Effects of protein-rich supplementation and nandrolone in lean elderly women with femoral neck fractures

AIM: To evaluate the effects of a protein-rich liquid supplementation, alone or in combination with the anabolic steroid nandrolone decanoate, on body composition, activities of daily living (ADL) status and the health-related quality of life (HRQoL) after a femoral neck fracture. METHODS: Sixty women, aged 83 +/- 5 years (mean +/- SD), BMI < 24 kg/m2 (20.4 +/- 2 kg/m2 ) and capable of co-operating, with a femoral neck fracture treated with internal fixation, were randomised to open treatment during 6 months with a protein-rich liquid formula alone (PR, Fortimel, 200 ml/day, 20 g protein/day) or in combination with nandrolone decanoate (PR/N, Deca-Durabol 25 mg i.m./3 weeks) or to a control group (C). The patients were re-examined after 6 and 12 months regarding body weight (BW), lean body mass (LBM, DXA), ADL status according to Katz, HRQoL according to EQ 5-D and fracture healing. RESULTS: LBM decreased in the C (-1.2 +/- 2 kg) and PR groups (-1.2 +/- 1 kg) but remained the same in the PR/N group (0.3 +/- 1 kg) (P < 0.05 between groups). ADL remained at a high level in the two intervention groups but declined significantly in the C group (P < 0.005 between groups). The decline in HRQoL was least pronounced in the PR/N group at 6 months (P < 0.05 between groups). Patients with fracture healing complications lost more BW (P < 0.05) and LBM (P < 0.01) than patients with uneventful fracture healing. CONCLUSION: Protein-rich liquid supplementation in combination with nandrolone given for 6 months to lean elderly women after a femoral neck fracture may positively affect LBM, ADL and HRQoL.     

Comparison of body composition measured by total body potassium and infrared interactance.

The purpose of this study was to find how closely a near infrared instrument (IRI), Futrex 5000, would compare to whole body counting (WBC) of potassium-40 (40K) in assessing body composition.

We measured lean body mass (LBM) and percent total body fat (PCF) in 177 males and 27 females by total body potassium (TBK) and by infrared interactance (IRI). TBK was assessed by 2 pi whole body counter (WBC) and IRI by Futrex (F) instrument. These subjects were measured for TBK and for IRI within 1 week of each other.

A large mean difference (p < or = 0.001) was found between the results using the two instruments: IRI data for LBM were higher and PCF lower compared to TBK.

As shown by repeated TBK measurements over a 22-year period in these same volunteers, this technique is reliable. The IRI assessments did not come to a close fit with TBK.     

Influence of energy source upon body composition in patients receiving intravenous nutrition

The influence of energy substrate upon body composition was investigated by measuring changes in the body composition of 24 patients who received intravenous nutrition for 2 weeks. The patients were randomly allocated to two groups. Twelve patients (the "glucose group") received all 'nonprotein' calories as glucose, the remaining 12 (the "fat-glucose group") received 60% of 'nonprotein' calories as fat emulsion (Intralipid). Amino acids (FreAmine II) were supplied to give a calorie/nitrogen ratio of 150:1. Total calories were supplied at a rate of 1.4 times the measured resting energy expenditure of each patient. Body composition was measured using routine anthropometric techniques and in vivo neutron activation analysis. Significant increases in body fat and total body potassium (TBK) were recorded in the glucose group, but there was no significant change in total body water (TBW) or total body nitrogen (TBN) in either group. The initial value of the ratio of TBK:TBW had a significant negative correlation with the change of TBK in both groups, and with the change of TBN in the glucose group. The study demonstrates the importance of considering nutritional status when analyzing the effects of intravenous nutrition. Glucose as the sole source of calories induced an increase in body potassium independent of protein synthesis; this effect was not observed in patients who received 60% of their energy supply as lipid emulsion.     

Nutritional treatment for acquired immunodeficiency virus-associated wasting using beta-hydroxy beta-methylbutyrate, glutamine, and arginine: a randomized, double-blind, placebo-controlled study

BACKGROUND: The current study was designed to examine whether a combination of three nutrients, consisting of beta-hydroxy-beta-methylbutyrate (HMB), a metabolite of leucine, L-glutamine (Gln) and L-arginine (Arg), each of which has been previously shown to slow muscle proteolysis, could synergistically alter the course of muscle wasting in patients with established acquired immunodeficiency syndrome (AIDS). METHODS: Sixty-eight human immunodeficiency virus (HIV)-infected patients with a documented weight loss of at least 5% in the previous 3 months were recruited from the HIV clinic at Nassau County Medical Center. The subjects were randomly assigned in a double-blind fashion to receive either placebo containing maltodextrin or the nutrient mixture (HMB/Arg/Gln) containing 3 g HMB, 14 g L-glutamine, and 14 g L-arginine given in two divided doses daily for 8 weeks. Body weights (BW) were recorded weekly and lean body mass (LBM) and fat mass (FM) were measured by air displacement plethysmography and by a single computerized tomography (CT) slice through the thigh at 0, 4, and 8 weeks. RESULTS: Forty-three subjects completed the 8-week protocol, (placebo, n = 21; HMB/Arg/Gln, n = 22). At 8 weeks, the subjects consuming the HMB/Arg/Gln mixture gained 3.0 +/- 0.5 kg of BW while those supplemented with the placebo gained 0.37 +/- 0.84 kg (p = .009). The BW gain in the HMB/Arg/Gln-treated subjects was predominantly LBM (2.55 +/- 0.75 kg) compared with the placebo-supplemented subjects who lost lean mass (-0.70 +/- 0.69 kg, p = .003). No significant change in FM gain was observed (0.43 +/- 0.83 kg for the group receiving HMB/Arg/Gln and 1.07 +/- 0.64 kg for the group receiving the placebo, p > .20). Similar percentage changes in muscle mass and fat mass were observed with CT scans. Immune status was also improved as evident by an increase in CD3 and CD8 cells and a decrease in the HIV viral load with HMB/Arg/Gln supplementation. CONCLUSIONS: The data indicate that the HMB/Arg/Gln mixture can markedly alter the course of lean tissue loss in patients with AIDS-associated wasting.     

Serum concentration of cobalamines during total parenteral nutrition in Crohn's disease

The vitamin B12 status was assessed by measuring the fasting serum (S-) concentration of cobalamines in a consecutive series of 12 patients with Crohn's disease (CD) given total parenteral nutrition (TPN)--nil per os--for between 21 and 97 days (mean, 49 days). At introduction of TPN the S-cobalamine concentration was less than 300 pmol/liter in four patients (group I) and more than 300 pmol/liter in eight (group II). Each day during TPN fat- and water-soluble vitamins, including 2 micrograms of cyanocobalamin, were given. In group I there was a small increase in the S-cobalamine level during the first 2 to 4 weeks of TPN, whereas in group II the values approached the middle of the reference range (190-680 pmol/liter) after 6 to 8 weeks of TPN. It would thus appear that the vitamin regimen studied, including 2 micrograms of cyanocobalamin per 24 hr, is able to maintain the S-cobalamine concentration within the reference range during 6 to 8 weeks of TPN in CD patients with no evidence of vitamin B12 deficiency, and to prevent the development of vitamin B12 deficiency during 2 to 4 weeks of TPN in CD patients with a S-cobalamine level initially below 300 pmol/liter.     

Effect of refeeding on the energy metabolism of adolescent girls who have anorexia nervosa.

The effect of refeeding on resting energy expenditure (REE) and substrate utilization was studied in 18 hospitalized adolescent girls (aged 12.9-19.1 years) suffering from anorexia nervosa. Changes in body composition were monitored weekly and included weight, fat body mass (FBM), lean body mass (LBM) and total body potassium (TBK). REE was studied weekly by open-circuit calorimetry. Weight gain was noted in all patients (38.2 +/- 5.6 to 44.5 +/- 5.3 kg), involving increased FBM and LBM. REE increased per kg of weight (91.6 +/- 15.1 to 101.7 +/- 18.0 kJ kg-1 d-1) and LBM over the first weeks of refeeding (P less than 0.025) and then stabilized. Substrate utilization showed an increase in carbohydrate and protein utilization (P less than 0.001) during the first few weeks of refeeding. We also studied the thermic effect of food (TEF) in 14 of the 18 subjects. Upon admission the subjects had a reduced TEF (36.4 +/- 24.3 kJ 2 h-1) (P less than 0.001). With refeeding TEF rose to a peak or plateau, then decreased to normal levels (61.9 +/- 36.0 kJ 2 h-1) before discharge from hospital. We conclude that the energy metabolism of adolescent girls adapts to semi-starvation by a reduction in both REE and TEF; with refeeding there is reversal of this adaptive function.     

Total body potassium in aging humans: a longitudinal study

Total body potassium (TBK) data calculated from longitudinal measurements over 18 y of 40K by whole-body counting of 564 male and 61 female healthy humans in a 2-pi liquid scintillation counter show little change in females younger than 50 y compared with males of those ages. Males show less TBK from 41 y onward as they age, with most rapid rate of loss between 41 and 60 y. Females have a rapid loss of TBK when they are older than 60 y; the loss is at a greater rate than that of males. Percent total body fat calculated from total body weight and lean body mass (LBM) derived from TBK document greater adiposity in females at all ages except ages 51-60 y when females are similar to males in change in percent fat per year per centimeter.     

Abnormal liver function in malnourished patients receiving total parenteral nutrition: a prospective randomized study

A prospective study was performed in clinically malnourished patients in which liver function was tested during a 4-week period of total parenteral nutrition (TPN). The purpose was to determine if concomitant intravenous lipid administration would reduce liver function abnormalities noted to occur frequently in patients receiving TPN. Twenty-five patients were randomly assigned to receive either daily infusions of 200 cc of a 20% lipid emulsion with TPN or TPN without lipid for the first week. In the subsequent 3 weeks all patients received daily intravenous lipid. The early lipid treatment group received 0.7 g lipid/kg BW/day and approximately 280 mg of choline/day from the lecithin emulsifier throughout the entire study period. Liver function tests were performed twice in the first week, then weekly thereafter. There were significant (p less than 0.05) elevations in liver function tests in the early lipid treatment group (for aspartate aminotransferase in weeks 1, 2, and 3, and lactic acid dehydrogenase in weeks 2 and 3). Alkaline phosphatase activity was elevated at weeks 2, 3, and 4 for the lipid-treatment group and at week 1 for the lipid-restricted group. The two groups had a similar elevation in gamma-glutamyltransferase activity. Analysis of covariance demonstrated that the overall duration of TPN, and not the presence or absence of intravenous lipid, was significantly related to the elevations in both alkaline phosphatase and gamma-glutamyltransferase (GGT) levels. In contrast, the early intravenous administration of lipid was significantly related to the increase in aspartate aminotransferase levels. The peak increase in AST was noted at day 7 in the lipid-administration group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Abnormal liver function in malnourished patients receiving total parenteral nutrition: a prospective randomized study.

A prospective study was performed in clinically malnourished patients in which liver function was tested during a 4-week period of total parenteral nutrition (TPN). The purpose was to determine if concomitant intravenous lipid administration would reduce liver function abnormalities noted to occur frequently in patients receiving TPN. Twenty-five patients were randomly assigned to receive either daily infusions of 200 cc of a 20% lipid emulsion with TPN or TPN without lipid for the first week. In the subsequent 3 weeks all patients received daily intravenous lipid. The early lipid treatment group received 0.7 g lipid/kg BW/day and approximately 280 mg of choline/day from the lecithin emulsifier throughout the entire study period. Liver function tests were performed twice in the first week, then weekly thereafter. There were significant (p less than 0.05) elevations in liver function tests in the early lipid treatment group (for aspartate aminotransferase in weeks 1, 2, and 3, and lactic acid dehydrogenase in weeks 2 and 3). Alkaline phosphatase activity was elevated at weeks 2, 3, and 4 for the lipid-treatment group and at week 1 for the lipid-restricted group. The two groups had a similar elevation in gamma-glutamyltransferase activity. Analysis of covariance demonstrated that the overall duration of TPN, and not the presence or absence of intravenous lipid, was significantly related to the elevations in both alkaline phosphatase and gamma-glutamyltransferase (GGT) levels. In contrast, the early intravenous administration of lipid was significantly related to the increase in aspartate aminotransferase levels. The peak increase in AST was noted at day 7 in the lipid-administration group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Correlations between preoperative malnutrition and septic complications of esophageal cancer surgery

Eight measures were used to assess the nutritional status of 80 patients with esophageal cancer, 58 with gastric cancer, and 50 healthy controls. Postoperative complications were divided into three categories: septic, anastomotic leakage, and nonseptic. Protein-calorie malnutrition (PCM) of esophageal cancer patients was characterized by a greater depletion of arm muscle circumference (AMC) and body weight (BW) compared with findings in the gastric cancer patients. Average AMC, BW, triceps skinfold (TSF), and levels of retinol-binding protein (RBP) on admission were lower in patients who suffered fatal septic complications than in those who did not. The reduction of AMC, BW, and RBP was observed even after preoperative total parenteral nutrition (TPN). It is concluded that patients with a nutritional depletion as assessed by these measures on admission should be treated with preoperative TPN, and, if nutritional correction of these measures is poor, other perioperative therapy to prevent fatal septic complications should be given.     

Serum concentration of folates during total parenteral nutrition in Crohn's disease

Folate status as evidenced by the fasting serum (S-) concentration of folates was determined in a consecutive series of 15 patients with Crohn's disease (CD) given total parenteral nutrition (TPN)—nil per os—for between 23 and 97 days (mean, 56 days). At introduction of TPN three patients displayed sub-normal S-folate levels—below 4.0 nmol/1—(group 1), whereas 12 patients recorded S-folates above 4.0 nmol/l (group 2). During the TPN each patient received one ampoule of water-soluble vitamins, including 0.2 mg of folic acia per 24 h. S-folates were normalised during the TPN in group 1 and maintained a level near the middle of the reference range (4–23 nmol/l) in group 2. It would thus appear that during 6–8 weeks of TPN the vitamin regimen studied, including 0.2 mg of folic acid per 24 h, is able to maintain the S-folate concentration within the reference range in CD patients with no evidence of folate deficiency and to prevent signs of folate deficiency in CD patients with an initially sub-normal S-folate concentration.     

Effect of two different weight-loss rates on body composition and strength and power-related performance in elite athletes

When weight loss (WL) is necessary, athletes are advised to accomplish it gradually, at a rate of 0.5-1 kg/wk. However, it is possible that losing 0.5 kg/wk is better than 1 kg/wk in terms of preserving lean body mass (LBM) and performance. The aim of this study was to compare changes in body composition, strength, and power during a weekly body-weight (BW) loss of 0.7% slow reduction (SR) vs. 1.4% fast reduction (FR). We hypothesized that the faster WL regimen would result in more detrimental effects on both LBM and strength-related performance. Twenty-four athletes were randomized to SR (n = 13, 24 ± 3 yr, 71.9 ± 12.7 kg) or FR (n = 11, 22 ± 5 yr, 74.8 ± 11.7 kg). They followed energy-restricted diets promoting the predetermined weekly WL. All athletes included 4 resistance-training sessions/wk in their usual training regimen. The mean times spent in intervention for SR and FR were 8.5 ± 2.2 and 5.3 ± 0.9 wk, respectively (p < .001). BW, body composition (DEXA), 1-repetition-maximum (1RM) tests, 40-m sprint, and countermovement jump were measured before and after intervention. Energy intake was reduced by 19% ± 2% and 30% ± 4% in SR and FR, respectively (p = .003). BW and fat mass decreased in both SR and FR by 5.6% ± 0.8% and 5.5% ± 0.7% (0.7% ± 0.8% vs. 1.0% ± 0.4%/wk) and 31% ± 3% and 21 ± 4%, respectively. LBM increased in SR by 2.1% ± 0.4% (p < .001), whereas it was unchanged in FR (-0.2% ± 0.7%), with significant differences between groups (p < .01). In conclusion, data from this study suggest that athletes who want to gain LBM and increase 1RM strength during a WL period combined with strength training should aim for a weekly BW loss of 0.7%.     

Resting metabolic rate and body composition of healthy Swedish women during pregnancy

Body weight, resting metabolic rate (RMR), total body potassium (TBK), and total body water were measured and total body fat (TBF) was calculated in a longitudinal study of 22 pregnant, healthy Swedish women. Measurements were made before pregnancy, at gestational weeks 16-18, 30, and 36, and 5-10 d and 6 mo postpartum. RMR increased more during pregnancy than previous estimates on well-nourished women showed and the increase was significantly correlated with the birth weight of the baby. TBK decreased during the first part of pregnancy; measurements at weeks 16-18 and 30 were significantly lower than the prepregnancy value and changes in TBK and RMR were significantly correlated. TBF gain during pregnancy was 5.8 +/- 4.0 kg and 60% was already gained by gestational weeks 16-18. Gain in fat was not correlated with birth weight.     

Comparison of total body chlorine, potassium, and water measurements in children with cystic fibrosis

BACKGROUND: Symptoms of cystic fibrosis (CF) may limit the utility of total body chlorine (TBCl) and total body potassium (TBK) measurements for assessing body fluid compartments of children. OBJECTIVE: This study assessed relations among independent measurements of TBCl, TBK, and total body water (TBW) in children with CF. DESIGN: We compared cross-sectional measurements of TBCl by in vivo neutron activation analysis, TBK by whole-body counting of (40)K, TBW by D(2)O dilution [TBW(D(2)O)], and TBW from TBCl and TBK [TBW(Cl + K)] in 19 prepubertal children (13 boys) aged 7.6-12.5 y who had mild symptoms of CF. Body-composition measurements were compared with data from previous studies of healthy children. RESULTS: Subjects with CF had deficits in TBCl, TBK, TBW, and body weight compared with control reference data (P < 0.05). The ratios (TBCl + TBK)/TBW and TBCl/TBK were not significantly different from control reference values, and plasma chlorine and potassium concentrations were within control reference ranges. The sum of TBCl and TBK correlated with TBW(D(2)O) (r(2) = 0.79, P < 0.001), and TBW(Cl + K) correlated with TBW(D(2)O) (r(2) = 0.78, P < 0.001). TBW(Cl + K) was similar to TBW(D(2)O) (mean +/- SEM: 19.0 +/- 0.5 compared with 19.4 +/- 0.5 L; NS). CONCLUSIONS: Prepubertal children with mild symptoms of CF can develop deficits in TBCl, TBK, and TBW that reflect chronic energy malnutrition. Mild symptoms of CF do not appear to affect normal relations among TBCl, TBK, and TBW. Measurements of TBCl and TBK may be used to assess body fluid compartments in these patients.     

Assessment of intracellular water by whole body bioelectrical impedance and total body potassium in HIV-positive patients

OBJECTIVE: Bioelectrical impedance analysis (BIA) is widely used as bedside assessment of body composition. Body cell mass (BCM) and intracellular water (ICW) are clinically important body compartments. Estimates of ICW obtained from BIA by different calculation approaches were compared to a reference method in male HIV-infected patients. PATIENTS: Representative subsample of clinically stable HIV-infected outpatients, consisting of 42 men with a body mass index of 22.4 +/- 3.8 kg/m(2)(range, 13-l31 kg/m(2)). METHODS: Total body potassium was assessed in a whole body counter, and compared to 50 kHz monofrequency BIA and multifrequency bioelectrical impedance spectroscopy. Six different prediction equations for ICW from BIA data were applied. Methods were compared by the Bland-Altman method. RESULTS: BIA-derived ICW estimates explained 58% to 73% of the observed variance in ICW (TBK), but limits of confidence were wide (-16.6 to +18.2% for the best method). BIA overestimated low ICW (TBK) and underestimated high ICW (TBK) when normalized for weight or height. Mono- and multifrequency BIA were not different in precision but population-specific equations tended to narrower confidence limits. CONCLUSION: BIA is an unreliable method to estimate ICW in this population, in contrast to the better established estimation of total body water and extracellular water. Potassium depletion in severe malnutrition may contribute to this finding but a major part of the residual between methods remains unexplained.     

Total body water and total body potassium in anorexia nervosa

In the ill hospitalized patient with clinically relevant malnutrition, there is a measurable decrease in the ratio of the total body potassium to total body water (TBK/TBW) and a detectable increase in the ratio of total exchangeable sodium to total exchangeable potassium (Nae/Ke). To evaluate body composition analyses in anorexia nervosa patients with chronic uncomplicated semistarvation, TBK and TBW were measured by whole body K40 counting and deuterium oxide dilution in 10 females with stable anorexia nervosa and 10 age-matched female controls. The ratio of TBK/TBW was significantly (p less than 0.05) higher in anorexia nervosa patients than controls. The close inverse correlation found in published studies between TBK/TBW and Nae/Ke together with our results suggest that in anorexia nervosa, Nae/Ke may be low or normal. A decreased TBK/TBW is not a good indicator of malnutrition in the anorexia nervosa patient. The use of a decreased TBK/TBW ratio or an elevated Nae/Ke ratio as a definition of malnutrition may result in inappropriate nutritional management in the patient with severe nonstressed chronic semistarvation.     

Validation of bioimpedance analysis as a measure of change in body cell mass as estimated by whole-body counting of potassium in adults

BACKGROUND: The body cell mass (BCM) is an important measure of macronutrient status, but measurements are difficult to obtain outside of sophisticated research laboratories. Bioimpedance analysis (BIA) is a simple technique that holds promise as a means of estimating body composition. The purpose of this study was to evaluate the ability of BIA to estimate changes in BCM as measured by whole body counting of 40K (TBK). METHODS: Paired studies of BCM, including both TBK and BIA, were compared in 87 human immunodeficiency virus-positive subjects and in 62 healthy, weight-stable control adults. Potential errors in the predictions were examined. RESULTS: BCM change by TBK and BIA correlated closely (r = .755). After accounting for errors related to repeat measures of TBK, the correlation coefficient was .784, with a standard error of the estimate of 1.24 kg. The differences between predicted and measured BCM change were consistent with a normal distribution. However, there was a systematic error in prediction, with BIA underpredicting the magnitudes of both gains and losses in BCM by TBK. CONCLUSIONS: BIA is a useful surrogate for measuring changes in BCM in clinical circumstances. Because TBK assesses only intracellular potassium, whereas BIA reflects all intracellular cations, the underprediction of BCM change by BIA compared with TBK could be related to changes in intracellular potassium concentration as a result of malnutrition or its treatment.     

Intracellular potassium and membrane potential in rat muscles during malnutrition and subsequent refeeding

Nutrition alters total body potassium (TBK) and muscle potassium but little is known about in vivo intracellular K+. We measured free intracellular potassium-ion activity (aKi+), membrane potential (Em), and total potassium (Kt) and calculated intracellular potassium concentration [K+]i in predominantly slow- (soleus) and fast- (extensor digitorum longus) twitch muscles in rats undergoing underfeeding and subsequent refeeding. After underfeeding, aKi+ and Em decreased (P less than 0.025 and P less than 0.006, respectively) only in soleus muscle with restoration after refeeding, whereas [K+]i decreased in both muscles (P less than 0.005) and remained low after refeeding. K+ supplementation did not significantly change these indices or the ratio of free to total intracellular potassium (gamma Ki+). The data show that aKi+ behaves differently from [K+]i during malnutrition and that changes in aKi+ occur especially in slow-twitch fibers, suggesting that previously observed changes in TBK and muscle function are the result of fundamental alterations in muscle-cell energetics and membrane functions, not just mass.     

Total body potassium and serum potassium among eating disorder patients

Objective: The purpose of the study was to determine body composition, including total body potassium (TBK⁺), serum potassium, and lean body mass (LBM), in anorexia nervosa. Method: TBK⁺ measurements, serum potassium levels, and anthropometric measurements were obtained from four anorectic patients in the first week after their hospital admission. All four patients had normal serum potassium levels but three of the four had significant depletion of total body potassium. Two methods of calculating LBM, based on TBK⁺ measures or anthropometric assessment, produced different results. Results: TBK⁺ may be depleted even when serum potassium levels are normal. It was also concluded that the two methods of calculating LBM were inaccurate. Discussion: Patients may be at risk for cardiac arrhythmias and other physiological abnormalities even when serum potassium is normal since TBK⁺ may be low. The need for comprehensive assessment of body composition based on four compartment models is discussed. © 1995 by John Wiley & Sons, Inc.     

The effect of acute alcohol withdrawal on the serum potassium and total body potassium in heavy drinkers

In a group of 20 patients with heavy alcohol intake a relation was found between withdrawal symptoms and fall in serum potassium. Total body potassium (TBK) was measured in all subjects and was lower in the group of subjects who displayed symptoms than in the group who did not. The subgroup of the four most severe reactors had a mean TBK value significantly less than the 'non-reactor' group. The minimum serum potassium levels observed for all subjects in the four day period following alcohol withdrawal correlated with their TBK values. We suggest that the mechanism for the serum potassium fall might be overactivity of the Na-K pump caused by ethanol consumption. There was also an association between withdrawal reaction and abnormal liver function and a transient rise in serum phosphate in the more severely reacting subjects.