Dynamics of ionized magnesium and ionized calcium during recovery from diabetic ketoacidosis managed with conventional treatment.

Serial measurements of ionized magnesium (iMg), ionized calcium (iCa) and pH performed during the management of diabetic ketoacidosis (DKA) in a 10 9/12-year-old female showed a progressive decrease in iMg and iCa to subnormal values which inversely correlated with the increase of pH, suggesting a state of depletion of these cations during conventional DKA management.

Effects of exogenous recombinant human growth hormone on an animal model of suboptimal nutrition.

BACKGROUND: Nutritional dwarfing, a form of suboptimal nutrition, has been identified as a frequent cause of short stature and delayed sexual development in children. Retarded growth is an adaptive response to suboptimal nutrition. OBJECTIVE: To assess whether recombinant human growth hormone (rhGH) may promote growth during various levels of suboptimal nutrition. METHODS: Using a previously developed rat model of suboptimal nutrition, six groups of rats (six rats/group) were fed a balanced 1:1 carbohydrate:fat ratio diet for 4 weeks. Three of the groups were administered daily injections of rhGH (0.1 mg/100 g BW) subcutaneously in the back while the other three groups were kept as controls and were given similar dosages of normal saline solution (NSS). Restricted rats within each treatment group were pair fed 80 and 60% of the ad-libitum rats intake. Daily intake of the 80 and 60% fed groups were determined based on the intake of the ad-libitum fed groups. Serum IGF-I and insulin were determined after 4 weeks of dietary treatment by radioimmunoassay while IGFBP-3 was determined by an immunoradiometric assay. Body composition was assessed in all rats by carcass analysis. RESULTS: After 4 weeks, total weight gain and tail growth were higher (p < 0.05) in the rhGH treated group at 80 and 60% of-libitum energy intake. Serum levels of IGF-I and IGFBP-3 were higher (p < 0.05) in rhGH treated rats fed at 60% of ad-libitum. In comparison to the NSS groups, administration of rhGH in rats fed ad-libitum increased total body water. Energy restriction caused decreased fat percentage (p < 0.05) in both rhGH and NSS groups without differences among treated groups. CONCLUSION: These results suggest that the anabolic effects of rhGH may overcome mild to moderate energy restriction.

Response to nutritional and growth hormone treatment in progeria.

Hutchinson-Gilford progeria syndrome (HGPS) is a rare condition with an unknown molecular defect. Patients with HGP progressively develop failure to thrive (FTT), alopecia, loss of subcutaneous fat, scleroderma, stiffening of various joints, and severe atherosclerosis. The median life span is 13 years, and the main cause of death is cardiovascular complications. There are few reports of endocrine and metabolic studies because of the rarity of this condition, and the response to long-term growth hormone (GH) treatment has not been described. We report the results of endocrine and metabolic studies performed to investigate the etiology of growth failure in five patients with HGP. Additionally, the response to nutritional therapy (NT) and GH treatment in three of these patients is presented. Our results suggest that elevated GH levels are characteristic of this disease and that an elevated basal metabolic rate (BMR) could be the cause of the FTT seen in HGP. Nonaggressive NT slightly improved weight gain and growth velocity (GV). Combined NT and GH treatment in three patients improved the GV, increased the levels of growth factors, and paradoxically resulted in decreased BMRs. However, the response to these therapies decreased over time and did not seem to prevent the progression of atherosclerotic disease.

Excess fruit juice consumption as a contributing factor in nonorganic failure to thrive.

OBJECTIVE: To determine whether excessive consumption of fruit juice is a contributing factor in nonorganic failure to thrive in early childhood. METHODS: Eight patients, aged 14 to 27 months, referred for failure to thrive were evaluated by medical history, physical examination, and biochemical assessment. Growth patterns were reviewed and anthropometric measurements including skinfold thickness and midarm circumference were obtained. Diet history included 3-day food records and 24-hour diet recalls. An open-ended interview explored factors associated with fruit juice consumption. Breath hydrogen testing of fructose, sorbitol, or fruit juice was performed in three children who had a history of diarrhea or gastrointestinal complaints. Nutritional intervention focused on reducing fruit juice consumption and increasing the energy and nutrient density of the children's diets. RESULTS: In each case, deterioration of weight and linear growth progression coincided with excessive juice consumption. All children exhibited weights < 5th percentile and five also had lengths < -5th percentile. Weight-for-length deficits ranged from 11% to 25%. Two patients demonstrated low arm muscle mass and five children had diminished fat stores. Organic disease was ruled out in all cases. Three children had iron deficiency. The children's diets were hypocaloric, providing 78% to 92% of recommended energy intake for age and weight. Dietary intake included considerable juice consumption (12 to 30 oz/d). Fruit juice, primarily apple juice, contributed 25% to 60% of daily energy intake. As a result, food consumption was reduced; lowering dietary protein, fat, and micronutrient intakes. Excessive juice was consumed for various reasons including children's preferences, parental health beliefs, behavioral feeding difficulties, and financial considerations. Breath hydrogen testing revealed malabsorption of fructose and/or sorbitol. After nutritional intervention, dietary intake increased to 96% to 116% of recommended intakes. Weight gain increased significantly in the first month and persisted for follow-up of 5 to 18 months. CONCLUSIONS: These findings indicate that large intakes of fruit juices may displace more calorie- and nutrient-dense foods. Additionally, fructose and sorbitol malabsorption may occur. Excess fruit juice consumption may present a contributing factor in nonorganic failure to thrive.

Alterations in spontaneous growth hormone (GH) secretion and the response to GH-releasing hormone in children with nonorganic nutritional dwarfing.

The effects of suboptimal nutrition on the spontaneous overnight GH secretion (SGHS) and the GH response to GHRH were studied. Sixteen patients with nonorganic nutritional dwarfing (ND) were compared with 25 healthy short children with familial short stature with or without constitutional growth delay (FC). The effects of puberty were also assessed. All patients underwent an overnight study to assess SGHS with serum GH levels sampled every 20 min for 12 h, and a GHRH stimulation test was administered. Pubertal ND children had a blunted SGHS with a mean overnight GH level of 4.9 +/- 1.1 micrograms/L, significantly less than the level of 6.2 +/- 1.8 micrograms/L of the pubertal FC children (P less than 0.05). Also, prepubertal ND patients had an area under the curve in GH secretion after GHRH which was greater than that of the pubertal ND patients (2483 +/- 1581 vs. 1600 +/- 1056, P less than 0.05). The peak GH response to GHRH in the prepubertal ND patients was also higher than that of the pubertal ND patients (51.8 +/- 22.1 micrograms/L vs. 22.5 +/- 15.4 micrograms/L, P less than 0.05). This study shows that the SGHS is attenuated in ND patients during puberty but their GH response to GHRH is increased before adolescence. These abnormalities may represent compensatory mechanisms to energy restriction and may increase our understanding of the poor growth seen in ND patients.

Oral hydration solutions in experimental osmotic diarrhea: enhancement by alanine and other amino acids and oligopeptides.

Improvement of sodium absorption during the administration of oral hydration solutions (OHS) could increase the efficacy of formulations used in the treatment of infantile diarrhea. To test this hypothesis, selected protein breakdown products were evaluated as absorption enhancers in OHS of different osmolalities and Na-to-glucose ratios in an animal model of osmotic diarrhea induced by cathartics. A very significant increase in water and Na absorption occurred in rats with diarrhea when they were perfused with a 90-mmol/L-Na, 111-mmol/L-glucose OHS containing 30 mmol/L of L-alanine (Ala). The same effect on Na retention was observed with a protein hydrolysate (PrH) in rats with diarrhea. Glycine was not effective. Other experimental OHS were ineffective in rats with diarrhea. The data indicate that in this animal model of chronic diarrhea Na transport enhancers, such as Ala and a PrH, are most efficacious in the presence of higher Na concentration.