Acetate and hypercalciuria during total parenteral nutrition

• Published in: The American journal of clinical nutrition Vol. 48; no. 6; pp. 1482 - 1489
• Main Authors: Berkelhammer, CH, Wood, RJ, Sitrin, MD
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Elsevier Inc 01-12-1988; American Society for Clinical Nutrition
• Subjects: ACETATE; Acetates - administration & dosage; Acetates - pharmacology; ACETATOS; Acetic Acid; Acid-Base Equilibrium - drug effects; Adult; ALIMENTACION PARENTERAL; ALIMENTATION ENTERALE; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bicarbonates - urine; Biological and medical sciences; CALCIO; Calcitriol - blood; CALCIUM; Calcium - urine; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Female; FEMME; HOMBRES; HOMME; HORMONAS; HORMONE; Humans; Intensive care medicine; Male; Medical sciences; MUJERES; Parathyroid Hormone - blood; Parenteral Nutrition, Total; TRASTORNOS METABOLICOS; TROUBLE DU METABOLISME; VITAMINA D; VITAMINE D; Human; Calcium; Acetate; Metabolism; Resuscitation; Parenteral administration; Feeding
• ISSN: 0002-9165; 1938-3207
• DOI: 10.1093/ajcn/48.6.1482

Hypercalciuria and negative calcium balance are complications of total parenteral nutrition (TPN). Because metabolism of the TPN formula generates an acid load that can induce hypercalciuria, we evaluated the effect of supplementing the formula with acetate. In a randomized crossover study six patients on continuous and six on cyclic TPN received no added acetate or 160 mmol acetate/d replacing 160 mmol chloride/d for 3 d each. Blood and urine measurements were obtained on day 3 of each formula. Acetate, which is metabolized to bicarbonate, increased blood pH and decreased renal acid excretion. Urinary Ca decreased in every patient from 422 +/- 63 to 240 +/- 46 mg/d (10.5 +/- 1.6 to 6.0 +/- 1.4 mmol/d) and from 468 +/- 68 to 285 +/- 54 mg/d (11.7 +/- 1.7 to 7.1 +/- 1.3 mmol/d) during continuous and cyclic TPN, respectively. Filtered Ca load decreased slightly whereas renal tubular Ca reabsorption increased significantly with acetate. Serum parathyroid hormone, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and urinary cyclic AMP were not different.