होम Journal of Bone and Mineral Research Anion effects on calcium metabolism

Anion effects on calcium metabolism

यह पुस्तक आपको कितनी अच्छी लगी?
फ़ाइल की गुणवत्ता क्या है?
पुस्तक की गुणवत्ता का मूल्यांकन करने के लिए यह पुस्तक डाउनलोड करें
डाउनलोड की गई फ़ाइलों की गुणवत्ता क्या है?
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आप पुस्तक समीक्षा लिख सकते हैं और अपना अनुभव साझा कर सकते हैं. पढ़ूी हुई पुस्तकों के बारे में आपकी राय जानने में अन्य पाठकों को दिलचस्पी होगी. भले ही आपको किताब पसंद हो या न हो, अगर आप इसके बारे में ईमानदारी से और विस्तार से बताएँगे, तो लोग अपने लिए नई रुचिकर पुस्तकें खोज पाएँगे.
Volume 11, Number 12,1996
Blackwell Science, Inc.
© 1996 American Society for Bone and Mineral Research

Letter to the Editor
Anion Effects on Calcium Metabolism
To the Editor:


Dr. Barzel's postulate "that the nature of the accompanying anion is the major determining factor of the effects of
sodium salts and calcium salts" is a sentiment we share, but
with the following caveat concerning calcium. Given the
nature of the typical Western diet, calcium accompanied by
a metabolizable anion such as carbonate is an efficacious
form of calcium for promoting calcium retention, but in
persons already consuming an alkaline diet such as vegetarians, it is not known whether more alkalinity is necessary
or even desirable. Further, excess metabolizable anion
intake, such as with sodium bicarbonate or calcium carbonate, is associated with development of the milk-alkali
syndrome.t!' which is becoming a more frequent
occurrence. (2)

1. Orwoll ES 1982 The milk-alkali syndrome: Current concepts.
Annals Intern Med 97:242-248.
2. Beall DP, Scofield RH 1995 Milk-alkali syndrome associated with

calcium carbonate consumption: Report of 7 patientswith parathyroid hormone levels and an estimate of prevalence among patients hospitalized with hypercalcemia. Medicine 74:89-96.
Susan J. Whiting, Ph.D.
Professor of Nutrition
University of Saskatchewan
Saskatoon, Canada
Linda K Massey, Ph.D., R.D.
Professor of Nutrition
Washington State University
Spokane, WA, U.S.A.

Anion Effects on Calcium Metabolism: A Caveat
To the Editor:
In their illuminating review of the effect of salt on calcium metabolism, Massey and Whiting briefly discuss the
potential role of the anion, chloride, in the causation of
salt-induced hypercalciuria.P? I believe that the effect of
sodium chloride on calcium metabolism is a special aspect
of the more general effect of acid-base imbalance on
boneP) The chloride in dietary salt presents the organism
with a load of unmetabolizable acid that must be ex; creted.
This viewpoint is supported by a few studies that directly
compare sodium chloride with metabolizable alkali saltssodium acetate and sodium bicarbonate. Berkelhammer et
alP) studied hypercalciuria that had been a common problem in total parenteral nutrition (TPN). By replacing
equimolar amounts of chloride with acetate in TPN, they
caused a significant reduction in renal acid excretion, enhanced tubular calcium reabsorption, and markedly reduced the hypercalciuria. In fact, the use of acetate allowed
their subjects to revert to positive or neutral calcium
Similarly, calciuria was reduced when sodium chloride
was replaced with sodium bicarbonate in a study performed

nearly 30 years ago in a small group of obese women who
were fasted under observation on a metabolic ward. The
patients were given 88 mEq NaCl daily for 4V2 weeks. The
NaCl was replaced in the last week of fasting by 88 mEq of
NaHC0 3 • Metabolic acidosis was present during the NaCI
period and partially corrected by NaHC0 3 administration.
Calciuria reached a mean of 190 mg/day late in the NaCI
period and fell to 99 mg/day when NaCl was replaced with
NaHC03 · (4 )
From this very limited repertoire of studies, and the data
cited by Massey and Whiting, one may reach a tentative
conclusion that in table salt the role the cation is playing in
calcium metabolism may be determined by the "company it
keeps." It is my postulate that the nature of the accompanying anion is the major determining factor in the effects of
sodium salts and of calcium salts on calcium metabolism.


Uriel S. Barzel, M.D.
Professor of Medicine
Montefiore Medical Center
and Albert Einstein College of Medicine
Bronx, NY, U.S.A.