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CALCIUM AND PHOSPHORUS METABOLISM IN A CASE OF NONTROPICAL SPRUE WITH ASSOCIATED TETANY

CALCIUM AND PHOSPHORUS METABOLISM IN A CASE OF NONTROPICAL SPRUE WITH ASSOCIATED TETANY Abstract During the course of investigations of various disorders of calcium and phosphorus metabolism, we had the opportunity of studying a patient with nontropical sprue complicated by tetany. The association of sprue with tetany is probably not so common as was once supposed. In reviewing the literature, one finds that a number of such cases have been reported. In some of these reports no mention is made of the values of the serum calcium or serum phosphorus. A search of the literature failed to reveal any report bearing on the total calcium and phosphorus metabolism in this disease syndrome. Analysis of the data reported in this case shows why the resultant tetany was secondary to the long-standing diarrhea and not related to parathyroid deficiency. REPORT OF CASE HistoryA man, aged 39, married, a Jewish physician, was admitted to the metabolism ward of the Massachusetts General Hospital References 1. McClure, C. W.; Wetmore, A. S., and Reynolds, L.: New Methods for Estimating Enzymatic Activities of Duodenal Contents of Normal Man , Arch. Int. Med. 27:706 ( (June) ) 1921.Crossref 2. Albright, F., and Bauer, W.: The Action of Sodium Chloride, Ammonium Chloride, and Sodium Bicarbonate on the Total Acid-Base Balance of a Case of Chronic Nephritis with Edema , J. Clin. Investigation 7:465 ( (Aug.) ) 1929.Crossref 3. McClure, Wetmore and Reynolds (footnote 1). 4. Ashford, B. K.: The Anemias of Sprue: Their Nature and Treatment , Arch. Int. Med. 45:647 ( (May) ) 1930.Crossref 5. Bauer, W., and Aub, J. C.: Studies of Inorganic Salt Metabolism: I. The Ward Routine and Methods , J. Am. Dietet. A. 3:106 ( (Sept.) ) 1927. 6. Fiske, C. H.: Method for Calcium Determination (unpublished). 7. Fiske, C. H., and Subbarow, Y.: The Colorimetric Determination of Phosphorus , J. Biol. Chem. 66:375 ( (Dec.) ) 1925. 8. Fiske, C. H.: A Method for the Estimation of Total Base in Urine , J. Biol. Chem. 51:55 ( (March) ) 1922. 9. Hawk, P. B., and Bergeim, O.: Practical Physiological Chemistry , Philadelphia, P. Blakiston's Son and Company, 1926, pp. 711 and 713. 10. Ashford, B. K., and Hernández, L. G.: Blood-Serum Calcium in Sprue and Other Pathologic States in the Tropics , Am. J. M. Sc. 171:575 ( (April) ) 1926.Crossref 11. Salvesen, H. A., and Linder, G. C.: Observations on the Inorganic Bases and Phosphates in Relation to the Protein of Blood and Other Body Fluids in Bright's Disease and in Heart Failure , J. Biol. Chem. 58:617, 1923. 12. Peters, J. P. and Eiserson, L.: The Influence of Protein and Inorganic Phosphorus on Serum Calcium , J. Biol. Chem. 84:155 ( (Oct.) ) 1929. 13. Albright and Bauer (footnote 2). 14. Hartman, A. F.: Chemical Changes Occurring in the Body as the Result of Certain Diseases , Am. J. Dis. Child. 35:557 ( (April) ) 1928.Crossref 15. Salvesen and Linder (footnote 10, first reference). 16. Albright, F.; Bauer, W.; Ropes, M., and Aub, J. C.: Studies of Calcium and Phosphorus Metabolism: IV. The Effect of the Parathyroid Hormone , J. Clin. Investigation 7:139 ( (April) ) 1929.Crossref 17. Cantlie, J.: Some Recent Observations on Sprue , Brit. M. J. 2:196 ( (Nov. 15) ) 1913.Crossref 18. Harrison, W. S., in discussion on Cantlie, Brit. M. J. 2:1296, 1913. 19. Bassett-Smith, P. W.: A Case of Sprue Associated with Tetany , Lancet 1:178 ( (Feb. 1) ) 1919.Crossref 20. Bovaird, D.: A Study of Tropical Sprue, or Psilosis , J. A. M. A. 77:753 ( (Sept. 3) ) 1921.Crossref 21. Barach, A. L., and Murray, H. A., Jr.: Tetany in a Case of Sprue , J. A. M. A. 74:786 ( (March 20) ) 1920.Crossref 22. Blumgart, H. L.: Three Fatal Adult Cases of Malabsorption of Fat: With Emaciation and Anemia, and in Two Acidosis and Tetany , Arch. Int. Med. 32:113 ( (July) ) 1923.Crossref 23. Scott, H. H.: The Nature and Treatment of Sprue , Brit. M. J. 2:1135 ( (Dec. 15) ) 1923.Crossref 24. Jamieson, T. H.: The Treatment of Sprue , Brit. M. J. 2:462 ( (Sept. 15) ) 1923. 25. Thaysen, T. E. H.: Ueber Fettdiarrhōen: III. Die Klinik der nichttropischen Sprue , Acta med. Scandinav. 64:352 ( (Sept.) ) 1926.Crossref 26. Baumgartner, E. A., and Smith, G. D.: Pernicious Anemia and Tropical Sprue , Arch. Int. Med. 40:203 ( (Aug.) ) 1927.Crossref 27. Holmes, W. H., and Starr, P.: A Nutritional Disturbance in Adults Resembling Celiac Disease and Sprue: Emaciation, Anemia, Tetany, Chronic Diarrhea and Malabsorption of Fat , J. A. M. A. 92:975 ( (March 23) ) 1929.Crossref 28. Maxwell, J. P.: Osteomalacia in China , J. Obst. & Gynæc. Brit. Emp. 32:1, 1925. 29. Hess, A. F., and Lewis, J. M.: Clinical Experience with Irradiated Ergosterol , J. A. M. A. 91:783 ( (Sept. 15) ) 1928. 30. Hess, A. F.: Rickets Including Osteomalacia and Tetany , Philadelphia, Lea & Febiger, 1929. 31. Steenbock H., and Nelson, M. T.: Fat-Soluble Vitamins: XIX. Induction of Calcifying Properties in a Rickets-Producing Ration by Radiant Energy , J. Biol. Chem. 62:209, 1924. 32. Hess and Lewis (footnote 24, second reference). 33. Karelitz, S., and Shohl, A. T.: Rickets in Rats: II. The Effect of Phosphate Added to the Diet of Ricketic Rats , J. Biol. Chem. 73:665 ( (June) ) 1927. 34. Orr, W. J.; Holt, L. E., Jr.; Wilkins, L., and Boone, F. H.: The Relation of Calcium and Phosphorus in the Diet to the Absorption of These Elements from the Intestine , Am. J. Dis. Child. 28:574 ( (Nov.) ) 1924. 35. Linder, G. C., and Harris, C. F.: Calcium and Phosphorus Metabolism in Chronic Diarrhea with Tetany , Quart. J. Med. 23:195 ( (Jan.) ) 1930. 36. Parsons, L. G.: Bone Changes in Renal and Celiac Infantilism , Arch. Dis. Child. 2:1 ( (Feb.) ) and 198 (Aug.) 1927. 37. Tammann, H.: Ueber die Beeinflüssung der porotischen Osteomalazie nach Gallenfistel durch das D-Vitamin , Beitr. z. klin. Chir. 142:83, 1928. 38. Dieterich, H.: Die porotische Malazie nach Gallenfistelin , Beitr. z. klin. Chir. 134:530, 1925. 39. Seifert, E.: Zur Frage der porotischen Malazie nach Gallenfisteln , Beitr. z. klin. Chir. 136:496, 1926. 40. Düttmann, G.: Die Veränderung des Säure-Basengleichgewichtes nach Gallenfisteln und ihre Bedeutung bei der Entstehung der sogenannten porotischen Malazie , Beitr. z. klin. Chir. 139:720, 1927. 41. Telfer, S. V.: Studies in Calcium and Phosphorus Metabolism: IV. The Influence of Free Fatty Acids in the Intestine on the Absorption and Excretion of the Mineral Elements , Quart. J. Med. 20:1, 1926 42. V. Infantile Rickets; The Excretion and Absorption of the Mineral Elements and the Influence of Fats in the Diet on Mineral Absorption , Quart. J. Med. 192620, p. 7. 43. Sokhey, S. S., and Malandkr, M. A.: Pancreatic Function in Sprue , Indian J. M. Research , 25:921 ( (April) ) 1928. 44. Irving, L., and Ferguson, J.: The Influence of Acidity in the Intestine Upon the Absorption of Calcium Salts by the Blood , Proc. Soc. Exper. Biol. & Med. 22:527 ( (May) ) 1925. 45. Babbott, F. L., Jr.; Johnston, J. A., and Haskins, C. H.: Gastric Acidity in Infantile Tetany , Am. J. Dis. Child. 26:486 ( (Nov.) ) 1923. 46. Porter, W. B., and Rucker, J. E.: The Treatment of Non-Tropical Sprue with Liver Extract , Am. J. M. Sc. 179:310 ( (March) ) 1930. 47. Elders, C.: Behandlung der Tropischen Sprue , Med. Welt 3:167, 1929. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

CALCIUM AND PHOSPHORUS METABOLISM IN A CASE OF NONTROPICAL SPRUE WITH ASSOCIATED TETANY

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Publisher
American Medical Association
Copyright
Copyright © 1931 American Medical Association. All Rights Reserved.
ISSN
0730-188X
DOI
10.1001/archinte.1931.00150030166013
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Abstract

Abstract During the course of investigations of various disorders of calcium and phosphorus metabolism, we had the opportunity of studying a patient with nontropical sprue complicated by tetany. The association of sprue with tetany is probably not so common as was once supposed. In reviewing the literature, one finds that a number of such cases have been reported. In some of these reports no mention is made of the values of the serum calcium or serum phosphorus. A search of the literature failed to reveal any report bearing on the total calcium and phosphorus metabolism in this disease syndrome. Analysis of the data reported in this case shows why the resultant tetany was secondary to the long-standing diarrhea and not related to parathyroid deficiency. REPORT OF CASE HistoryA man, aged 39, married, a Jewish physician, was admitted to the metabolism ward of the Massachusetts General Hospital References 1. McClure, C. W.; Wetmore, A. S., and Reynolds, L.: New Methods for Estimating Enzymatic Activities of Duodenal Contents of Normal Man , Arch. Int. Med. 27:706 ( (June) ) 1921.Crossref 2. Albright, F., and Bauer, W.: The Action of Sodium Chloride, Ammonium Chloride, and Sodium Bicarbonate on the Total Acid-Base Balance of a Case of Chronic Nephritis with Edema , J. Clin. Investigation 7:465 ( (Aug.) ) 1929.Crossref 3. McClure, Wetmore and Reynolds (footnote 1). 4. Ashford, B. K.: The Anemias of Sprue: Their Nature and Treatment , Arch. Int. Med. 45:647 ( (May) ) 1930.Crossref 5. Bauer, W., and Aub, J. C.: Studies of Inorganic Salt Metabolism: I. The Ward Routine and Methods , J. Am. Dietet. A. 3:106 ( (Sept.) ) 1927. 6. Fiske, C. H.: Method for Calcium Determination (unpublished). 7. Fiske, C. H., and Subbarow, Y.: The Colorimetric Determination of Phosphorus , J. Biol. Chem. 66:375 ( (Dec.) ) 1925. 8. Fiske, C. H.: A Method for the Estimation of Total Base in Urine , J. Biol. Chem. 51:55 ( (March) ) 1922. 9. Hawk, P. B., and Bergeim, O.: Practical Physiological Chemistry , Philadelphia, P. Blakiston's Son and Company, 1926, pp. 711 and 713. 10. Ashford, B. K., and Hernández, L. G.: Blood-Serum Calcium in Sprue and Other Pathologic States in the Tropics , Am. J. M. Sc. 171:575 ( (April) ) 1926.Crossref 11. Salvesen, H. A., and Linder, G. C.: Observations on the Inorganic Bases and Phosphates in Relation to the Protein of Blood and Other Body Fluids in Bright's Disease and in Heart Failure , J. Biol. Chem. 58:617, 1923. 12. Peters, J. P. and Eiserson, L.: The Influence of Protein and Inorganic Phosphorus on Serum Calcium , J. Biol. Chem. 84:155 ( (Oct.) ) 1929. 13. Albright and Bauer (footnote 2). 14. Hartman, A. F.: Chemical Changes Occurring in the Body as the Result of Certain Diseases , Am. J. Dis. Child. 35:557 ( (April) ) 1928.Crossref 15. Salvesen and Linder (footnote 10, first reference). 16. Albright, F.; Bauer, W.; Ropes, M., and Aub, J. C.: Studies of Calcium and Phosphorus Metabolism: IV. The Effect of the Parathyroid Hormone , J. Clin. Investigation 7:139 ( (April) ) 1929.Crossref 17. Cantlie, J.: Some Recent Observations on Sprue , Brit. M. J. 2:196 ( (Nov. 15) ) 1913.Crossref 18. Harrison, W. S., in discussion on Cantlie, Brit. M. J. 2:1296, 1913. 19. Bassett-Smith, P. W.: A Case of Sprue Associated with Tetany , Lancet 1:178 ( (Feb. 1) ) 1919.Crossref 20. Bovaird, D.: A Study of Tropical Sprue, or Psilosis , J. A. M. A. 77:753 ( (Sept. 3) ) 1921.Crossref 21. Barach, A. L., and Murray, H. A., Jr.: Tetany in a Case of Sprue , J. A. M. A. 74:786 ( (March 20) ) 1920.Crossref 22. Blumgart, H. L.: Three Fatal Adult Cases of Malabsorption of Fat: With Emaciation and Anemia, and in Two Acidosis and Tetany , Arch. Int. Med. 32:113 ( (July) ) 1923.Crossref 23. Scott, H. H.: The Nature and Treatment of Sprue , Brit. M. J. 2:1135 ( (Dec. 15) ) 1923.Crossref 24. Jamieson, T. H.: The Treatment of Sprue , Brit. M. J. 2:462 ( (Sept. 15) ) 1923. 25. Thaysen, T. E. H.: Ueber Fettdiarrhōen: III. Die Klinik der nichttropischen Sprue , Acta med. Scandinav. 64:352 ( (Sept.) ) 1926.Crossref 26. Baumgartner, E. A., and Smith, G. D.: Pernicious Anemia and Tropical Sprue , Arch. Int. Med. 40:203 ( (Aug.) ) 1927.Crossref 27. Holmes, W. H., and Starr, P.: A Nutritional Disturbance in Adults Resembling Celiac Disease and Sprue: Emaciation, Anemia, Tetany, Chronic Diarrhea and Malabsorption of Fat , J. A. M. A. 92:975 ( (March 23) ) 1929.Crossref 28. Maxwell, J. P.: Osteomalacia in China , J. Obst. & Gynæc. Brit. Emp. 32:1, 1925. 29. Hess, A. F., and Lewis, J. M.: Clinical Experience with Irradiated Ergosterol , J. A. M. A. 91:783 ( (Sept. 15) ) 1928. 30. Hess, A. F.: Rickets Including Osteomalacia and Tetany , Philadelphia, Lea & Febiger, 1929. 31. Steenbock H., and Nelson, M. T.: Fat-Soluble Vitamins: XIX. Induction of Calcifying Properties in a Rickets-Producing Ration by Radiant Energy , J. Biol. Chem. 62:209, 1924. 32. Hess and Lewis (footnote 24, second reference). 33. Karelitz, S., and Shohl, A. T.: Rickets in Rats: II. The Effect of Phosphate Added to the Diet of Ricketic Rats , J. Biol. Chem. 73:665 ( (June) ) 1927. 34. Orr, W. J.; Holt, L. E., Jr.; Wilkins, L., and Boone, F. H.: The Relation of Calcium and Phosphorus in the Diet to the Absorption of These Elements from the Intestine , Am. J. Dis. Child. 28:574 ( (Nov.) ) 1924. 35. Linder, G. C., and Harris, C. F.: Calcium and Phosphorus Metabolism in Chronic Diarrhea with Tetany , Quart. J. Med. 23:195 ( (Jan.) ) 1930. 36. Parsons, L. G.: Bone Changes in Renal and Celiac Infantilism , Arch. Dis. Child. 2:1 ( (Feb.) ) and 198 (Aug.) 1927. 37. Tammann, H.: Ueber die Beeinflüssung der porotischen Osteomalazie nach Gallenfistel durch das D-Vitamin , Beitr. z. klin. Chir. 142:83, 1928. 38. Dieterich, H.: Die porotische Malazie nach Gallenfistelin , Beitr. z. klin. Chir. 134:530, 1925. 39. Seifert, E.: Zur Frage der porotischen Malazie nach Gallenfisteln , Beitr. z. klin. Chir. 136:496, 1926. 40. Düttmann, G.: Die Veränderung des Säure-Basengleichgewichtes nach Gallenfisteln und ihre Bedeutung bei der Entstehung der sogenannten porotischen Malazie , Beitr. z. klin. Chir. 139:720, 1927. 41. Telfer, S. V.: Studies in Calcium and Phosphorus Metabolism: IV. The Influence of Free Fatty Acids in the Intestine on the Absorption and Excretion of the Mineral Elements , Quart. J. Med. 20:1, 1926 42. V. Infantile Rickets; The Excretion and Absorption of the Mineral Elements and the Influence of Fats in the Diet on Mineral Absorption , Quart. J. Med. 192620, p. 7. 43. Sokhey, S. S., and Malandkr, M. A.: Pancreatic Function in Sprue , Indian J. M. Research , 25:921 ( (April) ) 1928. 44. Irving, L., and Ferguson, J.: The Influence of Acidity in the Intestine Upon the Absorption of Calcium Salts by the Blood , Proc. Soc. Exper. Biol. & Med. 22:527 ( (May) ) 1925. 45. Babbott, F. L., Jr.; Johnston, J. A., and Haskins, C. H.: Gastric Acidity in Infantile Tetany , Am. J. Dis. Child. 26:486 ( (Nov.) ) 1923. 46. Porter, W. B., and Rucker, J. E.: The Treatment of Non-Tropical Sprue with Liver Extract , Am. J. M. Sc. 179:310 ( (March) ) 1930. 47. Elders, C.: Behandlung der Tropischen Sprue , Med. Welt 3:167, 1929.

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Archives of Internal Medicine – American Medical Association

Published: Sep 1, 1931

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