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June 1981, Vol 135, No. 6 >
Article | June 1981

Gluconate Calcium Therapy and Neonatal Hypercalciuria FREE

Martin A. Goldsmith, MD; Satinder S. Bhatia; William P. Kanto, MD; Michael H. Kutner, PhD; Daniel Rudman, MD
[+] Author Affiliations

Reprint requests to Department of Medicine, Clinical Research Facility, Emory University Hospital, 1364 Clifton Rd, NE GG23, Atlanta, GA 30322 (Dr Rudman).


Am J Dis Child. 1981;135(6):538-543. doi:10.1001/archpedi.1981.02130300038014.
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• Nephrolithiasis was present in a 2-month-old premature infant with bronchopulmonary dysplasia who had been receiving furosemide and intravenous (IV) gluconate calcium therapy. This infant was found to be hypercalciuric. Furosemide therapy is known to increase calcium excretion. In the present study, we examined sick infants who were receiving gluconate calcium without furosemide to evaluate the effect of gluconate calcium therapy on urinary calcium excretion. The sick infants receiving gluconate calcium had higher values of urinary calcium than did the well infants taking regular formula feedings. Moreover, the calciuria appeared to increase progressively with continued gluconate calcium therapy. It appears that prolonged use of either furosemide or IV gluconate calcium leads to hypercalciuria, which, in turn, may predispose the premature infant to nephrolithiasis.

(Am J Dis Child 1981;135:538-543)

REFERENCES

1 +
Hufnagle K, Penn D, Williams P:  Renal calcifications: A complication of long-term high-dose furosemide , abstracted. J Pediatr 1978;; 93:314-315.
2 +
Coe FL, Parks JH, Moore ES:  Familial idiopathic hypercalciuria . N Engl J Med 1979;;300:337-340.
3 +
Alexander RL:  Evaluation of an automatic calcium titrator . Clin Chem 1971;;17:1171-1175.
4 +
Oser BL (ed): Hawk's Physiological Chemistry . New York, McGraw-Hill Book Co, 1965;, pp 1233-1238.
5 +
Larsen K:  Creatinine assay by a reaction-kinetic principle . Clin Chim Acta 1972;;41:209-217.
6 +
Stein WH, Moore S:  The free amino acids of human blood plasma . J Biol Chem 1954;;211:915-926.
7 +
Briscoe AM, Ragan C:  Diurnal variations in calcium and magnesium excretion in man . Metabolism 1966;;15:1002-1010.
8 +
Massry SG, Coburn JW:  The hormonal and non-hormonal control of renal excretion of calcium and magnesium . Nephron 1973;;10:66-112.
9 +
Ghazali S, Barratt TM:  Urinary excretion of calcium and magnesium in children . Arch Dis Child 1974;;49:97-101.
10 +
Nordin BEC:  Assessment of calcium excretion from the urinary calcium/creatinine ratio . Lancet 1959;;2:368-371.
11 +
Suki WN, Yiumm JJ, Von Minden M, et al:  Acute treatment of hypercalcemia with furosemide . N Engl J Med 1970;;283:836-840.
12 +
Weiss Y, Ackerman C, Shmilovitz L:  Localized necrosis of scalp in neonates due to calcium gluconate infusions: A cautionary note . Pediatrics 1975;;56:1084-1086.
13 +
Barnes LA, Morrow G III, Silverio J, et al:  Calcium and fat absorption from infant formulas with different fat blends . Pediatrics 1974;;54:217-221.
14 +
Howard PJ, Wilde WS, Malvin RL:  Localization of renal calcium transport: Effect of calcium loads and of gluconate anion on water, sodium, and potassium . Am J Physiol 1959;; 197:337-341.
15 +
Bernstein D, Kleeman CR, Cutler RE, et al:  Comparison of renal clearance of calcium during infusions of calcium chloride and calcium gluconate . Proc Soc Exp Biol Med 1962;;110:671-673.
16 +
Crawford MA, Loughridge L, Milne MD, et al:  Organic acid excretion after calcium gluconate infusions . J Clin Pathol 1959;;12:524-529.
17 +
Epstein FH:  Calcium and the kidney . Am J Med 1968;;45:700-714.
18 +
Holliday MA, Winters RW, Welt LG, et al:  The renal lesions of electrolyte imbalance: II . J Exp Med 1959;;110:161-168.
19 +
Holliday MA, Bright NH, Schulz D, et al:  The renal lesions of electrolyte imbalance: III . J Exp Med 1961;;113:971-980.
20 +
Levine DZ, Roy D, Tolnai G, et al:  Chloride depletion and nephrocalcinosis . Am J Physiol 1974;;227:878-883.
21 +
Tsang RC, Chen I-Wen, Friedman MA, et al:  Neonatal parathyroid function: Role of gestational age and postnatal age . J Pediatr 1973;; 83:728-738.
22 +
David L, Anast CS:  Calcium metabolism in newborn infants: The interrelationship of parathyroid function and calcium, magnesium, and phosphorus metabolism in normal, 'sick,' and hypocalcemic newborns . J Clin Invest 54:287-296, 1974;.
23 +
Stern L:  Disturbances in glucose, calcium, and magnesium homeostasis , in Avery G (ed): Neonatology . Philadelphia, JB Lippincott Co, 1975;, pp 423-436.
24 +
Ganote CE, Philipsborn DS, Chen E, et al:  Acute calcium nephrotoxicity . Arch Pathol 1975;;99:650-657.
25 +
Bellet S: Essentials of Cardiac Arrhythmias . Philadelphia, WB Saunders Co, 1972;, pp 312-319.
26 +
Rosenthal A, Dick M:  Arrhythmias associated with systemic disease , in Roberts NK, Gelband H (eds): Cardiac Arrhythmias in the Neonate Infant and Child . New York, Appleton-Century-Crofts, 1977;, pp 317-372.
27 +
Drach GW, Smith MJV, Boyce WH:  Medical therapy of renal calculi . J Urol 1970;;104:635-639.
28 +
Ghazali S, Barratt TM, Williams DI:  Childhood urolithiasis in Britain . Arch Dis Child 1973;;48:291-295.
29 +
Paunier L, Borgeaud M, Wyss M:  Urinary excretion of magnesium and calcium in normal children . Helv Paediatr Acta 1970;;25:577-584.
30 +
Dean RFA, McCance RA:  Phosphate clearances in infants and adults . J Physiol 1948;; 107:182-186.
31 +
Richmond JB, Kravitz H, Segar W, et al:  Renal clearance of endogenous phosphate in infants and children . Proc Soc Exp Biol Med 1951;; 77:83-86.
32 +
Gibbs D, Watts RWE:  The variation of urinary oxalate excretion with age . J Lab Clin Med 1969;;73:901-908.
33 +
McCance RA, Von Finck MA:  The titratable acidity, pH, ammonia and phosphates in the urines of very young infants . Arch Dis Child 1947;;22:200-209.

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References

1 +
Hufnagle K, Penn D, Williams P:  Renal calcifications: A complication of long-term high-dose furosemide , abstracted. J Pediatr 1978;; 93:314-315.
2 +
Coe FL, Parks JH, Moore ES:  Familial idiopathic hypercalciuria . N Engl J Med 1979;;300:337-340.
3 +
Alexander RL:  Evaluation of an automatic calcium titrator . Clin Chem 1971;;17:1171-1175.
4 +
Oser BL (ed): Hawk's Physiological Chemistry . New York, McGraw-Hill Book Co, 1965;, pp 1233-1238.
5 +
Larsen K:  Creatinine assay by a reaction-kinetic principle . Clin Chim Acta 1972;;41:209-217.
6 +
Stein WH, Moore S:  The free amino acids of human blood plasma . J Biol Chem 1954;;211:915-926.
7 +
Briscoe AM, Ragan C:  Diurnal variations in calcium and magnesium excretion in man . Metabolism 1966;;15:1002-1010.
8 +
Massry SG, Coburn JW:  The hormonal and non-hormonal control of renal excretion of calcium and magnesium . Nephron 1973;;10:66-112.
9 +
Ghazali S, Barratt TM:  Urinary excretion of calcium and magnesium in children . Arch Dis Child 1974;;49:97-101.
10 +
Nordin BEC:  Assessment of calcium excretion from the urinary calcium/creatinine ratio . Lancet 1959;;2:368-371.
11 +
Suki WN, Yiumm JJ, Von Minden M, et al:  Acute treatment of hypercalcemia with furosemide . N Engl J Med 1970;;283:836-840.
12 +
Weiss Y, Ackerman C, Shmilovitz L:  Localized necrosis of scalp in neonates due to calcium gluconate infusions: A cautionary note . Pediatrics 1975;;56:1084-1086.
13 +
Barnes LA, Morrow G III, Silverio J, et al:  Calcium and fat absorption from infant formulas with different fat blends . Pediatrics 1974;;54:217-221.
14 +
Howard PJ, Wilde WS, Malvin RL:  Localization of renal calcium transport: Effect of calcium loads and of gluconate anion on water, sodium, and potassium . Am J Physiol 1959;; 197:337-341.
15 +
Bernstein D, Kleeman CR, Cutler RE, et al:  Comparison of renal clearance of calcium during infusions of calcium chloride and calcium gluconate . Proc Soc Exp Biol Med 1962;;110:671-673.
16 +
Crawford MA, Loughridge L, Milne MD, et al:  Organic acid excretion after calcium gluconate infusions . J Clin Pathol 1959;;12:524-529.
17 +
Epstein FH:  Calcium and the kidney . Am J Med 1968;;45:700-714.
18 +
Holliday MA, Winters RW, Welt LG, et al:  The renal lesions of electrolyte imbalance: II . J Exp Med 1959;;110:161-168.
19 +
Holliday MA, Bright NH, Schulz D, et al:  The renal lesions of electrolyte imbalance: III . J Exp Med 1961;;113:971-980.
20 +
Levine DZ, Roy D, Tolnai G, et al:  Chloride depletion and nephrocalcinosis . Am J Physiol 1974;;227:878-883.
21 +
Tsang RC, Chen I-Wen, Friedman MA, et al:  Neonatal parathyroid function: Role of gestational age and postnatal age . J Pediatr 1973;; 83:728-738.
22 +
David L, Anast CS:  Calcium metabolism in newborn infants: The interrelationship of parathyroid function and calcium, magnesium, and phosphorus metabolism in normal, 'sick,' and hypocalcemic newborns . J Clin Invest 54:287-296, 1974;.
23 +
Stern L:  Disturbances in glucose, calcium, and magnesium homeostasis , in Avery G (ed): Neonatology . Philadelphia, JB Lippincott Co, 1975;, pp 423-436.
24 +
Ganote CE, Philipsborn DS, Chen E, et al:  Acute calcium nephrotoxicity . Arch Pathol 1975;;99:650-657.
25 +
Bellet S: Essentials of Cardiac Arrhythmias . Philadelphia, WB Saunders Co, 1972;, pp 312-319.
26 +
Rosenthal A, Dick M:  Arrhythmias associated with systemic disease , in Roberts NK, Gelband H (eds): Cardiac Arrhythmias in the Neonate Infant and Child . New York, Appleton-Century-Crofts, 1977;, pp 317-372.
27 +
Drach GW, Smith MJV, Boyce WH:  Medical therapy of renal calculi . J Urol 1970;;104:635-639.
28 +
Ghazali S, Barratt TM, Williams DI:  Childhood urolithiasis in Britain . Arch Dis Child 1973;;48:291-295.
29 +
Paunier L, Borgeaud M, Wyss M:  Urinary excretion of magnesium and calcium in normal children . Helv Paediatr Acta 1970;;25:577-584.
30 +
Dean RFA, McCance RA:  Phosphate clearances in infants and adults . J Physiol 1948;; 107:182-186.
31 +
Richmond JB, Kravitz H, Segar W, et al:  Renal clearance of endogenous phosphate in infants and children . Proc Soc Exp Biol Med 1951;; 77:83-86.
32 +
Gibbs D, Watts RWE:  The variation of urinary oxalate excretion with age . J Lab Clin Med 1969;;73:901-908.
33 +
McCance RA, Von Finck MA:  The titratable acidity, pH, ammonia and phosphates in the urines of very young infants . Arch Dis Child 1947;;22:200-209.

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