Suboptimal Mineral Composition of Cow's Milk Formulas: A Risk Factor for the Development of Late Metabolic Acidosis

Kalhoff, Hermann; Manz, Friedrich; Diekmann, L; Stock, G. J.

doi:10.1111/j.1651-2227.1990.tb11549.x

Cited by 18 publications

(12 citation statements)

References 8 publications

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“…Thirdly, protein intake and degradation determine urinary excretion of SO4. These three groups of nutrients are the primary determinants of the food-borne estimated average renal acid load [18]. OA excretion in healthy individuals depends mainly on body size, but can be moderately influenced by protein intake [6,19].…”

Section: Renal Nae Actual Renal Net Acid Load and Estimated Averagementioning

confidence: 99%

“…Thus, a theoretical concept considering blood acid base status, serum data, intake data of protein and minerals, estimated average renal acid load, and measured renal Table 1. Estimation of renal net acid excretion in a hypothetical normal infant with a postnatal age of 26 days, a body weight of 2.4 kg, a weight gain of 11 g/kg per day, and an intake of human milk of 169 ml/ kg per day corresponding to the observed mean values of a group of nine premature infants fed human milk [12,13] (Table 2) [18]. When looking at the effect of nutrition on actual renal acid load, three groups of nutrients influencing renal NAE can be distinguished.…”

Section: Renal Nae Actual Renal Net Acid Load and Estimated Averagementioning

confidence: 99%

“…In pathophysio-233 Table 2. Measured and estimated renal net acid excretion in a term baby with late metabolic acidosis (age 29 days, body weight 3.11 kg, intake of formula 174 ml/kg per day) [18]. Estimation was carried out for a normal healthy term baby of the same age, body weight, and intake volume.…”

Section: Advantages Of the Classical Operational Concept Of Acid Basementioning

confidence: 99%

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Renal acid excretion in early infancy

Manz

Kalhoff

Remer

1997

Pediatric Nephrology

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In early infancy, complex disorders of acid base metabolism are more frequent than in any other age group, with a predisposition to metabolic acidosis due to an age-related low renal capacity for acid excretion and an unphysiologically high actual renal acid load in nutrition with common formulas. Recently in preterm and small-for-gestational-age infants, persistent maximum renal net acid excretion (NAE) with subnormal or normal blood acid base status, impaired weight gain, and adaptive hormonal reactions have been observed. Incipient late metabolic acidosis is one example of a mixed disorder of acid base metabolism with maximum renal NAE in early infancy. Alkali therapy is highly effective and can be realized both on an individual basis, using urine pH screening as a diagnostic criterium for maximum renal acid stimulation, or on a general preventive level using modified standard formula with a reduced actual renal NAE similar to that seen on alimentation with human milk. From an integrated point of view, the low glomerular filtration rate and renal capacity for acid excretion beyond the developmental age of more than 44 weeks, may well be interpreted as the result of a specific adaptation to breast feeding sparing energy, and thus an evolutionary advantage for the survival of mother and child.

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Section: Renal Nae Actual Renal Net Acid Load and Estimated Averagementioning

confidence: 99%

Section: Renal Nae Actual Renal Net Acid Load and Estimated Averagementioning

confidence: 99%

Section: Advantages Of the Classical Operational Concept Of Acid Basementioning

confidence: 99%

See 1 more Smart Citation

Renal acid excretion in early infancy

Manz

Kalhoff

Remer

1997

Pediatric Nephrology

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“…Occasionally, hypocalcaemic tetany may occur in otherwise healthy term infants receiving a high phosphorus formula (Venkataraman et al 1985). Finally, a high phosphorus intake is a risk factor for the development of metabolic acidosis in high risk term infants (Kalhoff et al 1990).…”

Section: Minerals a N D Trace Elementsmentioning

confidence: 99%

The Composition of Human Milk as a Model for the Design of Infant Formulas: Recent Findings and Possible Applications

Goedhart

Bindels

1994

Nutr. Res. Rev.

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“…High renal net acid excretion on alimenta tion with a given formula is not solely depen dent on the composition of the diet, but varies also with individual bioavailability and me tabolism of several nutrients [2,3], We wondered whether small prematures with body weights below 1,600 g show a net acid excretion similar to larger prematures and small-for-date newborns with body weights above 2,100 g on alimentation with the same standard commercial preterm for mula.…”

Section: Introductionmentioning

confidence: 99%

Increased Renal Net Acid Excretion in Prematures below 1,600 g Body Weight Compared with Prematures and Small-for-Date Newborns above 2,100 g on Alimentation with a Commercial Preterm Formula

Kalhoff¹,

Wiese²,

Kunz³

et al. 1994

Neonatology

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In 76 low birth weight infants with an actual body weight ranging from 1,210 to 2,540 g and fed a commercial preterm formula, urine samples were collected and blood acid base status was measured on day 38 ( ± 17, mean ± SD) of life. Infants with an actual body weight below 1,600 g demonstrated a higher daily weight gain (22 ± 3 vs. 14 ± 5 g/kg/day), lower blood pCO₂ (35.4 ± 5.0 vs. 38.9 ± 3.8 mm Hg), lower urine pH (5.8 ± 0.5 vs. 6.5 ± 0.3), higher renal net acid (1.86 ± 0.38 vs. 1.28 ± 0.55 mmol/ kg/day) and higher phosphorus excretion (0.67 vs. 0.52 mmol/kg/day) than infants with an actual body weight above 2,100 g. Urinary ionogram data of these 2 groups of infants show that the increased renal net acid excretion of the smaller prematures is the result of a lower urinary excretion of sodium, potassium and chloride, due to a higher daily weight gain, probably a higher retention of these minerals, and a higher urinary phosphorus excretion probably due to an age-specific lower intestinal calcium absorption, and therefore a lower rate of calcium and phosphorus retention. Considering the low renal capacity for hydrogen ion excretion, very low birth weight infants still run a considerable risk for disturbances of acid base metabolism due to the high mean level of net acid excretion in nutrition with preterm formulas and an additional age-specific augmentation of renal acid load.

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Suboptimal Mineral Composition of Cow's Milk Formulas: A Risk Factor for the Development of Late Metabolic Acidosis

Abstract: Late metabolic acidosis was observed in a term baby boy with renal tubular acidosis type 4 who received two cow's milk formulas in succession. Suboptimal mineral composition of the formulas turned out to be an important risk factor for the development of late metabolic acidosis.

Cited by 18 publications

References 8 publications

Renal acid excretion in early infancy

Renal acid excretion in early infancy

The Composition of Human Milk as a Model for the Design of Infant Formulas: Recent Findings and Possible Applications

Increased Renal Net Acid Excretion in Prematures below 1,600 g Body Weight Compared with Prematures and Small-for-Date Newborns above 2,100 g on Alimentation with a Commercial Preterm Formula

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