films from normal and positive controls. In contrast, patients with X-linked hypophosphatemia exhibited rachitic abnormalities in only 5 of 11 wrist and 13 of 15 knee radiographs. As a result, 4 patients within this study group had rickets at the knee and not at the wrist, whereas 5 displayed classic defects at both sites. Perhaps more important, 2 patients, aged 3.8 and 5.2 years, displayed no evidence of rickets in either wrist or knee films, although relatives exhibited demonstrable rachitic abnormalities. Our data indicate that radiographically detectable rickets is a variable abnormality of X-linked hypophosphatemia and does not provide an unambiguous index for the diagnosis of this disease.Presented in part at the annual scientific meeting of the American Society of Bone and Mineral Research, New Orleans, June 3–7, 1988. Part of this work has appeared in abstract form in J Bone Min Res (1988) 3 [Suppl 1]:S132     

连续性静脉-静脉血液滤过中低磷血症的防治初探

目的对危重患者应用连续性静脉静脉血液滤过(CVVH)治疗过程中低磷血症的防治进行初步分析与探讨。方法选择危重患者30例,按急性生理与慢性健康评分(APACHEⅡ评分)不同分为2组(<15分13例为A组,≥15分17例为B组)。两组均行CVVH治疗,置换液速度A组2 000 ml/h、B组4 000 ml/h,持续时间8~12 h/d;补充甘油磷酸钠A组10~20 ml/d,B组为30~40 ml/d;治疗前、24小时、48小时、72小时检测血清磷的浓度、进行APACHEⅡ评分,并作血磷与APACHEⅡ评分的相关分析,计算磷清除率。结果B组磷清除率大于A组[(42.76±2.39)ml/min vs(23.84±3.05)ml/min,P<0.05];治疗前B组血磷浓度低于A组[(0.78±0.19)mmol/L vs(1.25±0.27)mmol/L,P<0.05];第24小时两组血磷浓度均开始下降,补磷后第48小时A组血磷浓度正常,B组为轻度低磷血症,经调整补磷剂量后,第72小时恢复正常;CVVH治疗后两组患者APACHEⅡ评分均有降低的趋势;血磷与APACHEⅡ评分的相关分析提示两者呈负相关。结论危重患者易发生低磷血症,且与病情危重程度相关,采用CVVH治疗更易加重低磷血症,补磷应做到个体化,且不必拘泥于常规剂量限制,同时通过密切监测血磷变化来调整。     

Suboptimal vitamin D status is a highly prevalent but treatable condition in both hospitalized patients and the general population

PURPOSE: To heighten awareness of the problems related to the high prevalence of suboptimal vitamin D status in hospitalized patients and the general population, including an overview of vitamin D biology, how vitamin D status is defined, the negative health issues associated with suboptimal vitamin D status, indications for treatment, treatment strategies, and controversies in the field. DATA SOURCES: (a) Literature review was performed using PubMed and CINAHL databases to locate and review medical, nursing, and nutritional journals. (b) Authors' recent prospective studies of 100 patients in a general tertiary hospital rehabilitation unit and 51 nonhospitalized volunteers. CONCLUSION: Poor vitamin D status (ranging from suboptimal to overt deficiency) is common in both hospitalized patients and ostensibly healthy individuals of all ages and geographic latitude. Suboptimal vitamin D status is associated with muscle weakness, functional deficits, and perhaps longer length of stay of hospitalized patients. Predictors of vitamin D status include race, poor nutrition, advanced age, use of multivitamins, ultraviolet light exposure, and grip strength. Fortunately, treatment with 50,000 IU of vitamin D(2) for several weeks is a very inexpensive and safe yet effective treatment to replete vitamin D status. IMPLICATIONS FOR PRACTICE: NPs should be aware of the indications for monitoring vitamin D status and the appropriate treatment for suboptimal vitamin D status. Improving vitamin D status may improve a patient's functional ability, therefore decreasing falls and preventing fractures, decreasing length of stay in the hospital, and decreasing the cost of health care. Providers can potentially improve the life of older adults by educating patients on the importance of vitamin D supplementation.     

危重病患儿血磷变化及临床意义

目的观察危重病患儿血磷变化，探讨其临床意义。方法对29例危重病患儿急性期血磷、血钙、血镁进行检测，并以22例正常儿作为对照。结果危重病患儿组血磷较对照组明显降低（P〈0．001），血钙、镁则无明显差异（P〉0．05），但危重病患儿组血磷与血钙、血镁之间均无相关性。结论危重病患儿常伴有低磷血症，及时补磷治疗也是提高危重患儿抢救成功率的关键手段之一。     

Therapeutic Effects of Anti‐FGF23 Antibodies in Hypophosphatemic Rickets/Osteomalacia

X‐linked hypophosphatemia (XLH), characterized by renal phosphate wasting, is the most common cause of vitamin D‐resistant rickets. It has been postulated that some phosphaturic factor plays a causative role in XLH and its murine homolog, the Hyp mouse. Fibroblast growth factor 23 (FGF23) is a physiological phosphaturic factor; its circulatory level is known to be high in most patients with XLH and Hyp mice, suggesting its pathophysiological role in this disease. To test this hypothesis, we treated Hyp mice with anti‐FGF23 antibodies to inhibit endogenous FGF23 action. A single injection of the antibodies corrected the hypophosphatemia and inappropriately normal serum 1,25‐dihydroxyvitamin D. These effects were accompanied by increased expressions of type IIa sodium‐phosphate cotransporter and 25‐hydroxyvitamin‐D‐1α‐hydroxylase and a suppressed expression of 24‐hydroxylase in the kidney. Repeated injections during the growth period ameliorated the rachitic bone phenotypes typically observed in Hyp mice, such as impaired longitudinal elongation, defective mineralization, and abnormal cartilage development. Thus, these results indicate that excess actions of FGF23 underlie hypophosphatemic rickets in Hyp mice and suggest a novel therapeutic potential of the FGF23 antibodies for XLH.     

再喂养综合征患者营养治疗方式的探讨

目的 加深医务人员对再喂养综合征的认识。方法 通过报道1例再喂养综合征的案例,笔者查阅国内外相关文献,对再喂养综合征风险的筛查、风险等级的评定、诊断及如何安全启动营养治疗等方面进行了详细的阐述,并总结其治疗经验。结果 通过补充维生素B₁、纠正电解质紊乱、早期低热卡供给及液体管理等一系列措施,该患者的营养状况得到明显的改善。结论 再喂养综合征是营养治疗常见的并发症之一,医务人员需早期识别高危人群并为其制定个体化营养治疗方案,充分发挥营养治疗的临床价值。