Byline: Rodo O. von Vigier (1), Nicole Offermann (1), Benedetta C. Beretta-Piccoli (1), M. G. Bianchetti (1) Keywords: KeywordsaPaucisymptomatic hemolytic-uremic syndrome; Shigatoxin-associated ...glomerulonephritic syndrome Author Affiliation: (1) Department of Pediatrics, Inselspital, 3010 Bern, Switzerland e-mail: mario.bianchetti@insel.ch, CH
Selective electrodes have been designed for determining plasma ionized magnesium. In kidney disease the relationship between ionized and total circulating magnesium is often altered. Hence plasma ...ionized magnesium (ETH 7025 membrane) was determined in 25 patients with primary renal tubular disorders; 6 patients had total hypomagnesemia. Total plasma magnesium was never reduced in the remaining 19 patients. Plasma ionized magnesium values were low in the 6 patients with total hypomagnesemia. In 18 of the 19 patients without total hypomagnesemia plasma ionized magnesium values were not reduced. Ionized hypomagnesemia was noted in a patient with normal total plasma magnesium in the context of hypercalciuric nephrocalcinosis of unknown origin. The study demonstrates an excellent concordance between plasma total and ionized magnesium in tubular disorders associated with total hypomagnesemia and a good concordance in tubular disorders that are not linked with total hypomagnesemia. The determination of circulating ionized magnesium is of little value in the diagnostic work-up of the vast majority of renal tubular disorders. The determination might perhaps disclose latent hypomagnesemia in nephrocalcinosis of unknown cause.
It has been postulated that parathormone, calcitonine, insulin and catecholamines are involved in extracellular magnesium homeostasis. Yet, there is still a rudimentary knowledge of the endocrine ...factors that control circulating magnesium homeostasis. The effects of exogenous glucagon injection on circulating total and ionized magnesium were investigated in 11 healthy humans (five females and six males, aged between 21 and 30, median 26 years). As compared with a control study, intravenous injection of a bolus of 1 mg of glucagon was associated with the expected raised glucose (at 5, 10, 20 and 30 min) and with decreased potassium (at 20 and 30 min) and inorganic phosphate (at 20 and 30 min) levels. Intravenous glucagon was not followed by significant changes in plasma total and ionized magnesium. Consequently, there is still little evidence for a glucagon-dependent control of the extracellular magnesium concentration after acute administration of glucagon.
The purpose of this analysis was to investigate biochemical disturbances at presentation and initial fluid resuscitation before surgery in infantile pyloric stenosis. The charts of 139 consecutive ...infants (113 boys and 26 girls) between 7 d and 20 wk of age with hypertrophic pyloric stenosis were reviewed. The infants were treated at the Department of Pediatric Surgery, University of Bern, Switzerland, in the period between 1987 and 1997. A trend towards hypokalaemia (13 of the 139 patients), hypochloraemia (39 patients) and especially metabolic alkalosis (98 patients) was frequently noted on admission. In 84 patients, data on fluid management and on circulating sodium, potassium, chloride and the acid-base balance immediately before surgery were also available. In these patients a significant correlation was found between the parenteral chloride dose given for fluid repair (y = 0.310 x; r = 0.54; p < 0.001) and the changes in plasma bicarbonate. The equation indicates that a chloride dose of 10 mmol/kg body weight is required to reduce plasma bicarbonate on average by 3 mmol/.
Since assessment of the fluid volume stated by physical examination and history is inaccurate in infants with vomiting, the severity of metabolic alkalosis helps to define the amount of fluid required for repair.
