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PubMed2000

Monte carlo simulation of the mixed alkali effect with cooperative jumps

In our previous works on molecular dynamics (MD) simulations of lithium metasilicate (Li2SiO3), it has been shown that the long time behavior of the lithium ions in Li2SiO3 has been characterized by the component showing the enhanced diffusion (Levy flight) due to cooperative jumps. It has also been confirmed that the contribution of such component decreases by interception of the paths in the mixed alkali silicate (LiKSiO3). Namely, cooperative jumps of like ions are much decreased in number owing to the interception of the path for unlike alkali-metal ions. In the present work, we have performed a Monte Carlo simulation using a cubic lattice in order to establish the role of the cooperative jumps in the transport properties in a mixed alkali glass. Fixed particles (blockage) were introduced instead of the interception of the jump paths for unlike alkali-metal ions. Two types of cooperative motions (a pull type and a push type) were taken into account. Low-dimensionality of the jump path caused by blockage resulted in a decrease of a diffusion coefficient of the particles. The effect of blockage is enhanced when the cooperative motions were introduced.

Journal Article↗
PubMed1977

Selectivity of alkali cation influx across the plasma membrane of oat roots: cation specificity of the plasma membrane ATPase.

Influx of alkali cations (Li(+), Na(+), K(+), Rb(+), Cs(+)) across plasma membranes of cells of excised roots of Avena sativa cv. Goodfield was selective, but different, in the absence and in the presence of 1 mm CaSO(4). Ca(2+) reduced the influx rates of all of the alkali cations-especially Na(+) and Li(+). Transport selectivity changed as the external concentrations of the alkali cations increased.Plasma membrane ATPase, purified from Avena sativa roots, was differentially stimulated by alkali cations. This specificity, however, was not altered by Ca(2+) or the external cation concentrations. A close correspondence existed between the relative influx rates of K(+), Rb(+), and Cs(+) and the relative stimulation of the ATPase by these cations. A similar correspondence did not occur for Na(+) and Li(+).Selective cation transport in oat roots could result, in part, from the specificity of the plasma membrane ATPase, but other factors such as specific carriers or porters or differential diffusion rates must also be involved.

Journal Article↗
PubMed1975

Further characterization of some heterophile agglutinins reacting with alkali-labile carbohydrate chains of human erythrocyte glycoproteins.

The nature of the receptor sites for several agglutinins is characterized by hemagglutination inhibition assays. The inhibitory activity of human erythrocytes glycoproteins, from which sialic acid, sialic acid and galactose or alkali-labile oligosaccharides have been removed, is compared to the inhibitory effect of compounds with known structure. It is shown that the lectin from Arachis hypogea and anti-T bind to alkali-labile galactosyl-residues. Agglutinins from Bauhinia purpurea and variegata (non- or N-specific), Maclura aurantiaca, Iberis amara, sempervirens, umbellata hybrida and umbellata nana (M- or nonspecific), Moluccella laevis (A- plus N-specific), Helix pomatia, Helix aspersa, Helix lucorum and Caucasotachea atrolabiata interact with alkali-labile N-acetylgalactosamine. The results obtained with the anti-A agglutinins from various snails suggest that human erythrocyte glycoproteins contain, besides the alkali-labile tetrasaccharide, a peptide-linked sialyl-N-acetyl-galactosaminyl-residue. The investigations do not allow a precise definition of the receptor sites for the lectins having M- or N-specificity.

Agglutinins↗
PubMed1993

Relationships between alkali light-chain complement and myosin heavy-chain isoforms in single fast-twitch fibers of rat and rabbit.

The present study compares the alkali myosin light chain (LC) complement of the fast fiber types IIB, IID and IIA in single fibers from rat muscle, as well as in type IID and type IIA fibers from rabbit muscle. Single fibers were classified according to their electrophoretically determined myosin heavy chain (HC) isoforms, HCIIb, HCIId, and HCIIa. Alkali myosin light chains were analysed by densitometric evaluation of two-dimensional electrophoresis performed on extracts from the same fibers. On the average, the fraction of LC3f, i.e. LC3f/(LC1f+LC3f), was highest in type IIB fibers and lowest in type IIA fibers. Type IID fibers occupied an intermediate position. Also in the rabbit, type IID fibers displayed a higher fraction of LC3f than type IIA fibers. Large scattering of the LC3f fraction in IIB, IID, and IIA fibers indicated that each fiber type is composed of fibers identical with regard to their specific myosin heavy chain complement, but heterogeneous with regard to their fast alkali light chain composition and the resulting light-chain-based isomyosins. It is suggested that the variable proportions of the two alkali light chains in the three fast fiber populations serve as a fine tuning of contractile velocities within the ranges determined by the three fast myosin heavy-chain isoforms.

Animals↗
PubMed1996

Regulatory aspects of alkali tolerance induction in Escherichia coli.

Escherichia coli shifted from external pH (pH(O)) 7.0 to pH(O) 8.5-9.5 rapidly becomes tolerant to pH(O) 10.0-11.5, induction of tolerance (alkali habituation) being dependent on periplasmic or external alkalinization with either NaOH or KOH. Induction needs protein synthesis and makes organisms resistant to DNA damage by alkali and better able to repair any damage that occurs. Induction of tolerance was reduced by glucose (not reversed by cAMP) and by amiloride, was dependent on DNA gyrase and was abolished by fur and himA lesions (the latter suggests IHF involvement). Tolerance induction was not prevented by L-leucine, FeCl3 or FeSO4 nor by hns or relA mutations. Habituation probably involves attachment of IHF upstream of the promoter leading to DNA bending which switches on transcription. Habituation is aberrant in nhaA mutants, so ability to resist alkali damage may only arise if NhaA is induced, with extrusion of Na+ by this antiporter during alkali challenge. In accord with one tolerance component involving NhaA induction, beta-galactosidase formation from nhaA-lacZ fusions at pH(O) 9.0 was inhibited by glucose and amiloride.

DNA Damage↗
PubMed1995

Effective treatment for acute alkali injury to the esophagus using weak-acid neutralization therapy: an ex-vivo study.

OBJECTIVE: 1) To evaluate whether neutralization therapy with weak acid is effective in reducing observed histopathologic esophageal tissue injury secondary to liquid alkali, 2) to quantify the temperature change of the neutralizing agent, and 3) to determine the effect of interval to therapy on injury severity. METHODS: Harvested Sprague-Dawley rat esophagi were catheterized and placed in an oxygenated saline bath (37 degrees C) for 60 minutes and then fixed in 10% formalin. Nine groups (n = 10) were perfused with 50% sodium hydroxide (NaOH). Six of the groups were treated by neutralization with cooled orange juice (OJ) or cola that was maintained between 2 degrees C and 4 degrees C. This was performed at 0, 5, or 30 minutes after injury. In addition, two positive control groups were exposed to OJ or cola at time 0 and were not exposed to strong alkali. A third control group was exposed to strong alkali but was not administered any subsequent treatment. The temperature of the neutralizing agent was recorded prior to instillation and after exiting the esophagus. Blinded pathologic scoring of 0 (no injury) to 3 (severe) was recorded performed for six histopathologic categories: epithelial cell viability, cornified epithelial cell differentiation, granular cell differentiation, epithelial cell nuclei, muscle cells, and muscle cell nuclei. Comparisons were made among treatment times using the Kruskal-Wallis test and linear trend analysis. RESULTS: For each histopathologic category and each treatment mode, the Kruskal-Wallis test showed significant differences between the groups (p < 0.002) over time. Trend analyses showed more severe injury with delayed neutralization therapy (p < 0.05) for each treatment mode and histopathologic category. CONCLUSION: Early neutralization therapy with OJ or cola reduces acute esophageal alkali injury. Additional in-vivo study is needed before neutralization therapy is adopted for clinical use.

Acids↗
PubMed1970

Effect of Alkali on the Immunological Reactivity of Lipopolysaccharide from Salmonella typhimurium.

The effect of mild alkaline hydrolysis on the immunological reactivity of Salmonella typhimurium lipopolysaccharide (LPS) was studied. Hydrolysis of LPS at 37 C in 0.01 to 0.25 n NaOH caused a decrease in precipitation of LPS by antiserum. Red cells sensitized with alkali-treated LPS were less responsive to hemagglutination by antiserum than were cells sensitized with heated LPS. Hemagglutination-inhibition studies showed that alkali-treated S. typhimurium LPS was antigenically deficient. Alkaline hydrolysis of S. typhimurium LPS destroys antigen 5 of the Kauffmann-White scheme by cleavage of O-acetyl groups. However, abequose, the immunodominant sugar for antigen 4, is also cleaved from the O side chains by alkali, suggesting the loss of more than one antigenic determinant. It is concluded that alkali treatment of LPS to promote the sensitization of red cells may alter the serological specificity and therefore places limitations on its use in serological studies.

Journal Article↗
PubMed1985

Transport of citrate across renal brush border membrane: effects of dietary acid and alkali loading.

Dietary acid or alkali loading was given to rats by providing 150 mM NH4Cl or 150 mM NaHCO3 in place of drinking water for 6 days; control animals received 150 mM NaCl. After 6 days, the citrate clearance was 0.04 +/- 0.01 ml/min (mean +/- SE) in the acid-loaded group, 0.9 +/- 0.1 ml/min in the control group, and 2.5 +/- 0.2 ml/min in the alkali-loaded group. At the end of the experiment, the rats were killed, and the Na+ gradient-dependent (Nao+ greater than Nai+) citrate uptake (pmol/mg protein) was measured in brush border membrane (BBM) vesicles prepared from each group. At 0.3 min, the [14C]citrate uptake was 198 +/- 8 pmol/mg protein (mean +/- SE) in the acid-loaded group, 94 +/- 16 pmol/mg protein in the control group, and 94 +/- 13 pmol/mg protein in the alkali-loaded group. The rate of Na+-independent (NaCl in medium replaced by KCl) [14C]-citrate uptake by BBM vesicles was the same for acid-loaded, control, and alkali-loaded animals. Thus, the increased capacity of the proximal tubular BBM to transport citrate from the tubular lumen into the cell interior may be an important factor that contributes to decreased urinary citrate in the presence of metabolic acidosis induced by chronic dietary acid loading.

Acid-Base Equilibrium↗
PubMed1993

Effects of in vivo and in vitro alkali treatment on intracellular pH regulation of OMCDis cells.

To examine functional changes of the transporters in the inner stripe of the outer medullary collecting ducts (OMCDis) by the peritubular acid-base status, in vitro microperfusion using the acetoxymethyl ester of 2',7'-bis(2-carboxyethyl)-5(6)-carboxyfluorescein was performed. Cell alkalinization systems were assessed by the recovery rate (dpHi/dt) of intracellular pH (pHi) after intracellular acid loading by NH(4+)-NH3 prepulse with bath amiloride. In alkali-loaded rabbits (0.15 M NaHCO3 drinking for 14 days), dpHi/dt showed a significant decrease (1.80 +/- 0.29 pH units/s x 10(3)) compared with either control (3.30 +/- 0.59) or acid-loaded rabbits (0.15 M NH4Cl drinking for 14 days, 3.05 +/- 0.46). The difference of dpHi/dt between control and alkali-loaded rabbits was eliminated by lumen N-ethylmaleimide (NEM), suggesting that H+ pump activity was decreased. The effect of in vitro alkali treatment (50 mM HCO3-, pH 7.7) for 3-4 h was also examined. This incubation significantly decreased the dpHi/dt (1.83 +/- 0.35) compared with the time control experiments (3.18 +/- 0.28), whereas no significant difference was seen in the presence of lumen NEM. Anion exchanger activity, as determined from the pHi changes after Cl- addition to the bath, showed no significant change with in vivo or in vitro alkali treatment. The results indicate that cell function of the OMCDis is regulated in response to the peritubular acid-base environment via changes in the H(+)-adenosinetriphosphatase.

Amiloride↗
PubMed1990

Alkali citrate for preventing recurrence of calcium oxalate stones.

The use of alkali citrates for preventing the recurrence of calcium oxalate stones was investigated in two trials. In trial I, alkali citrates were given continuously for 18 months to 8 patients who had shown a tendency to recurrent stone formation. In trial II, 12 similar patients were given intermittent therapy for 12 months. The expected changes in urine chemistry were checked at intervals of 3 months. Recurrent stone formation (2 episodes) was observed in only 1 patient (in trial II) during alkali citrate administration; before therapy this patient had suffered an average of 10 attacks of stone formation annually. In the light of the experience gained in these trials, continuous administration of alkali citrates is recommended; the duration of treatment should be tailored to individual needs, but it should not be prolonged indefinitely. Besides having well-attested effectivity of stone prevention, this mode of therapy carries a relatively low incidence of side effects.

Adult↗
PubMed2005

Thymosin-beta4 modulates corneal matrix metalloproteinase levels and polymorphonuclear cell infiltration after alkali injury.

PURPOSE: Corneal alkali injury is highly caustic, and present clinical therapies are limited. The purpose of this study was to investigate the ability of thymosin-beta4 (Taubeta4) to promote healing in an alkali injury model and the mechanisms involved in that process. METHODS: Corneas of BALB/c mice were injured with NaOH, irrigated copiously with PBS, and treated topically with either Tbeta4 or PBS twice daily. At various time points after injury (PI), corneas from the Tbeta4- versus the PBS-treated group were examined for polymorphonuclear leukocyte (PMN) infiltration, chemokine, and matrix metalloproteinase (MMP)/tissue inhibitor of metalloproteinase (TIMP) expression. RESULTS: Tbeta4-treated corneas demonstrated improved corneal clarity at day 7 PI. Whereas Tbeta4 decreased corneal MMP-2 and -9 and MT6-MMP levels after alkali injury, no change in TIMP-1 and -2 expression was detected. Tbeta4 treatment also decreased corneal KC (CXCL1) and macrophage inflammatory protein (MIP)-2 chemokine expression and PMN infiltration. Immunohistochemistry studies demonstrated MMP-9 expression at the leading edge of the epithelial wound, in the the limbus (containing stem cells), and in stromal PMNs. CONCLUSIONS: Tbeta4 treatment decreases corneal inflammation and modulates the MMP/TIMP balance and thereby promotes corneal wound repair and clarity after alkali injury. These results suggest that Tbeta4 may be useful clinically to treat severe inflammation-mediated corneal injuries.

Animals↗
PubMed2003

Effect of alkali metal ions on photochromic behavior of bisviologen-incorporated oligo-oxyethylene units.

Two bisviologen derivatives, 1,11-bis(N-propyl-4,4'-bipyridinium)-3,6,9-trioxaundecane tetrakis-(hexafluorophosphate) (1) and 1,8-bis(N-propyl-4,4'-bipyridinium)-3,6-dioxaoctane tetrakis-(hexafluorophosphate) (2), each incorporating trioxaundecane and dioxaoctane groups between two viologen units, respectively, were prepared so that their photochromic behavior in the absence and the presence of alkali metal ions in a thin polymer film could be investigated. Photoirradiation of the films containing 1 and 2 caused color changes from pale yellow to blue, associated with the photoinduced reduction of the viologen units from the dication to the radical cation. The addition of alkali metal ions, especially, K+ and Na+, caused change in the spectra of the photoreduced viologen radical cation for 1 and 2, respectively, because of the increase in the fractional amplitude for the dimer component of the radical cation rather than the monomer one. This may be related to the guest-induced conformational change of 1 and 2, in which the alkali metal ion is surrounded by the oligo-oxyethylene unit of 1 and 2. The regulation in photochromic properties of viologen derivatives can be achieved by addition of alkali metal ions.

Journal Article↗
PubMed1987

Inflammatory mediators in alkali-burned corneas: preliminary characterization.

Leukocyte chemotactic factors (LCF) are important inflammatory mediators which activate and recruit leukocytes from the circulation into sites of tissue damage. These factors were recently detected in the tear fluid of inflamed eyes induced by alkali burn. It remains unclear, however, whether the detected LCF are released from injured corneal tissues or leaked from the circulation. Using a corneal cup model developed in our laboratory, we began examining the capability of corneal tissues to produce LCF in response to alkali injury. We also evaluated the influence of citric acid on the production of LCF from corneas preinjured by the alkali sodium hydroxide (NaOH). For these studies, the epithelial surfaces of corneas isolated from bovine and human eyes were exposed to 1N NaOH for 35 seconds at room temperature. The NaOH was then removed and the epithelial surfaces washed once with buffer and incubated with culture medium for 1, 2, 4, and 6 hours at 37 degrees C/5% CO2 atmosphere. Our results showed that (1) NaOH2 induced corneal epithelial cell injury ranging from cell discoloration and moderate damage of the upper half of the epithelium (1-4 hrs) to total destruction of the epithelium (6 hrs); (2) NaOH-injured corneas (2 hr incubation post injury) produced significant levels of chemotactic activity (via checkerboard analysis) specific for neutrophils (115% maximum chemotactic response [MCR]) and mononuclear cells (94% MCR); (3) preliminary characterization of these factors revealed that they are protease and heat sensitive, extractable by organic solvents, and possess molecular weight values greater than 100,000 daltons; and (4) incubation of NaOH-pretreated corneas with 0.01% citric acid for 2 hours markedly inhibited the production of LCF for both neutrophils (98% inhibition) and mononuclear cells (91% inhibition). Results of these studies indicate that alkali-burned bovine and human corneas generate leukocyte chemoattractants which differ in their biochemical characteristics from previously known low molecular weight chemotactic factors such as C5a, interleukin-1, or leukotriene B4.

Animals↗
PubMedDate not supplied

Calcium carbonate toxicity: the updated milk-alkali syndrome; report of 3 cases and review of the literature.

OBJECTIVE: To describe 3 patients with calcium carbonate-induced hypercalcemia and gain insights into the cause and management of the milk-alkali syndrome. METHODS: We report the clinical and laboratory data in 3 patients who presented with severe hypercalcemia (corrected serum calcium > or = 14 mg/dL) and review the pertinent literature on milk-alkali syndrome. RESULTS: The 3 patients had acute renal insufficiency, relative metabolic alkalosis, and low parathyroid hormone (PTH), PTH-related peptide, and 1,25-dihydroxyvitamin D concentrations. No malignant lesion was found. Treatment included aggressive hydration and varied amounts of furosemide. The 2 patients with the higher serum calcium concentrations received pamidronate intravenously (60 and 30 mg, respectively), which caused severe hypocalcemia. Of the 3 patients, 2 were ingesting acceptable doses of elemental calcium (1 g and 2 g daily, respectively) in the form of calcium carbonate. In addition to our highlighted cases, we review the history, classification, pathophysiologic features, and treatment of milk-alkali syndrome and summarize the cases reported from early 1995 to November 2003. CONCLUSION: Milk-alkali syndrome may be a common cause of unexplained hypercalcemia and can be precipitated by small amounts of orally ingested calcium carbonate in susceptible persons. Treatment with hydration, furosemide, and discontinuation of the calcium and vitamin D source is adequate. Pamidronate treatment is associated with considerable risk for hypocalcemia, even in cases of initially severe hypercalcemia.

Adult↗
PubMed2002

Survival and growth of alkali-stressed Listeria monocytogenes on beef frankfurters and thermotolerance in frankfurter exudates.

Cells of Listeria monocytogenes exposed at 4 degrees C to 1% solutions of two alkaline cleaners or alkali-adapted in tryptose phosphate broth (pH 10.0) at 37 degrees C for 45 min, followed by 4 degrees C for 48 h, were inoculated onto beef frankfurters containing high fat (16 g) and high sodium (550 mg) or low fat (8 g) and low sodium (250 mg) per 57-g serving. Frankfurters were surface inoculated (2.0 log10 CFU/g), vacuum packaged, stored at -20, 4, or 12 degrees C, and analyzed for populations of L. monocytogenes at 2-day to 2-week intervals. Populations did not change significantly on frankfurters stored at -20 degrees C for up to 12 weeks. After storage at 4 degrees C for 6 weeks (I week before the end of shelf life), populations of control cells and cells exposed to alkaline cleaners were ca. 6.0 log10 CFU/g of low fat, low sodium (LFLS) frankfurters and ca. 3.5 log10 CFU/g of high fat, high sodium (HFHS) frankfurters. Growth of alkali-adapted cells on both types of frankfurters was retarded at 4 degrees C. Growth of L. monocytogenes on frankfurters stored at 12 degrees C was more rapid than at 4 degrees C, but a delay in growth of alkali-adapted cells on HFHS and LFLS frankfurters was evident during the first 9 and 6 days, respectively. Alkali-adapted cells had a significantly (P < or = 0.05) lower logistic D59 degrees C-value (decimal reduction time) than alkaline cleaner-exposed cells, but the D59 degrees C-value was not different from that of control cells. Cells exposed to a nonbutyl alkaline cleaner, and then heated in LFLS frankfurter exudates, had a significantly lower D62 degrees C-value than cells that had been exposed to some of the other treatments. Growth characteristics of L. monocytogenes inoculated onto the surface of frankfurters may be altered by previous exposure to alkaline environments. Differences in growth characteristics of L. monocytogenes on HFHS versus LFLS beef frankfurters stored at refrigeration temperatures indicate that composition influences the behavior of both alkaline-stressed and control cells.

Animals↗
PubMed1999

Effect of metalloproteinase inhibitor on corneal cytokine expression after alkali injury.

PURPOSE: Interleukin (IL)-1alpha and IL-6 levels in the cornea are greatly elevated during the early stages after an alkali burn in mice. The authors investigated the effect of synthetic inhibitor of matrix metalloproteinase (SIMP) on the expression of inflammatory cytokines in alkali-burned murine corneas and evaluated the clinical appearance of the eyes. METHODS: After 0.5N NaOH-alkali burns to 400 corneas of ICR mice, 200 received 400 microg/ml of SIMP topically 4 times a day while 200 corneas were similarly treated with vehicle only. At days 4, 7 and 14 after injury, each cornea was assigned a clinical score for corneal opacity, corneal epithelial defect, hyphema and cataract. Extracts of injured corneas in each group were then assayed for cytokine production using ELISA systems for IL-1alpha, IL-1beta, IL-6 and tumor necrosis factor-alpha (TNF-alpha). RESULTS: The levels of IL-1alpha, IL-1beta and IL-6 were significantly lower in the SIMP-treated group than in the vehicle-treated group 7 days after the burn. However, levels of these cytokines were similar in the SIMP and non-SIMP groups at days 4 and 14. Levels of TNF-alpha did not differ between both groups at any postinjury time. In the SIMP-treated corneas, there was less opacification and hyphema formation and epithelial regeneration was faster. CONCLUSIONS: Topical application of SIMP in alkali-burned murine corneas reduced the expression of IL-1alpha, IL-1beta, and IL-6 and lessened the severity of the injury.

Animals↗
PubMed1992

A structural study of the membrane domain of band 3 by tryptic digestion. Conformational change of band 3 in situ induced by alkali treatment.

Nine peptides derived from the transmembrane domain of band 3 were purified and sequenced. All of the sequences agreed completely with deduced sequences from cDNA of human erythroid band 3. Five peptides, KS-1 to KS-5, were released from the band 3 molecule when alkali-stripped membranes were digested with trypsin, while four other peptides, KM-6 to KM-9, were obtained following subsequent urea treatment. This indicates that at least 13 new in situ cleavage sites were demonstrable by these procedures, that the released peptides are parts of hydrophilic connector loops, and that the other peptide portions constitute membrane-spanning helices. The topological designations are consistent with the hydropathy prediction of murine band 3 according to Passow ((1986) Rev. Physiol. Biochem. Pharmacol. 103, 61-203). One mol of histidine residue was found/mole of KS-1, KS-2, KS-4, and KM-6. The conformation of band 3 in situ was apparently changed by alkali treatment of erythrocyte membranes, i.e. the amount of KS-1, KS-2, and KS-4 peptides released by trypsin treatment increased as NaOH concentration was raised from 10 to 100 mM. Similarly, [3H]dihydro-4,4'-diisothiocyanostilbene-2,2'-disulfonic acid was found to bind to band 3 in membranes treated with 10 mM NaOH as well as to band 3 in white ghosts, but not to membranes treated with 100 mM NaOH. In addition, alkali treatment of membranes tended to increase the amount of band 3 cross-linked by 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (DIDS). The conformational change in band 3 by alkali treatment was also supported by the interaction of antibodies against peptides released by trypsin. The release of KS-1, KS-2, and KS-4 from the membrane was strongly inhibited by pretreating the erythrocyte membrane with DIDS, suggesting that the DIDS-band 3 complex which is in the outward facing form, is more compact and becomes resistant to trypsin compared to band 3 without DIDS.

4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid↗
PubMed2006

Milk-alkali syndrome in pre-eclamptic pregnancy: report of a patient and evaluation of albumin-corrected calcium in pre-eclamptic pregnancies.

BACKGROUND: First reported in 1923 due to excessive ingestion of milk and bicarbonate for peptic ulcer disease, milk-alkali syndrome nearly disappeared by the 1980s. More recently, however, this syndrome has become a more common cause of hypercalcemia. This increase is likely due to the increased use of calcium carbonate for the prevention and treatment of osteoporosis. Pregnancy likely places women at risk for milk-alkali syndrome due to increased intestinal absorption of calcium. Recommendations for increased oral calcium intake during pregnancy along with frequent use of calcium carbonate for GI symptoms during late pregnancy increase this risk. METHODS: We performed a retrospective chart review of pregnant women with pre-eclampsia, ages 18-35 years, who were admitted for delivery to the University of Oklahoma Health Sciences Center. Serum calcium levels were reviewed and compared with those of an age- and sex-matched control group consisting of 100 non-pregnant women admitted to the same facility. RESULTS: Twenty-nine of the 100 pregnant patients (29%) had an albumin-corrected calcium above normal compared to only six patients (6%) in the control group (P = 18.32, p < 0.0001). The highest corrected serum calcium in the pregnant group was 12.3 mg/dl compared to 10.7 mg/dl in the control group. SUMMARY: Milk-alkali syndrome is not an uncommon cause of hypercalcemia, and pregnancy may predispose women to milk-alkali syndrome as demonstrated by the patient reported. Albumin-corrected calcium is frequently high in women with pre-eclampsia but ionized calcium is not.

Adolescent↗