oxalates and Short-Bowel-Syndrome

Systemic oxalosis is a condition in which calcium oxalate crystals deposit into various bodily tissues. Although this may occur as the result of a rare primary syndrome in which an error of glyoxylate metabolism causes an overproduction of oxalate, it is more often seen as a secondary process characterized by increased enteric oxalate absorption. Here, we describe a patient with short bowel syndrome on long-term parenteral nutrition support who developed a unique manifestation of systemic oxalosis, leading to deposition of oxalate crystals within the bone marrow contributing to pancytopenia. In this report, in addition to reviewing the literature on this presumably rare manifestation of oxalosis, we also discuss its pathogenesis in the setting of short bowel syndrome and its management, including prevention.

Topics: Bone Marrow; Humans; Hyperoxaluria; Oxalates; Pancytopenia; Short Bowel Syndrome

Short bowel syndrome (SBS) occurs in patients who have had extensive resection. The primary physiologic consequence is malabsorption, resulting in fluid and electrolyte abnormalities and malnutrition. Nutrient digestion, absorption, and assimilation may also be diminished by disturbances in the production of bile acids and digestive enzymes. Small bowel dilation, dysmotility, loss of ileocecal valve, and anatomical changes combined with acid suppression and antimotility drugs increase the risk of small intestinal bacterial overgrowth, further contributing to malabsorption. Metabolic changes that occur in SBS due to loss of colonic regulation of gastric and small bowel function can also lead to depletion of calcium, magnesium, and vitamin D, resulting in demineralization of bone and the eventual development of bone disease. Persistent inflammation, steroid use, parenteral nutrition, chronic metabolic acidosis, and renal insufficiency may exacerbate the problem and contribute to the development of osteoporosis. Multiple factors increase the risk of nephrolithiasis in SBS. In the setting of fat malabsorption, increased free fatty acids are available to bind to calcium, resulting in an increased concentration of unbound oxalate, which is readily absorbed across the colonic mucosa where it travels to the kidney. In addition, there is an increase in colonic permeability to oxalate stemming from the effects of unabsorbed bile salts. The risk of nephrolithiasis is compounded by volume depletion, metabolic acidosis, and hypomagnesemia, resulting in a decrease in renal perfusion, urine output, pH, and citrate excretion. This review examines the causes and treatments of small intestinal bacterial overgrowth, bone demineralization, and nephrolithiasis in SBS.

Topics: Bacteria; Bone and Bones; Bone Density; Calcium; Colon; Humans; Intestinal Mucosa; Intestine, Small; Kidney; Kidney Calculi; Osteoporosis; Oxalates; Short Bowel Syndrome

Diarrhoea, malabsorption and malnutrition characterise the short bowel syndrome. The underlying gastrointestinal disorders, the types of intestinal resections performed and the subsequent pathophysiological situations are reviewed. Recommended therapeutic measures in the postoperative period as well as in the rehabilitation of patients with short bowel syndrome are discussed in more detail. In the postoperative period, parenteral nutrition is essential followed by an enteral diet to stimulate bowel adaptation, reduce fluid loss and increase nutrient absorption. The final diet should be based on the anatomy of the retained bowel (presence or absence of a colon and ileum). The importance of the colon as a digestive organ in patients with short bowel and the need of a low-oxalate diet are underlined. The possible benefit of new treatment options (glutamine, growth hormone and glucagon-like peptide 2) is discussed. Both typical complications of the short bowel syndrome and management of these complications are presented.

Topics: Combined Modality Therapy; Enteral Nutrition; Glucagon-Like Peptide 2; Glucagon-Like Peptides; Glutamine; Growth Hormone; Humans; Intestinal Absorption; Jejunostomy; Oxalates; Parenteral Nutrition, Total; Postoperative Complications; Prognosis; Randomized Controlled Trials as Topic; Short Bowel Syndrome; Treatment Outcome; Water-Electrolyte Balance

Topics: Animals; Diarrhea; Humans; Oxalates; Parenteral Nutrition; Short Bowel Syndrome

We present a case of a patient with short bowel syndrome in a hemodialysis program, with recurrent episodes of serious acidosis. The presence of a D-lactic acidosis peak secondary to bacterial overgrowth in the intestine was discovered during an acute episode of acidosis, with neurological affection. The detection of acidosis in predialysis measurements and the acute episodes of acidosis, made it necessary to administer bicarbonate to the patient and give him additional hemodialysis sessions.

Topics: Acidosis, Lactic; Adult; Bicarbonates; Brain Diseases, Metabolic; Consciousness Disorders; Drug Therapy, Combination; Dysarthria; Gram-Positive Bacteria; Humans; Intestines; Kidney Failure, Chronic; Lactates; Male; Neomycin; Oxalates; Paromomycin; Recurrence; Renal Dialysis; Short Bowel Syndrome; Urinary Calculi

One hundred and sixty three children who received total parenteral nutrition (TPN), including 7 cases of short bowel syndrome, were studied to evaluate the role of TPN in the management of infants with extremely short bowel. Three of the seven were died of sepsis related with central venous catheter (CV catheter) during the period of malabsorption when TPN was necessary. Two children of other diseases were died of catheter sepsis, 5 out of 163 in total, making the mortality late of TPN 3%. Incidence of CV catheter related complications was significantly less frequent in Broviac catheter when compared with conventional Silastic catheter (p less than 0.01). Another significant complication of TPN in cases of short bowel syndrome was hepatic dysfunction. Cholestatic liver dysfunction seemed to be cleared when enteral feeding was started even with TPN going on. Oral feeding should be started in the early postoperative period with concomitant TPN covering the fluid loss. A case of copper deficiency with high output jejunostomy and a case of urolithiasis with hyperoxaluria complicated with short bowel were reported.

Topics: Catheterization; Child; Child, Preschool; Follow-Up Studies; Humans; Liver Diseases; Malabsorption Syndromes; Oxalates; Parenteral Nutrition, Total; Short Bowel Syndrome

Topics: Adaptation, Physiological; Adolescent; Adult; Aged; Animals; Child; Child, Preschool; Cholelithiasis; Diarrhea; Dogs; Humans; Infant; Infant, Newborn; Long-Term Care; Malabsorption Syndromes; Middle Aged; Oxalates; Parenteral Nutrition; Parenteral Nutrition, Total; Patient Care Team; Short Bowel Syndrome