Clinical pharmacology of sodium cellulose phosphate

Vitamin D-dependent Hypercalcemia

Vitamin D metabolism represents a well-integrated, hormonally regulated endocrine unit interlinking calcium and phosphate metabolism. Pathophysiologic processes disturbing vitamin D metabolism comprise classic defects of vitamin D activation and action presenting as different forms of vitamin D-dependent rickets as well as disorders with increased vitamin D activity. The latter may result in hypercalcemia, hypercalciuria, and renal calcifications. Acquired and hereditary disorders causing hypervitaminosis D are discussed, including vitamin D intoxication, granulomatous disease, and idiopathic infantile hypercalcemia that may be caused by either a defective vitamin D degradation or by a primary defect in phosphate conservation.

Vapor Phosphorylation of Cellulose by Phosphorus Trichlo-Ride: Selective Phosphorylation of 6-Hydroxyl Function-The Synthesis of New Antimicrobial Cellulose 6-Phosphate(III)-Copper Complexes

This research is focused on a synthesis of copper-cellulose phosphates antimicrobial complexes. Vapor-phase phosphorylations of cellulose were achieved by exposing microcrystalline cellulose to phosphorus trichloride (PCl₃) vapors. The cellulose-O-dichlorophosphines (Cell-O-PCl₂) formed were hydrolyzed to cellulose-O-hydrogenphosphate (P(III)) (Cell-O-P(O)(H)(OH)), which, in turn, were converted into corresponding copper(II) complexes (Cell-O-P(O)(H)(OH)∙Cu²⁺). The analysis of the complexes Cell-O-P(O)(H)(OH)∙Cu²⁺ covered: scanning electron microscopy (SEM), attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR), atomic absorption spectrometry with flame excitation (FAAS), and bioactivity tests against representative Gram-negative bacteria (Escherichia coli) and Gram-positive bacteria (Staphylococcus aureus). The antimicrobial tests of synthesized Cell-O-P(O)(H)(OH)∙Cu²⁺ revealed their potential applications as an antibacterial material.

Long-term follow-up of patients with idiopathic infantile hypercalcaemia

Idiopathic infantile hypercalcaemia (IIH) is a rare disorder of unknown etiology that presents with hypercalcaemia in a child's first year of life. There is only a limited number of published reports of the natural history of this condition, and the long-term prognosis is largely unknown. The presentation, treatment and long-term follow-up of 11 children with IIH treated at our institution since 1993 are described. Hypercalcaemia resolved in the majority of children by the time they were 3 years of age, but nephrocalcinosis and persistent hypercalciuria were common, and, in some cases, urinary calcium excretion increased after initially becoming normal. This study suggests that clinical and biochemical abnormalities may persist for longer than previously reported and implies the need for ongoing surveillance of patients with IIH.

Drug-induced hypomagnesaemia : scope and management

Nearly 50 medications have been implicated as inducing hypomagnesaemia, sometimes based on insufficient data regarding clinical significance and frequency of occurrence. In fact, clinical effects attributed to hypomagnaesemia have been reported in only 17 of these drugs. A considerable amount of literature relating to individual drugs has been published, yet a comprehensive overview of this issue is not available and the hypomagnesaemic effect of a drug could be either overemphasised or under-rated. In addition, there are neither guidelines regarding treatment, prevention and monitoring of drug-induced hypomagnesaemia nor agreement as to what serum level of magnesium may actually be defined as 'hypomagnesaemia'. By compiling data from published papers, electronic databases, textbooks and product information leaflets, we attempted to assess the clinical significance of hypomagnesaemia induced by each drug. A practical approach for managing drug-induced hypomagnesaemia, incorporating both published literature and personal experience of the physician, is proposed. When drugs classified as inducing 'significant' hypomagnesaemia (cisplatin, amphotericin B, ciclosporin) are administered, routine magnesium monitoring is warranted, preventive treatment should be considered and treatment of hypomagnesaemia should be initiated with or without overt clinical manifestations. In drugs belonging to the 'potentially significant' category, among which are amikacin, gentamicin, laxatives, pentamidine, tobramycin, tacrolimus and carboplatin, magnesium monitoring is justified when either of the following occurs: clinical manifestations are apparent; persistent hypokalaemia, hypocalcaemia or alkalosis are present; other precipitating factors for hypomagnesaemia coexist; or treatment is with more than one potentially hypomagnesaemic drug. No preventive treatment is required and treatment should be initiated only if hypomagnesaemia is accompanied by symptoms or clinically significant relevant laboratory findings. In those drugs whose hypomagnesaemic effect is labelled as 'questionable', including furosemide and hydrochlorothiazide, routine monitoring and treatment are not required.

Prednisolone and cellulose phosphate treatment in idiopathic infantile hypercalcaemia with nephrocalcinosis

A girl presented at the age of 8 months with idiopathic infantile hypercalcaemia complicated by hypercalciuria, nephrocalcinosis and failure to thrive. Her hypercalcaemia was partially corrected by prednisolone, but resolved with the addition of cellulose phosphate. Her height and weight showed significant improvement during the treatment period. Cellulose phosphate should be considered in the management of children with idiopathic infantile hypercalcaemia and nephrocalcinosis.

Cellulose phosphate and chlorothiazide in childhood idiopathic hypercalciuria

A calcium loading test performed on seven of eight children with idiopathic hypercalciuria identified the hyperabsorptive form of hypercalciuria in five and renal hypercalciuria in one. The type of hypercalciuria was not identified in the other patient. Three children presented with hematuria without calculus formation. Chlorothiazide reduced the urinary calcium excretion level in two of six patients to the normal range. The addition of cellulose phosphate to chlorothiazide reduced the urinary calcium excretion level to the normal range in those four patients who showed an incomplete response to chlorothiazide alone. There was clinical improvement with cellulose phosphate in another child whose symptoms did not disappear after chlorothiazide had reduced urinary calcium level to the normal range. Cellulose phosphate is effective in children with recurrent stone formation who have shown inadequate response to chlorothiazide.

New drug therapy for kidney stones: a review of cellulose sodium phosphate, acetohydroxamic acid, and potassium citrate

Kidney stones have an overall incidence of two to three percent in western countries. In many patients, the disease process is difficult to control and recurrence rates are high: 20 to 50 percent over the subsequent ten years. The pathogenesis and standard methods of treatment for the five major types of stones (i.e., calcium oxalate, struvite, calcium phosphate, uric acid, and cystine) are reviewed. Three new drugs are reviewed in the context of their roles in the selective treatment of kidney stones. Cellulose sodium phosphate (Calcibind) is a nonabsorbable ion-exchange resin with a limited indication for the treatment of calcium stones associated with absorptive hypercalciuria Type I. Acetohydroxamic acid (Lithostat) is an urease-inhibitor that is indicated as adjunctive therapy in patients with chronic urea-splitting urinary tract infections and struvite stones. Potassium citrate (Urocit) is an investigational agent that has clinical efficacy in patients with calcium oxalate and calcium phosphate stones who are hypocitraturic. In addition, potassium citrate is an alkalinizing agent that can be used in patients with uric acid stones.

Rice bran treatment for patients with hypercalciuric stones: experimental and clinical studies

The purpose of this study is to confirm the hypocalciuric effect of rice bran experimentally and clinically. Urinary calcium excretion and its absorption in the intestine were reduced significantly by rice bran or phytin in rats fed high calcium diets, while there were no significant decreases with a low calcium diet. For the clinical study 70 patients with idiopathic hypercalciuria were treated with rice bran (10 gm. twice daily) for 1 month to 3 years. In almost all patients rice bran caused a significant decrease in urinary calcium excretion, which was maintained during treatment. Evidence of stones has decreased clearly among patients treated with rice bran for 1 to 3 years, although this might be a halfway judgment of the long-term treatment. We suggest that phytin should be the most effective substance to reduce the intestinal absorption of calcium and that rice bran treatment should be effective for prevention of recurrent urinary stone disease.

Cation exchange resin preparation in recurrent calcium urolithiasis

The efficacy of the cation exchange preparation, Campanyl, was studied in animal experiments and also in patients with absorptive hypercalciuria suffering from recurrent calcium stones, both in short-term studies on several treatment groups and with long-term maintenance dosage. In a dose of 15 Gm daily, taken with the main meal, the preparation was well tolerated and no serious side effects occurred. The frequency of stone passage, compared with that in the pretreatment period, was reduced by more than half, and urinary calcium excretion was considerably reduced. Litholysis was not observed. Campanyl is considered to be especially useful in patients with hyperabsorptive hypercalciuria. Dosage should be adjusted individually according to urinary calcium concentration.