Relationship between the sulfur content of total parenteral nutrition and sulfoester excretion in low-birthweight infants

Urinary sulfur excretion and the nitrogen/sulfur balance ratio reveal nonprotein sulfur amino acid retention in piglets

We evaluated the use of urinary sulfur (S) excretion as a measure of sulfur amino acid (SAA) catabolism and the nitrogen/sulfur (N/S) molar balance ratio as an indicator of nonprotein SAA storage in growing piglets. After confirming that an intravenous dose of sulfate is fully recovered in urinary sulfate, we measured urinary S recovery after an intravenous dose of methionine in 6 piglets fed an adequate protein (AP) diet and 6 piglets fed a low protein (LP) diet with normal energy provision. As measured over 48 h, recoveries of the methionine load as urinary total S was 106% in the AP group but only 69% in the LP group (P < 0.05). On the baseline diets the N/S balance ratio in the AP group was 36, whereas that in the LP group was 30 (P < 0.05); immediately after the methionine load, this ratio remained constant in the AP group but decreased further, to 26 (P < 0.05) in the LP group. These results indicate that protein-deficient piglets accumulate relatively more S than N from their diet, and under these conditions a significant portion of the S derived from a methionine load is retained in nonprotein compounds. Urinary S excretion, a simple nontracer measurement, can provide an accurate measure of SAA catabolism, and the N/S balance ratio is a potentially useful indicator of changes in nonprotein SAA stores of growing piglets.

Quantitation of sulfate and thiosulfate in clinical samples by ion chromatography

For assay of serum sulfate, quantitation by ion conductimetry after separation by anion-exchange chromatography is the method of choice. In comparison to classical barium precipitation methods, chromatographic methods demonstrate increased precision, specificity and sensitivity, and they may be superior to spectrophotometric methods that rely on organic cation precipitation of sulfate. The increased sensitivity and specificity, as well as the inherent capacity of chromatographic methods for simultaneous determination of other anions, has led to its increasing use in the determination of excreted sulfate in clinical profiles of urinary anion composition. Ion chromatography can also be used to quantitate free sulfate in other clinical samples, including cerebrospinal fluid, sweat, saliva, breast milk and human tissues. Finally, ion chromatography shows promise as a more precise and sensitive method for measurement of total acid-labile sulfoesters and thiosulfate.

The depression of hepatic drug conjugation reactions in rats after lipid-free total parenteral nutrition administered via the portal vein

BACKGROUND

Total parenteral nutrition provides nutrition support in patients who are unable to eat. Long-term parenteral nutrition is accompanied by alterations in gut and liver function including changes in drug metabolism. This study examined the effects of lipid-free total parenteral nutrition in rats on (1) the overall elimination pharmacokinetics of acetaminophen, (2) changes in sulfation and glucuronidation pathways during acetaminophen elimination, and (3) hepatic drug metabolizing enzyme activities determined in vitro.

METHODS

Chronic indwelling catheters were implanted in the aorta, inferior vena cava, and portal vein of adult male Sprague-Dawley rats. Total parenteral nutrition, consisting of 25% dextrose, 5% amino acids, electrolytes, and vitamins, was infused via the portal vein for up to 14 days. Acetaminophen pharmacokinetics were characterized in vivo and selected drug metabolizing enzyme activities were determined in vitro.

RESULTS

Parenteral nutrition for 10 days decreased the total clearance of acetaminophen by 23% (from 11.5 +/- 1.4 to 8.9 +/- 1.4 mL/min per kg; p < .05) and decreased the formation clearance to acetaminophen sulfate (from 6.2 +/- 0.4 to 3.9 +/- 0.5 mL/min per kg; p < .05). Parenteral nutrition decreased microsomal cytochrome P450 concentration (47%), p-nitroanisole demethylase activity (68%) and p-nitrophenol UDP-glucuronosyltransferase activity (58%). Cytosolic glutathione-S-transferase activity towards 1-chloro-2,4-dinitrobenzene decreased 29%. Sulfotransferase activity towards p-nitrophenol and acetaminophen was decreased 48% and 25%, respectively.

CONCLUSION

Lipid-free, total parenteral nutrition depresses drug conjugative metabolism in rats. The magnitude of this effect in humans remains to be investigated.

Developmental changes in the renal capacity for sulfate reabsorption in the guinea pig

During growth, immature guinea pigs maintain a positive inorganic sulfate balance. In the present study, renal clearance techniques were used to determine the maximum renal capacity for sulfate reabsorption [TmRsi/glomerular filtration rate (GFR)] in three groups of guinea pigs at different stages of development (10-34 days, 35-80 days and greater than 120 days of age). These ages are comparable to infant, adolescent, and adult guinea pigs. The guinea pigs were weaned at 10 days and then maintained on normal guinea pig chow (0.13% sulfate). The TmRsi/GFR was determined by infusions of increasing concentrations of sulfate (0-16.8 mumol/min). TmRsi/GFR was significantly greater in young (infant and adolescent) than in older (adult) guinea pigs (2.20 +/- 0.26 mumol/ml and 1.80 +/- 0.27 mumol/ml vs 0.942 +/- 0.08 mumol/ml, P less than 0.05). These results demonstrate that the tubular capacity for inorganic sulfate reabsorption per milliliter of glomerular filtrate is enhanced in immature guinea pigs and decreases with age.

Mineral requirements of low-birth-weight infants

The minerals calcium (Ca), magnesium (Mg), and phosphorus (P) are essential for tissue structure and function. Recent studies have resulted in a more rational approach to the management of mineral intake in preterm infants receiving parenteral nutrition (PN) and enteral nutrition (EN). For preterm infants requiring PN, the use of PN solutions with a Ca content of 1.25-1.5 mmol/dl (50-60 mg/dl), a P content of 1.29-1.45 mmol/dl (40-45 mg/dl), and an Mg content of 0.2-0.3 mmol/dl (5-7 mg/dl) is supported by studies of mineral homeostasis with serial chemical and calciotropic hormone measurements, standard balance studies, and improved radiographic indices of bone mineralization. For infants requiring EN, an intake of approximately 4 mmol (200 mg) of Ca, 3.2 mmol (100 mg) of P, and 0.33 mmol (8 mg) of Mg/kg/day based on an average retention rate of 64% for Ca, 71% for P, and 50% for Mg should be sufficient to meet the requirements of preterm infants in early infancy. This level of intake is supported by data from balance studies using standard and stable isotope techniques, changes in bone mineral content (BMC) measurements, and calciotropic hormone data. Based on the timing of development of fractures and rickets, changes in BMC, and skeletal growth data, the increased Ca and P intake should continue for at least 3 months after birth or until reaching a body weight of about 3.5 kg. In addition, nonnutritional factors may have the potential to increase mineral loss and disturb mineral homeostasis; chronic diuretic therapy increases mineral loss, and aluminum contamination of nutrients theoretically may compound any skeletal disorder. Thus, attention to the level of mineral intake and factors important in mineral loss and mineral metabolism should optimize mineral retention in small preterm infants.

Quantitation of free sulfate and total sulfoesters in human breast milk by ion chromatography

A method for the assay of free sulfate and total sulfoesters in human breast milk by ion chromatography is described. After incubation in 1 M hydrochloric acid at 95 degrees C for 90 min, hydrolytic cleavage of sulfoester standards was essentially complete. The increase in free sulfate after hydrolysis was used as a measure of total acid-labile sulfoesters. We found that this fraction [222 +/- 16 mumol/l (mean +/- standard error), n = 29] comprised 87% of the total sulfate in mature milk. Free sulfate (35 +/- 3 mumol/l) therefore makes only a small contribution to the total sulfate pool available to human infants.