Metabolic Studies in Paralytic Acute Anterior Poliomyelitis. Ii. Alterations in Calcium and Phosphorus Metabolism 1

Abstract

Further evidence of the extensive effects of infection with the poliomyelitis virus upon many bodily systems is presented in this paper, the second of a series (1) describing metabolic and physiological features of the natural course of paralytic acute anterior poliomyelitis during its acute, convalescent and chronic phases.The most marked alteration in metabolism noted during the immobilization of healthy subjects in body casts (2) was greatly increased excretion of calcium, progressing to urinary calcium outputs more than double those of the control phase and to large negative calcium balances. This striking result suggested that it would be pertinent to investigate the extent of mineral loss occurring in patients with a seriously immobilizing disease such as paralytic acute anterior poliomyelitis.Several indications of alteration in calcium and phosphorus metabolism in poliomyelitis have been reported, such as hypercalcemia, hypercalciuria, urinary tract lithiasis, bone rarefaction and retardation of bone growth. Orr (3) found hypercalcemia four months after onset in a nine-yearold boy with extensive paralysis and, later, in 10 of 11 other children with paralytic poliomyelitis. Wilkins (4) noted "hypercalcemia in some of the paralytic cases at Children's Hospital" in Baltimore. Hypercalciuria in poliomyelitis has been mentioned several times but quantitatively only once, by Wilkins (5) who found as much as 1 gram per day in the urine of a patient, presumably a child, with poliomyelitis. The frequence of urinary tract calculi formation in poliomyelitis is well known, particularly in severely paralyzed patients

Measurement of Ionised Calcium in Body Fluids—A Review

“…4, taken from the data of Heath et al, 1972). Ailshown there is also a well-documented increase in urinary calcium excretion during the immobilisation period (Albright et al, 1941;Whedon and Shorr, 1957). In contrast with the effect of short-term changes in posture (Fig.…”

“…induces an imbalance between the rates of bone formation and resorption (Heaney, 1962), caused by the absence of longitudinal pressure (weight-bearing) on bone (Whedon and Shorr, 1957). …”

Metabolic Studies in Paralytic Acute Anterior Poliomyelitis. Iv. Effects of Testosterone Propionate and Estradiol Benzoate on Calcium, Phosphorus, Nitrogen, Creatine and Electrolyte Metabolism 1

“…The methods for analysis of urine, stool and serum for the various chemical constituents have been given in the first two papers of this series (1,2). Metabolic balance studies were carried out in six-day periods.…”

“…= estradiol benzoate; and in Table III trogen excretion previously described ( 1 ) had passed its peak and was declining, and urinary creatine excretion was also beginning to recede from high levels. Urinary calcium excretion was approaching a peak, and, from the data of other patients who were not given gonadal steroids, would be expected to maintain a high plateau level for many weeks (2). Testosterone propionate was given to two male patients, D.A.…”

“…(Submitted for publication July 27, 1956; accepted November 26, 1956) The first two papers in this series (1,2) described various marked metabolic derangements resulting from paralytic acute anterior poliomyelitis, particularly those involving nitrogen, creatine, calcium and phosphorus metabolism. The third paper (3) related the results of an attempt to minimize these extensive derangements by use of the slowly oscillating bed.…”