DOCSLIB.ORG

Chlorthalidone Is Superior to Potassium Citrate in Reducing Calcium Phosphate Stones and Increasing Bone Quality in Hypercalciuric Stone-Forming Rats

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Chlorthalidone Is Superior to Potassium Citrate in Reducing Calcium Phosphate Stones and Increasing Bone Quality in Hypercalciuric Stone-Forming Rats BASIC RESEARCH www.jasn.org Chlorthalidone Is Superior to Potassium Citrate in Reducing Calcium Phosphate Stones and Increasing Bone Quality in Hypercalciuric Stone-Forming Rats Nancy S. Krieger,1 John R. Asplin,2 Ignacio Granja,2 Felix M. Ramos,1 Courtney Flotteron,1 Luojing Chen,1 Tong Tong Wu,3 Marc D. Grynpas,4 and David A. Bushinsky1 1Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York; 2Litholink Corporation, Laboratory Corporation of America Holdings, Chicago, Illinois; 3Department of Biostatistics and Computational Biology, University of Rochester School of Medicine, Rochester, New York; and 4Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada ABSTRACT Background The pathophysiology of genetic hypercalciuric stone-forming rats parallels that of human idiopathic hypercalciuria. In this model, all animals form calcium phosphate stones. We previously found that chlorthalidone, but not potassium citrate, decreased stone formation in these rats. Methods To test whether chlorthalidone and potassium citrate combined would reduce calcium phos- phate stone formation more than either medication alone, four groups of rats were fed a fixed amount of a normal calcium and phosphorus diet, supplemented with potassium chloride (as control), potassium citrate, chlorthalidone (with potassium chloride to equalize potassium intake), or potassium citrate plus chlorthalidone. We measured urine every 6 weeks and assessed stone formation and bone quality at 18 weeks. Results Potassium citrate reduced urine calcium compared with controls, chlorthalidone reduced it fur- ther, and potassium citrate plus chlorthalidone reduced it even more. Chlorthalidone increased urine citrate and potassium citrate increased it even more; the combination did not increase it further. Potassium citrate, alone or with chlorthalidone, increased urine calcium phosphate supersaturation, but chlorthali- done did not. All control rats formed stones. Potassium citrate did not alter stone formation. No stones formed with chlorthalidone, and rats given potassium citrate plus chlorthalidone had some stones but fewer than controls. Rats given chlorthalidone with or without potassium citrate had higher bone mineral density and better mechanical properties than controls, whereas those given potassium citrate did not. Conclusions In genetic hypercalciuric stone-forming rats, chlorthalidone is superior to potassium citrate alone or combined with chlorthalidone in reducing calcium phosphate stone formation and improving bone quality. JASN 30: ccc–ccc, 2019. doi: https://doi.org/10.1681/ASN.2018101066 Idiopathic hypercalciuria (IH), an excess of urinary calcium (Ca) without a demonstrable metabolic cause, is the most common metabolic abnormality Received October 31, 2018. Accepted March 14, 2019. 1–3 in patients who form Ca-based kidney stones. Published online ahead of print. Publication date available at Elevated levels of urinary Ca increase the probabil- www.jasn.org. ity for nucleation and growth of calcium oxalate Correspondence: Dr. Nancy S. Krieger, Division of Nephrology, (CaOx) or calcium hydrogen phosphate (brushite) Department of Medicine, University of Rochester School of crystals into clinically significant kidney stones.4 Medicine and Dentistry, 601 Elmwood Avenue, Box 675, Ro- Patients with IH generally have normal serum Ca, chester, NY 14642. Email: [email protected] normal or elevated serum 1,25–dihydroxyvitamin Copyright © 2019 by the American Society of Nephrology JASN 30: ccc–ccc,2019 ISSN : 1046-6673/3007-ccc 1 BASIC RESEARCH www.jasn.org D , normal or elevated serum parathyroid hormone, and low 3 Significance Statement bone mineral density (BMD).4,5 IH exhibits a polygenic mode of inheritance.3,6,7 Genetic hypercalciuric stone-forming rats, which universally and To study this disorder we generated a strain of rats, the spontaneously form calcium phosphate stones, have a pathophys- genetic hypercalciuric stone-forming (GHS) rats to model hu- iology resembling that of human idiopathic hypercalciuria. The authors previously demonstrated that chlorthalidone, but not po- man IH. Selectively inbred for over 111 generations, GHS rats tassium citrate, decreased stone formation in this rat model. In this excrete approximately ten times the normal urine Ca of their study, they investigated whether chlorthalidone and potassium parent Sprague–Dawley rats.8,9 When fed a normal Ca diet, citrate combined would reduce calcium phosphate stone formation all form calcium phosphate (CaP) kidney stones.10 We have more than either medication alone. They found that chlorthalidone shownthathypercalciuriainGHSratsispolygenic.11,12 was more effective than potassium citrate alone or combined with chlorthalidone in reducing stone formation and increasing me- Like patients with IH, these rats have increased intestinal chanical strength and bone quality. However, replication of these Ca absorption,10,13 decreased renal Ca reabsorption,14 findings in patients with nephrolithiasis is needed before concluding and increased bone resorption,15 leading to increased urine that chlorthalidone alone is more efficacious in this regard than Ca excretion and CaP stone formation10,16,17 as well as a de- potassium citrate alone or in combination with chlorthalidone. 18,19 crease in BMD. Serum 1,25-dihydroxyvitamin D3 levels 13,20,21 are normal. imaging in a Faxitron. Femurs, humeri, tibiae, and vertebral Two important strategies that are used to decrease recurrent columns were harvested and prepared for BMD, histologic stone formation in humans are the use of potassium citrate studies, and mechanical testing. The University of Rochester 22,23 (KCit) or thiazide diuretics, alone or in combination. In Committee for Animal Resources approved all procedures. humans both KCit and thiazides alone have been shown to decrease stone formation24; however, there is a paucity of Urine and Serum Chemistries data directly comparing the efficacy of these two medications Urine Ca, magnesium, phosphorus, ammonium, and creati- in combination to prevent recurrent stone formation. We nine were measured spectrophotometrically using a Beckman have previously shown that giving GHS rats thiazides (specif- AU autoanalyzer (Beckman Coulter, Brea, CA). Urine potas- ically chlorthalidone [CTD]) decreases urine Ca, reduces sium, chloride, and sodium were measured by ion-specific urine CaP supersaturation, and decreases stone formation.25 electrodes on the Beckman AU and urine pH using a glass We also found that CTD improves BMD and bone quality in electrode. Urine citrate, oxalate, and sulfate were measured GHS rats.26 In a separate study we observed that giving by ion chromatography using a Dionex ICS 2000 system GHS rats KCit also decreases urine Ca, but increases CaP su- (Dionex Corp., Sunnyvale, CA). Oxalate was measured enzy- persaturation and does not decrease stone formation.27 In this matically using oxalate oxidase. All urine solutes were mea- study, we tested the hypothesis that CTD and KCit combined sured at 6, 12, and 18 weeks and a mean value for each time would more effectively reduce CaP stone formation and im- period as well as an overall mean was calculated. Serum Ca and prove BMD and bone quality in GHS rats than either treat- phosphorus were determined colorimetrically (BioVision, ment alone. Milpitas,CA).SerumparathyroidhormoneandReceptor activator of NF-kB ligand were determined by enzyme im- munoassay (Immutopics, San Clemente, CA and R&D Sys- METHODS tems, Minneapolis, MN). All of these methods have been used previously.16,26–30 Study Protocol Three-month-old GHS rats from the 111th generation were Urine Supersaturation randomly divided into four groups (each n=10) and housed Urine supersaturation with respect to CaOx and CaP solid individually in metabolic cages. All rats were fed a fixed phases were calculated from solute measurements using the amount of a normal Ca (1.2% Ca) and phosphorus computer program EQUIL2,31 as we have done previ- (0.65%) diet, supplemented with either potassium chloride ously.10,27,30,32–34 (4 mmol/d), KCit (4 mmol/d), CTD (1.25 mg/d) plus potas- sium chloride (to keep potassium intake constant), or KCit plus Kidney Stone Formation CTD, and had free access to deionized, distilled water. At weeks Kidneys and ureters were removed from each rat en bloc, fro- 6, 12, and 18, each rat was weighed and 24-hour urine was zen, and imaged in a Faxitron radiography device (Tucson, collected over 4 days, with two collections in thymol for pH, AZ) to determine extent of kidney stone formation. Three uric acid, and chloride, and two collections in hydrogen chlo- observers blinded to treatment scored all radiographs on a ride for all other measurements. Each rat received an intraper- scale ranging from 0 (no stones) to 4 (extensive stones). itoneal injection of 1% calcein green at 10 and 2 days before being euthanized for dynamic histomorphometry. At 18 weeks, Dual-Energy X-Ray Absorptiometry rats were euthanized and blood was collected via cardiac punc- Dual-energy x-ray absorptiometry with a Lunar PIXImus Bone ture. Kidneys, ureters, and bladders were removed for x-ray Densitometer (Lunar GE, Mississauga, Canada) was used to 2 JASN JASN 30: ccc–ccc,2019 www.jasn.org BASIC RESEARCH determine tissue density and mineral content. The areal BMD, Biomechanical Properties bone mineral content, and bone area were measured. Biomechanics of femurs were assessed using an Instron
Load more

Recommended publications
  • Appendix a Common Abbreviations Used in Medication
    UNIVERSITY OF AMSTERDAM MASTERS THESIS Impact of Medication Grouping on Fall Risk Prediction in Elders: A Retrospective Analysis of MIMIC-III Critical Care Database Student: SRP Mentor: Noman Dormosh Dr. Martijn C. Schut Student No. 11412682 – SRP Tutor: Prof. dr. Ameen Abu-Hanna SRP Address: Amsterdam University Medical Center - Location AMC Department Medical Informatics Meibergdreef 9, 1105 AZ Amsterdam Practice teaching period: November 2018 - June 2019 A thesis submitted in fulfillment of the requirements for the degree of Master of Medical Informatics iii Abstract Background: Falls are the leading cause of injury in elderly patients. Risk factors for falls in- cluding among others history of falls, old age, and female gender. Research studies have also linked certain medications with an increased risk of fall in what is called fall-risk-increasing drugs (FRIDs), such as psychotropics and cardiovascular drugs. However, there is a lack of consistency in the definitions of FRIDs between the studies and many studies did not use any systematic classification for medications. Objective: The aim of this study was to investigate the effect of grouping medications at different levels of granularity of a medication classification system on the performance of fall risk prediction models. Methods: This is a retrospective analysis of the MIMIC-III cohort database. We created seven prediction models including demographic, comorbidity and medication variables. Medica- tions were grouped using the anatomical therapeutic chemical classification system (ATC) starting from the most specific scope of medications and moving up to the more generic groups: one model used individual medications (ATC level 5), four models used medication grouping at levels one, two, three and four of the ATC and one model did not include med- ications.
    [Show full text]
  • Potassium-Magnesium Citrate Is an Effective Prophylaxis Against Recurrent Calcium Oxalate Nephrolithiasis
    0022-5347/97/1586-2069$03.00/0 JOURNAL OF UROLOGY Vol. 158,2069-2073, December 1997 Copyright Q 1997 by AMERICANUROLOGICAL ASS~CIATION, INC. Printed in U.S.A. POTASSIUM-MAGNESIUM CITRATE IS AN EFFECTIVE PROPHYLAXIS AGAINST RECURRENT CALCIUM OXALATE NEPHROLITHIASIS BRUCE ETTINGER,* CHARLES Y. C. PAK, JOHN T. CITRON, CARL THOMAS, BEVERLEY ADAMS-HIJET AND ARLINE VANGESSEL From the Diuision of Research, Kaiser Permanente Medical Care Program, Oakland, California, the Department of Mineral Metabolism, Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, Department of Medicine, Kaiser Permanente Medical Center, Walnut Creek, California, Department of Urology, Kaiser Permanente Medical Center, San Francisco, California, and Kaiser Foundation Research Institute, Kaiser Foundation Hospitals, Oakland, California ABSTRACT Purpose: We examined the efficacy of potassium-magnesium citrate in preventing recurrent calcium oxalate kidney calculi. Materials and Methods: We conducted a prospective double-blind study of 64 patients who were randomly assigned to receive placebo or potassium-magnesium citrate (42 mEq. potassium, 21 mEq. magnesium, and 63 mEq. citrate) daily for up to 3 years. Results. New calculi formed in 63.6%of subjects receiving placebo and in 12.9%of subjects receiving potassium-magnesiumcitrate. When compared with placebo, the relative risk of treat- ment failure for potassium-magnesium citrate was 0.16 (95%confidence interval 0.05 to 0.46). potassium-magnesium citrate had a statistically significant effect (relative risk 0.10,95%confi- dence interval 0.03 to 0.36) even after adjustment for possible confounders, including age, pretreatment calculous event rate and urinary biochemical abnormalities.
    [Show full text]
  • The Importance of Minerals in the Long Term Health of Humans Philip H
    The Importance of Minerals in the Long Term Health of Humans Philip H. Merrell, PhD Technical Market Manager, Jost Chemical Co. Calcium 20 Ca 40.078 Copper 29 Cu 63.546 Iron Magnesium 26 12 Fe Mg 55.845 24.305 Manganese Zinc 25 30 Mn Zn 55.938 65.380 Table of Contents Introduction, Discussion and General Information ..................................1 Calcium ......................................................................................................3 Copper .......................................................................................................7 Iron ...........................................................................................................10 Magnesium ..............................................................................................13 Manganese ..............................................................................................16 Zinc ..........................................................................................................19 Introduction Daily intakes of several minerals are necessary for the continued basic functioning of the human body. The minerals, Calcium (Ca), Iron (Fe), Copper (Cu), Magnesium (Mg), Manganese (Mn), and Zinc (Zn) are known to be necessary for proper function and growth of the many systems in the human body and thus contribute to the overall health of the individual. There are several other trace minerals requirements. Minimum (and in some cases maximum) daily amounts for each of these minerals have been established by the Institute of
    [Show full text]
  • Some Drugs Are Excluded from Medicare Part D, but Are Covered by Your Medicaid Benefits Under the Healthpartners® MSHO Plan (HMO)
    Some drugs are excluded from Medicare Part D, but are covered by your Medicaid benefits under the HealthPartners® MSHO Plan (HMO). These drugs include some over‐the‐counter (OTC) items, vitamins, and cough and cold medicines. If covered, these drugs will have no copay and will not count toward your total drug cost. For questions, please call Member Services at 952‐967‐7029 or 1‐888‐820‐4285. TTY members should call 952‐883‐6060 or 1‐800‐443‐0156. From October 1 through February 14, we take calls from 8 a.m. to 8 p.m., seven days a week. You’ll speak with a representative. From February 15 to September 30, call us 8 a.m. to 8 p.m. Monday through Friday to speak with a representative. On Saturdays, Sundays and holidays, you can leave a message and we’ll get back to you within one business day. Drug Description Strength 3 DAY VAGINAL 4% 5‐HYDROXYTRYPTOPHAN 50 MG ABSORBASE ACETAMINOPHEN 500 MG ACETAMINOPHEN 120MG ACETAMINOPHEN 325 MG ACETAMINOPHEN 650MG ACETAMINOPHEN 80 MG ACETAMINOPHEN 650 MG ACETAMINOPHEN 160 MG/5ML ACETAMINOPHEN 500 MG/5ML ACETAMINOPHEN 160 MG/5ML ACETAMINOPHEN 500MG/15ML ACETAMINOPHEN 100 MG/ML ACETAMINOPHEN 500 MG ACETAMINOPHEN 325 MG ACETAMINOPHEN 500 MG ACETAMINOPHEN 80 MG ACETAMINOPHEN 100.00% ACETAMINOPHEN 80 MG ACETAMINOPHEN 160 MG ACETAMINOPHEN 80MG/0.8ML ACETAMINOPHEN‐BUTALBITAL 50MG‐325MG ACNE CLEANSING PADS 2% ACNE TREATMENT,EXTRA STRENGTH 10% ACT ANTI‐CAVITY MOUTH RINSE 0.05% Updated 12/01/2012 ACTICAL ACTIDOSE‐AQUA 50G/240ML ACTIDOSE‐AQUA 15G/72ML ACTIDOSE‐AQUA 25G/120ML ACTIVATED CHARCOAL 25 G ADEKS 7.5 MG
    [Show full text]
  • Colonoscopy Instructions Using Miralax and Gatorade, with Magnesium Citrate
    Procedure Locations: The Vancouver Clinic Ambulatory Surgery Center 700 NE 87th Ave Suite 320 Vancouver, WA 98664 Legacy Salmon Creek Hospital Patient Name:_________________________ 2211 NE 139th St. Vancouver, WA 98686 Appointment Date:_____________________ (2nd floor, Surgery Patient Check-in) Arrival Time:__________________________ Peacehealth SW Medical Center 400 NE Mother Joseph Place Provider:______________________________ Vancouver, WA 98664 (5th Street entrance, Short Stay Unit) Please call our office at (360) 397-3805 with any questions Colonoscopy instructions using Miralax and Gatorade, with magnesium citrate. Bowel preparation (cleansing) is needed to perform a high-quality colonoscopy. Any stool remaining in the colon can hide important findings and result in the need to repeat the procedure. It is critical that you follow the instructions as directed. It is important that you follow the prep instructions as below, and not those located on the prep kit packaging. Prior to and during the procedure you will receive sedation (unless you request otherwise) through and IV. The sedation interferes with forming memories, so most patients do not even remember the procedure. Your physician will discuss any findings of your procedure with you in the recovery room. If biopsies are taken or polyps removed, you will receive a letter or MyChart message in 2-3 weeks detailing the final results and recommendations. If your results require a change in your current treatment plan, you may receive a phone call from the office. We make every effort to keep your appointment at the scheduled time, however unexpected delays may occur and your wait time prolonged. Please note that you may be asked to come in earlier than your scheduled time to accommodate changes that occur in the schedule.
    [Show full text]
  • Magnesium Citrate Preparation
    Division of Gastroenterology COLONOSCOPY PREPARATION INSTRUCTIONS Magnesium Citrate Preparation WHAT IS A COLONOSCOPY? • Your physician has recommended that you have a colonoscopy. This test is a visual examination of the lining of the large intestine. During the test, a colonoscope, which is a long, flexible instrument that has a light and a camera at the tip, will be passed through the rectum and around the colon. Your doctor will view the colonoscopy on a television screen and look for any abnormalities that may be present. • Colonoscopy usually is performed to evaluate and treat colon cancer, polyps, gastrointestinal bleeding and diarrhea. If necessary, biopsies (tiny tissue samples) may be taken painlessly during the examination and sent for laboratory analysis. Polyps (abnormal growths of tissue) also may be removed and bleeding areas may be identified and treated. PREPARING FOR A COLONOSCOPY Food and Drink • In order for your doctor to perform an adequate and safe examination, the colon must be clear. You will be given a laxative solution to drink prior to the examination. Follow the instructions carefully. • You should be on a modified diet the entire day before your colonoscopy. You may continue to have clear fluids the day of your procedure, up to three (3) hours prior to your examination. A clear fluid diet includes jello, coffee (please do not add milk), tea (please do not add milk), soft drinks, ices, clear soups, sports drinks such as Gatorade or Powerade and apple or white grape juice. Please avoid red or purple drinks, jello or popsicles for the 24 hours prior to the examination.
    [Show full text]
  • Liquid Cal/Mag/D
    PRODUCT DATA DOUGLAS LABORATORIES® 03/2013 1 Liquid Cal/Mag/D DESCRIPTION Liquid Cal/Mag/D by Douglas Laboratories provides the essential nutrients for bone health, which include calcium and magnesium in a 2:1 ratio and vitamin D3 in a great-tasting raspberry-flavored liquid, sweetened naturally with organic stevia and xylitol. FUNCTIONS The adult human body holds about 99% of all calcium and about 60% of magnesium in the skeleton. The remaining 1% of total body calcium and 40% of total body magnesium are found in the soft tissues and play important roles in such vital functions as nerve conduction, muscle contraction, energy metabolism, blood clotting, membrane permeability, and hormonal signaling. Blood calcium levels are carefully maintained within very narrow limits by the interplay of several hormones, including 1,25-dihydroxy-cholecalciferol, which control calcium absorption and excretion, as well as bone metabolism. The intracellular levels of magnesium are also very tightly regulated, since their alterations can have profound effects on cardiac and skeletal muscle physiology. Bone is constantly turning over, a continuous process of formation and resorption. In children and adolescents, the rate of formation of bone mineral predominates over the rate of resorption. In later life, resorption predominates over formation. Therefore, in normal aging, there is a gradual loss of bone. It is generally accepted that obtaining enough dietary calcium, magnesium, and vitamin D throughout life can significantly support optimal bone health. Vitamin D is a key regulatory hormone for calcium and bone metabolism. Adequate vitamin D status is essential for ensuring normal calcium absorption and maintenance of healthy calcium plasma levels.
    [Show full text]
  • Colonoscopy — Dulcolax®, Miralax® and Magnesium Citrate Prep
    EDUCATION Colonoscopy — Dulcolax®, MiraLAX® and Magnesium Citrate Prep Colonoscopy Your Procedure A colonoscopy is a procedure that lets your health care provider see your large intestine Location: ______________________________ (colon). This procedure is done using a long, Health care provider: ___________________ flexible tube (a “scope”) that passes into your rectum and through your colon. Date: _________________________________ The procedure takes about 15 to 30 minutes. Arrival time: ______________ a.m. / p.m. What You Will Need to Buy Procedure time: ___________ a.m. / p.m. Buy the following ingredients: Phone number: ________________________ — 10 milligrams (mg) Dulcolax® laxative Call the phone number above if you have (Do not use Dulcolax stool softener.) questions about your procedure. If you — MiraLAX® powder (238-gram bottle) need to cancel or reschedule, please call at least 24 hours before your procedure. — Gatorade®, Powerade® or water (64 ounces) — magnesium citrate (10-ounce bottle of — are pregnant liquid or 0.5-ounce package of powder). — have bleeding after surgery. Arrange to have someone drive you home The Week Before Your Procedure and stay with you for 24 hours after your You may receive a phone call from a nurse procedure. You will not be able to drive within 1 week of your procedure. after your procedure. You cannot take public transportation home alone. Tell your primary care provider if you: You will not be able to return to work after ® ® — take warfarin (Coumadin , Jantoven ) the procedure. or any type of blood thinners — take insulin or a diabetes pill. The Day Before Your Procedure He or she may want to change your dosages.
    [Show full text]
  • Magnesium Citrate Colonoscopy Prep
    Magnesium Citrate Colonoscopy Prep Instructions **READ INSTRUCTIONS CAREFULLY - AT LEAST 5 DAYS PRIOR TO PROCEDURE** In order for the physician to perform a colonoscopy, a bowel "cleanout" must be completed at home prior to your procedure. A bowel cleanout is a combination of a clear liquid diet and oral laxatives. All of the items can be obtained at your local pharmacy without a prescription. You will need to purchase the following: » Three 10 ounces bottles of Magnesium Citrate (liquid not pill form) » A small box of Dulcolax tablets (5 milligram tablets). NOT suppositories. » Clear liquids of your choice (see below for examples) » Baby wipes and/or Desitin or A&D ointment OPTIONAL. This helps prevent sore bottom. Do not wear ointment on bottom when you leave for procedure (obscures image) MANUFACTURER'S INSTRUCTIONS MAY DIFFER. PLEASE FOLLOW THE INSTRUCTIONS BELOW »**Contact Kayla, at physician's office, regarding any prescription blood thinners taken at home. »Discontinue any fiber supplements (Metamucil, Citrucel, Fibercon, etc.) at least five 5 days prior to procedure. »If you take narcotics, or suffer from chronic constipation, please take Miralax twice a day for five days prior to procedure. »Do not take any iron pills for 3 days prior to your colonoscopy. »It is best to eat lightly for a few days before your exam. It makes the cleanout easier and more effective. »Avoid whole wheat products and fibrous foods with skins, seeds, etc. DAY BEFORE COLONOSCOPY - Clear Liquids Only ** If you take narcotics at home, please take a bottle of Magnesium Citrate in the morning and then follow instructions below.
    [Show full text]
  • Cal/Mag/D Liquid Introduced 2012
    Product Information Sheet – February 2015 Cal/Mag/D liquid Introduced 2012 What Is It? Recommendations Cal/Mag/D liquid provides calcium and magnesium in a 2:1 ratio, Pure Encapsulations recommends 1 serving daily, with a meal, or as combined with vitamin D3 to promote calcium utilization and enhance directed by a health professional. healthy bone mineralization. This formula combines highly bioavailable forms of calcium, magnesium and vitamin D in a great-tasting raspberry Are There Any Potential Side Effects Or liquid for convenient dosing.* Precautions? High doses of magnesium can cause loose stools. If pregnant or Uses For Cal/Mag/D liquid lactating, or have a history of kidney stones, consult your physician Bone Health: Randomized, double-blind, placebo-controlled before taking this product. studies have reported statistically significant benefits of calcium supplementation for bone health. Magnesium, like calcium, is Are There Any Potential Drug Interactions? an essential bone matrix mineral that promotes healthy bone Calcium should be taken separately from certain antibiotics and metabolism. A trial involving 2,038 older individuals indicated that thyroid medications. Calcium and magnesium should be taken higher intakes of magnesium were positively associated with bone separately from bisphosphonate medications. Consult your physician mineralization for certain individuals. Vitamin D promotes intestinal for more information. calcium and phosphorous absorption and reduces urinary calcium loss, essential mechanisms for maintaining healthy calcium levels in Cal/Mag/D liquid the body and for healthy bone composition. A recent 7-year study involving 36,282 women indicated that combined supplementation of two teaspoons (10 ml / 0.33 fl oz) contain v calcium and vitamin D promoted healthy hip bones.
    [Show full text]
  • Estonian Statistics on Medicines 2016 1/41
    Estonian Statistics on Medicines 2016 ATC code ATC group / Active substance (rout of admin.) Quantity sold Unit DDD Unit DDD/1000/ day A ALIMENTARY TRACT AND METABOLISM 167,8985 A01 STOMATOLOGICAL PREPARATIONS 0,0738 A01A STOMATOLOGICAL PREPARATIONS 0,0738 A01AB Antiinfectives and antiseptics for local oral treatment 0,0738 A01AB09 Miconazole (O) 7088 g 0,2 g 0,0738 A01AB12 Hexetidine (O) 1951200 ml A01AB81 Neomycin+ Benzocaine (dental) 30200 pieces A01AB82 Demeclocycline+ Triamcinolone (dental) 680 g A01AC Corticosteroids for local oral treatment A01AC81 Dexamethasone+ Thymol (dental) 3094 ml A01AD Other agents for local oral treatment A01AD80 Lidocaine+ Cetylpyridinium chloride (gingival) 227150 g A01AD81 Lidocaine+ Cetrimide (O) 30900 g A01AD82 Choline salicylate (O) 864720 pieces A01AD83 Lidocaine+ Chamomille extract (O) 370080 g A01AD90 Lidocaine+ Paraformaldehyde (dental) 405 g A02 DRUGS FOR ACID RELATED DISORDERS 47,1312 A02A ANTACIDS 1,0133 Combinations and complexes of aluminium, calcium and A02AD 1,0133 magnesium compounds A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 811120 pieces 10 pieces 0,1689 A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 3101974 ml 50 ml 0,1292 A02AD83 Calcium carbonate+ Magnesium carbonate (O) 3434232 pieces 10 pieces 0,7152 DRUGS FOR PEPTIC ULCER AND GASTRO- A02B 46,1179 OESOPHAGEAL REFLUX DISEASE (GORD) A02BA H2-receptor antagonists 2,3855 A02BA02 Ranitidine (O) 340327,5 g 0,3 g 2,3624 A02BA02 Ranitidine (P) 3318,25 g 0,3 g 0,0230 A02BC Proton pump inhibitors 43,7324 A02BC01 Omeprazole
    [Show full text]
  • Bowel Preparation for Colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
    142 Guideline Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline Authors C. Hassan1, M. Bretthauer2, M. F. Kaminski3, M. Polkowski3, B. Rembacken4, B. Saunders5, R. Benamouzig6, O. Holme7, S. Green5, T. Kuiper8, R. Marmo9, M. Omar10, L. Petruzziello1, C. Spada1, A. Zullo11, J. M. Dumonceau12 Institutions Institutions are listed at the end of article. Bibliography Background and aim: This Guideline is an official yethylene glycol (PEG) solution (or a same-day re- DOI http://dx.doi.org/ statement of the European Society of Gastrointes- gimen in the case of afternoon colonoscopy) for 10.1055/s-0032-1326186 tinal Endoscopy (ESGE). It addresses the choice routine bowel preparation. A split regimen (or Published online: 18.1.2013 amongst regimens available for cleansing the co- same-day regimen in the case of afternoon colo- Endoscopy 2013; 45: 142–150 © Georg Thieme Verlag KG lon in preparation for colonoscopy. noscopy) of 2L PEG plus ascorbate or of sodium Stuttgart · New York Methods: This Guideline is based on a targeted lit- picosulphate plus magnesium citrate may be valid ISSN 0013-726X erature search to evaluate the evidence support- alternatives, in particular for elective outpatient ing the use of bowel preparation for colonoscopy. colonoscopy (strong recommendation, high qual- Corresponding author J. M. Dumonceau, MD PhD The Grading of Recommendations Assessment, ity evidence). In patients with renal failure, PEG is HUG – Gastroenterology Development and Evaluation (GRADE) system the only recommended bowel preparation. The Rue Micheli-du-Crest 24 was adopted to define the strength of recommen- delay between the last dose of bowel preparation Geneva 1205 dation and the quality of evidence.
    [Show full text]