Intestinal absorption of calcium and magnesium in hepatobiliary disease in infancy

Abstract

Archives of Disease in Childhood, 49, 90. Intestinal absorption of calcium and magnesium in hepatobiliary disease in infancy. The intestinal absorption of calcium and magnesium was measured by metabolic balance studies in 6 normal infants, 13 infants with biliary atresia, 5 infants with successfully repaired biliary atresia, 7 infants with neonatal hepatitis, and 2 infants with choledochal cyst. The absorption of both elements was impaired in these disorders. The malabsorption of these elements was most marked in biliary atresia. In successfully repaired biliary atresia the absorption was increased to the normal levels. In neonatal hepatitis the degree of the malabsorption was variable in individual cases. In choledochal cyst the reduction of the absorption was less marked than in biliary atresia and neonatal hepatitis. In biliary atresia parenteral vitamin D increased moderately the absorption of both elements, though oral vitamin D had little effect. In infants with biliary atresia receiving a milk containing medium-chain triglycerides the absorption was moderately raised. There was a clear relation between the absorption of calcium and that of magnesium: the per cent. absorption of magnesium was almost the same as that of calcium in most cases. The serum calcium level determined during the studies was within the normal ranges in hepatobiliary diseases. The serum magnesium level was, however, found to be generally reduced in these conditions. It was greatly reduced in the patients with biliary atresia.

Serum 25-hydroxy-vitamin D in hepatobiliary disease in infancy.

“…This conclusion accords with our previous report on the intestinal absorption of calcium and magnesium in hepatobiliary disease in infancy (Kobayashi et al, 1974b). In the paper, it was shown that in biliary atresia parenteral vitamin D increased moderately the absorption of both elements, although oral vitamin D had little effect.…”

Effect of Dietary Calcium on Metabolic Balance of Normal Infants

“…Although absorption of calcium and fat were consistently lower in this subject than in the other five subjects, the absorption of other nutrients was not noticeably affected. Increased fecal excretion of fat (47)(48)(49) as well as impaired digestion of lactose (50, 5 1) have been shown to be associated with impaired absorption of calcium. However, if impaired absorption of fat or lactose had been the primary defect, one would have expected some recognizable clinical correlate and probably poor absorption of other nutrients.…”

Bone disease in infants and children with hepatobiliary disease

“…Bile is important for the intestinal absorption of calcium and magnesium because it is necessary for the absorption of vitamin D (Schachter, Finkelstein, and Kowarski, 1964), which enhances the absorption of both elements. Bone disease may be attributable to the malabsorption of these elements in hepatobiliary disease in which bile flow into the intestines is deficient or absent (Kobayashi et al, 1974). Furthermore, vitamin D that is absorbed from the gastrointestinal tract via the lymphatics and is transported from there to the liver in the chylomicron of the plasma may be hydroxylated in the liver to a more potent metabolite, 25-hydroxycholecalciferol (25-HCC) (Lund and DeLuca, 1966;Ponchon, Kennan, and DeLuca, 1969), which is thought to be converted to more active forms, 1, 25or 21,25or 21, in the kidneys (Fraser and Kodicek, 1970).…”

“…Kobayashi et al (1974) showed that in biliary atresia oral vitamin D had little, if any, effect on the absorption of calcium and magnesium, though the vitamin moderately increased absorption when given intramuscularly. It is reasonable to conclude from these studies that vitamin D should be given intramuscularly to reduce the incidence and severity of rickets in this disorder.…”