Hypochloremic alkalosis in infants associated with soy protein formula

Linshaw, Michael A.; Harrison, H.; Gruskin, Alan B.; Prebis, James W.; Harris, JoAnn; Stein, Robert B.; Jayaram, Manjunath; Preston, David F.; DiLiberti, John H.; Baluarte, H. Jorge; Elzouki, Aziz; Carroll, Nancy M.

doi:10.1016/s0022-3476(80)80728-1

Cited by 31 publications

(9 citation statements)

References 7 publications

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“…Other case reports associated with G. max , with satisfactory demonstration of causality, are as follows: (i) gastrointestinal adverse effects, including enterocolitis, vomiting, abdominal pain and diarrhoea, gastric cancer and hepatitis ; (ii) thyroid dysfunction caused by the consumption of soybean ‘milk’ containing high levels of iodine ; (iii) bladder cancer ; and (iv) cases with different symptoms, such as hypophosphataemia in very‐low‐birthweight infants, fatal hypernatraemia, migraine, hypochloraemic alkalosis and transient methaemoglobinaemia .…”

Section: Resultsmentioning

confidence: 99%

Adverse effects of plant food supplements and botanical preparations: a systematic review with critical evaluation of causality

Lorenzo

Ceschi

Kupferschmidt

et al. 2015

Brit J Clinical Pharma

117

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AIMSThe objective of this review was to collect available data on the following: (i) adverse effects observed in humans from the intake of plant food supplements or botanical preparations; (ii) the misidentification of poisonous plants; and (iii) interactions between plant food supplements/botanicals and conventional drugs or nutrients. METHODSPubMed/MEDLINE and Embase were searched from database inception to June 2014, using the terms 'adverse effect/s', 'poisoning/s', 'plant food supplement/s', 'misidentification/s' and 'interaction/s' in combination with the relevant plant name. All papers were critically evaluated according to the World Health Organization Guidelines for causality assessment. RESULTSData were obtained for 66 plants that are common ingredients of plant food supplements; of the 492 papers selected, 402 (81.7%) dealt with adverse effects directly associated with the botanical and 89 (18.1%) concerned interactions with conventional drugs. Only one case was associated with misidentification. Adverse effects were reported for 39 of the 66 botanical substances searched. Of the total references, 86.6% were associated with 14 plants, including Glycine max/soybean (19.3%), Glycyrrhiza glabra/liquorice (12.2%), Camellia sinensis/green tea ( 8.7%) and Ginkgo biloba/gingko (8.5%). CONCLUSIONSConsidering the length of time examined and the number of plants included in the review, it is remarkable that: (i) the adverse effects due to botanical ingredients were relatively infrequent, if assessed for causality; and (ii) the number of severe clinical reactions was very limited, but some fatal cases have been described. Data presented in this review were assessed for quality in order to make the results maximally useful for clinicians in identifying or excluding deleterious effects of botanicals.

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Section: Resultsmentioning

confidence: 99%

Adverse effects of plant food supplements and botanical preparations: a systematic review with critical evaluation of causality

Lorenzo

Ceschi

Kupferschmidt

et al. 2015

Brit J Clinical Pharma

117

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“…Citrate has been suggested as providing sufficient alkali to generate the alkalosis associated with the intake of chloridedeficient soy formula (14). Although the contribution of citrate to the generation of HMA cannot be quantitated in our studies, the fact that chloride replenishment despite continued citrate intake normalized serum bicarbonate levels suggest that factors other than citrate were responsible for the maintenance and correction phases of HMA.…”

Section: Discussionmentioning

confidence: 58%

“…It is believed that chloride ion 497 depletion is responsible for the development of metabolic alkalosis and resultant electrolyte imbalances (9-11 ). Either citrate alone or in combination with other counter anions used to replace chloride in soy formulas has also been implicated in the development ofHMA (12,14).…”

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confidence: 99%

Severe Chloride Deficiency in the Neonate: The Canine Puppy as an Animal Model

et al. 1987

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ABSTRACT. Studies were designed to develop an animal depletion is responsible for the development of metabolic alkamodel for the syndrome of hypochloremic, hypokalemic losis and resultant electrolyte imbalances (9-1 1). Either citrate metabolic alkalosis (HMA), and failure to thrive in infants alone or in combination with other counter anions used to due to intake of chloride-deficient formula. Littermate replace chloride in soy formulas has also been implicated in the canine puppies, 2 wk old, were fed soy formula containing development of HMA (12, 14). normal chloride, 20 mEq/liter (NC, n = S), or low chloride, Essential to the further study of CDS in human infants is a 1 mEq/liter (LC, n = 5) for 4 wk, first by gavage and ad neonatal animal model that demonstrates the biochemical and libitum thereafter. After 1 wk of LC formula, HMA de-clinical abnormalities characteristic of the disorder in infants. veloped in LC puppies although both NC and LC puppies Therefore, the present study was primarily designed to develop had similar fluid and caloric intake and gain in weight and a neonatal animal model of HMA. In addition, the role of forelimb length. Two wk of LC formula also resulted in a chloride ion in the pathogenesis of HMA was evaluated. higher serum creatinine and calcium but lower phosphate level in LC than NC puppies. After 4 wk of LC, weight and forelimb length were much less in LC than NC puppies. METHODSPlasma renin activity decreased with age in NC but re-~1 1 experiments were carried out on littermate mongrel canine mained elevated in LC. In a separate group of puppies (n puppies randomly assigned to one of two formulas (Table 1) = 6, with HMA, LC prepared under the direction of the Infant Formula Council to as NaC1 NC levels HMA despite meet the dietary requirements of puppies (15). NC contained 20 citrate intake. We conclude that the canine PUPPY is an mEq/liter chloride and the LC contained 1 mEq/liter chloride. appropriate model to study HMA due to decreased chloride ~0 t h the LC and the NC formulas contained 20 mEq/liter of intake. Low chloride intake independent of citrate caused sodium with citrate added as the counter ion in the LC formula. the HMA. (Pediatr Res 21: 497-501, 1986) The formula containing 1 kcal/ml was fed to the puppies commencing 2 wk following birth. Formula was fed by gavage Abbreviations every 6 h until the puppies were able to feed themselves, which LC, low chloride occurred at about 6 wk of age. At 6 wk of age the animals were NC, normal chloride fed every 8 h. Intake was monitored by measuring the amount CDS, chloride deficiency syndrome of formula given and the amount of formula refused or regurgi-HMA, hypochloremic metabolic alkalosis tated with each feeding. Formula was given to the puppies to PRA, plasma renin activity assure caloric intake of about 160 to 225 kcallkg per day.BUN, blood urea nitrogen Two litters of puppies were studied. The first litter (group I)Cr, creatinine had 10 puppies; five puppies were randomized to the LC group and five to the NC group....

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“…Recently, at least two formula products were found to contain levels of sodium and chloride below the standards recommended by the Committee on Nutrition of the American Academy of Pediatrics (8). Such imbalances in infant formula products although very rare, have however, been associated with limited morbidity in some infants in the United States (66,67). The accidental use of such imbalanced formula products, in the face of inadequate regulatory mechanisms for quality control, may result in potential problems in developing countries where such infants may not be brought to medical attention promptly and the feeding may even be continued for long periods.…”

Section: Beneficial Effects Of Breast Feedingmentioning

confidence: 99%