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Effects of Alternate and Simultaneous Administrations of Calcium and Phosphorus on Calcium Metabolism in Children Receiving Total Parenteral Nutrition

Department of Pediatrics, Osaka University Medical School, Fukushima-ku, Osaka, Japan

Osamu Nose, M.D.

Department of Pediatrics, Osaka University Medical School, Fukushima-ku, Osaka, Japan

Yoshiki Seino, M.D.

Department of Pediatrics, Osaka University Medical School, Fukushima-ku, Osaka, Japan

Tokuzo Harada, M.D.

Department of Pediatrics, Osaka University Medical School, Fukushima-ku, Osaka, Japan

Shinobu Kanaya, M.D.

Department of Pediatrics, Osaka University Medical School, Fukushima-ku, Osaka, Japan

Hyakuji Yabuuchi, M.D.

Department of Pediatric Surgery, Osaka University Medical School, Fukushima-ku, Osaka, Japan

Takeo Itakura, M.D.

Department of Pediatric Surgery, Osaka University Medical School, Fukushima-ku, Osaka, Japan

Yoji Takagi, M.D.

Department of Pediatric Surgery, Osaka University Medical School, Fukushima-ku, Osaka, Japan

Akira Okada, M.D.

Department of Pediatrics, Osaka University Medical School, Fukushima-ku, Osaka, Japan

The effects of alternate and simultaneous administrations of calcium (Ca) and phosphorus (P) on Ca metabolism in children receiving total parenteral nutrition (TPN) were examined. Eight children, aged 2 to 36 months, were studied. The following three solutions were administered: solution 1 contains Ca (533 mg/liter); solution 2 contains P (413 mg/liter); and solution 3 contains Ca (267 mg/liter) and P (207 mg/liter). Solutions 1 and 2 were administered alternately for 24-hr periods. (Results) I. During administration of solution 1, significant hypophosphatemia (4.39 ± 0.26 mg/dl) and hypercalcemia (9.96 ± 0.15 mg/dl) were observed and, conversly, during administration of solution 2, significant hypocalcemia (8.36 ± 0.18 mg/dl) and hyperphosphatemia (6.16 ± 0.27 mg/ dl) were observed. During administration of solution 3, the serum levels of both minerals were maintained within the normal ranges (Ca 9.46 ± 0.12 mg/dl, P 5.65 ± 0.21 mg/dl). II. The urinary excretion of cyclic AMP was significantly lower during administration of solution 1 (6.67 ± 0.45 nmol/mg creatinine (Cr)) as compared with solution 3 (7.50 ± 0.61 nmol/ mg of Cr). On the other hand, the excretion was significantly higher during administration of solution 2 (11.55 ± 1.58 nmol/ mg of Cr) as compared with solution 3, indicating the existence of secondary hyperparathyroidism. III. The Ca and Pretention rates were significantly higher with solution 3 (Ca 79.0 ± 5.5%, P 73.2 ± 7.2% of the intake) than with solutions 1 and 2 alternately (Ca 62.7 ± 4.5%, P 49.2 ± 9.3%). (Conclusions) Simultaneous administrations of Ca and P are preferable to their alternate administrations for Ca metabolism in children receiving TPN. (Journal of Parenteral and Enteral Nutrition 10: 513-516,1986)

Journal of Parenteral and Enteral Nutrition, Vol. 10, No. 5, 513-516 (1986)
DOI: 10.1177/0148607186010005513


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