Identification of crystals deposited in brain and kidney after xylitol administration by biochemical, histochemical, and electron diffraction methods

Evans, Gary W.; Phillips, Gael E.; Mukherjee, T. M.; Snow, Michael R.; Lawrence, J. R.; Thomas, David W.

doi:10.1136/jcp.26.1.32

Cited by 76 publications

(8 citation statements)

References 10 publications

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“…Acidosis is followed by deteriorating renal function and death. Oxalate crystals have been demonstrated in the kidney and brain of patients dying in this way (Evans et al, 1973;Schroder et al, 1974). More recent studies have suggested that patients with renal failure who are infused rapidly with large doses of xylitol are unable to excrete the large amounts of glycolic acid formed.…”

Section: Acquired Oxalosismentioning

confidence: 99%

“…Various sophisticated techniques such as x-ray diffraction, electron microprobe, and chromatography have all been used to identify calcium oxalate derived from histological material (Bennett and Rosenblum, 1961;Bennington et al, 1964;Evans et al, 1973). Facilities for such techniques are not always readily available, while the random orientation and fragmentation of the crystals create difficulties in their application.…”

Section: (B) Histological Characterisation Of Calcium Oxalatementioning

confidence: 99%

“…It is insoluble in water, alkalis, alcohol, and other organic solvents, poorly soluble in periodic acid, and markedly soluble in mineral acids (Yasue, 1969a;Evans et al., 1973;Chaplin, 1974). It is its insolubility in acetic acid which distinguishes calcium oxalate from other calcium salts and forms the basis of its histological identification.…”

Section: Solubilitymentioning

confidence: 99%

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Histopathological occurrence and characterisation of calcium oxalate: a review.

Chaplin¹

1977

J Clin Pathol

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Section: Acquired Oxalosismentioning

confidence: 99%

Section: (B) Histological Characterisation Of Calcium Oxalatementioning

confidence: 99%

Section: Solubilitymentioning

confidence: 99%

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Histopathological occurrence and characterisation of calcium oxalate: a review.

Chaplin¹

1977

J Clin Pathol

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“…During the past 30 years several cases of fatal reactions following xylitol infusion have been reported (Evans et al 1973;Schultze et al 1983;Frydl 1987;Bergmann et al 1991;Heye et al 1991;Leidig et al 2001). In all cases the most striking abnormality was the presence of birefringent crystalline material in the tubules of the kidneys.…”

Section: Introductionmentioning

confidence: 94%

Fatal cerebro-renal oxalosis after appendectomy

Pfeiffer¹,

Weiss²,

Karger³

et al. 2004

International Journal of Legal Medicine

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A case of a 24-year-old male with fatal cerebro-renal oxalosis assumed to be due to infusions of the sugar surrogate xylitol after appendectomy is reported. The diagnosis was established only after intensive histological investigations following the autopsy. The clinical picture was characterized by an acute seizure, coma and renal failure 2 days after the first xylitol infusion. Death occurred due to cerebral dysregulation as a very rare complication after parenteral administration of xylitol. Subendothelial double refractive calcium oxalate crystals were found in the walls of cerebral blood vessels, in particular in the stem ganglion regions and in the cortical renal tubules. The most common type of primary oxalosis was excluded by sequencing analysis. The young age, the minor surgical intervention and the otherwise unremarkable history are special features of this case. Since the genetic background of xylitol intolerance is still unclear, it is suggested that it should be banned as a sugar surrogate in clinical practice.

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“…Different toxicities associated with nonglucose carbohydrates have been observed. Xylitol overdose has caused a few cases of deposits of oxalate crystals in the kidney and brain (Evans et al, 1973;Heye et al, 1991). Administration of large amounts of fructose or xylitol can produce lactic acidosis (Leutenegger et al, 1977;Ladefoged et al, 1982;Danahoe & Powers, 1970).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of nonglucose carbohydrates in parenteral nutrition for diabetic patients

et al. 2001

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Objective: There is little information on the advantages of nonglucose carbohydrates in total parenteral nutrition (TPN) for diabetic patients. The aim of this study is to evaluate glycemic control and insulin requirements in diabetic patients who received TPN with different sources of carbohydrates, and to determine whether insulin requirements are different when septic and non-septic diabetic patients are studied. Materials and Methods: One-hundred and thirty-eight patients were randomly divided into two groups receiving either glucose (G), n ¼ 71, or glucose-fructose-xylitol 2 : 1 : 1 (GFX), n ¼ 67. There were no differences between the demographic or anthropometric characteristics of the groups, nor between the patients with diabetes mellitus type 1 and type 2, nor the initial TPN composition. Acceptable glycemic control was considered when glycemia reached < 200 mg=dl. Results: Glycemic control was attained in 79.7% of patients (74.6 vs 85.1%), in the same period of treatment. At the end of treatment, insulin requirements were not different (45 AE 19 vs 45 AE 26 UI=day) in both groups, while similar amounts of carbohydrates (191 AE 36 vs 187 AE 45 g=day) were infused. The ratio insulin=body weight and insulin=carbohydrates were equal in both groups. In the GFX group nonseptic and septic patients needed less and more insulin, respectively, than their counterparts in the G group. No major adverse events related to carbohydrate infusions were observed. Conclusions: Either G or GFX could be used in TPN for diabetic patients, providing glycemic control in most cases with similar insulin requirements. GFX mixtures were slightly more beneficial to attain glycemic control in nonseptic patients, but septic diabetic patients had higher insulin needs in this group.

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Identification of crystals deposited in brain and kidney after xylitol administration by biochemical, histochemical, and electron diffraction methods

Cited by 76 publications

References 10 publications

Histopathological occurrence and characterisation of calcium oxalate: a review.

Histopathological occurrence and characterisation of calcium oxalate: a review.

Fatal cerebro-renal oxalosis after appendectomy

Evaluation of nonglucose carbohydrates in parenteral nutrition for diabetic patients

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