In 19 chronic alcoholics with rhabdomyolysis the clinical picture demonstrated markedly different degrees of severity of myolysis. Muscle pain, muscle swellings and brown-coloured urine were rare. But symptoms of delirium, at times with cerebral seizures, were frequent at the onset. Renal failure of different degrees was common; five patients had to be dialysed. Two patients died in irreversible shock. Respiratory insufficiency and hypercalcaemia were other complications. Early recognition of the disease is important, because early treatment can prevent acute "myoglobinuric" renal failure.

During her second pregnancy a 27-year-old woman had recurrent acute pancreatitis, in the course of which primary hyperparathyroidism was diagnosed. After regression of the acute signs and under conservative treatment a parathyroid tumour was removed in the 26th week of pregnancy. Comparison of surgical and conservative treatment of primary hyperparathyroidism during pregnancy has indicated that the risk of complications in the neonate is much lower after surgical removal of the adenoma than with an attempt to postpone by symptomatic drug treatment the parathyroidectomy until after delivery.

report ‘Rhabdomyolysis and acute renal failure after terbutaline overdose’ cases of ß2-adrenoceptor agonist-induced rhabdomyolysis one case after therapeutic oral doses of fenoterol for tocolysis the after an of terbutaline

Oestrogen metabolites from the urine of males and pregnant and non-pregnant females were enriched by a procedure involving column chromatography on adsorber resins, gels and ion exchangers, enzymatic solvolysis and extraction, thereby separating the oestrogens from most of the interfering material. After derivatization of the oestrogens as their trimethylsilyl ethers profiles were measured with a fused silica column and a flame ionization detector by gas chromatography. Using a combination of capillary gas chromatography and mass spectrometry approximately 50 oestrogen metabolites were detected in the human urine of males and females, of which 19 were unknown urine compounds. Not all could be identified definitely owing to the lack of reference material. Mass spectra of trimethylsilylated oestrogens with functional groups at position 11 (11-dehydroestradiol, 11-dehydroestrone and 11 beta-hydroxyestrone) were discussed in their common and discernible fragmentations.

In view of the increasing pollution of our environment and forest decline, growing interest has been focused on aluminum toxicity. Aluminum is one of the most abundant metals and commonly present in tap water, beverages, food, cosmetics, and pharmaceutical preparations. Thus everybody is exposed to aluminum to a greater or lesser extent. It is now beyond any doubt that aluminum intoxication may cause encephalopathy, fracturing vitamin D resistant osteomalacia, and microcytic anemia in patients with chronic renal insufficiency as well as in experimental animals. The risk of aluminum intoxication has also to be considered in several other groups. These include elderly individuals with physiologically impaired excretory renal function who are treated with aluminum — containing antacids, patients with chronic liver disease, infants who are fed highly aluminum-contaminated formula at a time when their excretory renal function has not jet fully developed, patients on total parenteral nutrition, and, possibly, patients with Alzheimer's disease.

In view of the increasing pollution of our environment and forest decline, growing interest has been focused on aluminum toxicity. Aluminum is one of the most abundant metals and commonly present in tap water, beverages, food, cosmetics, and pharmaceutical preparations. Thus everybody is exposed to aluminum to a greater or lesser extent. It is now beyond any doubt that aluminum intoxication may cause encephalopathy, fracturing vitamin D resistant osteomalacia, and microcytic anemia in patients with chronic renal insufficiency as well as in experimental animals. The risk of aluminum intoxication has also to be considered in several other groups. These include elderly individuals with physiologically impaired excretory renal function who are treated with aluminum-containing antacids, patients with chronic liver disease, infants who are fed highly aluminum-contaminated formula at a time when their excretory renal function has not jet fully developed, patients on total parenteral nutrition, and, possibly, patients with Alzheimer's disease.

AbstractNeutral steroid metabolites enriched from urine and hemofiltrate were identified by gas chromatography/mass spectrometry and quantified by capillary gas chromatography. This study included 20 healthy controls and 37 uremic patients. Before enrichment of steroids from biological material, the standard deviation of the workup procedure and subsequent derivatization into the trimethylsilyl‐enol‐trimethylsilyl ethers was tested and found to be 2–5% in urine and 12–17% in the more complicated workup procedure of hemofiltrate, but essentially smaller than the biological standard deviation. Compared to the 24 h urinary excretion rates of controls, the excretion rates of androsterone, etiocholanolone, and corticoid metabolites were significantly lower in uremic body fluids, while those of 11‐oxygenated androstanolones, degradation products of corticoids, were enhanced in uremic urine. The ratio of corticoid metabolites to 11‐oxygenated androstanolones in urine of nondialyzed uremics correlated significantly with their plasma creatinine levels.

Steroid metabolites enriched from urine, haemofiltrate, and CAPD-dialysate (Continuous Ambulatory Peritoneal Dialysis) were identified by gas chromatography-mass spectrometry and quantified by capillary gas chromatography. The study included twenty healthy controls, twenty-six non-dialysed uraemics, thirty-nine patients on regular dialysis treatment, and twenty-two allograft recipients. Compared to the 24 h urinary excretion rates of controls the excretion rates of androsterone and etiocholanolone were in the lower normal range up to significantly decreased in the body fluids of all patients, and those of the corticoid metabolites were also significantly decreased. 11-Oxygenated androstanolones in urine from non-dialysed uraemics correlated significantly decreased. 11-oxygenated androstano-levels and were significantly increased, but normal in haemofiltrate and CAPD-dialysate, while in urine of allograft recipients the values were significantly lower.

Capillary gas chromatography of amino acid derivatives obtained from biological material shows a large number of previously unknown constituents. The profiles of amino acids obtained from urine of healthy individuals and haemofiltrate of uraemic patients indicate that haemofiltration removes some amino acids to a considerably higher extent from uraemic patients than the kidney does from healthy persons. For instance, if haemofiltration is required three times a week, an approximately ten-fold amount of the essential amino acid methionine and a forty-fold amount of the essential amino acid leucine is lost compared to their excretion in urine by a healthy individual over the same period.

alpha-Ketoisovaleric acid levels increase from 10.6 +/- 0.8 to 121 +/- 20 mumol/L, and valine levels increase from 175 +/- 14 to 940 +/- 50 mumol/L after oral administration of an isomolar (62.5 mg/kg) bolus of alpha-ketoisovaleric acid or valine to healthy human subjects. alpha-Ketoisovaleric acid levels have a different time course relative to valine. alpha-Ketoisovaleric acid and valine affect various other amino and keto acids, and some of these effects are qualitatively different. alpha-Ketoisovaleric acid enhances alpha-ketoisocaproic acid and alpha-keto-beta-methyl-n-valeric acid, but diminishes the corresponding amino acids, and causes an early decline of ornithine along with a late augmentation of plasma arginine. Valine does the opposite. The data suggest that in humans, overall capacity for alpha-ketoisovaleric acid decarboxylation appears greater than the capacity for valine transamination, and that all branched-chain amino acids and branched-chain keto acids seem to be interconvertible by reversible transaminations.

The neutral steroid fractions in the urine of eleven patients suffering from various forms of liver disease with cholestasis and of ten healthy individuals were studied by glass capillary gas chromatography-mass spectrometry. The steroid conjugates in urine were enzymatically solvolysed, the liberated steroids extracted and transformed into the trimethylsilylether for measurements. The excretion rates of androstane and pregnane metabolites of patients with liver disease were far lower than those of healthy persons. The main compounds in the urine of the former were the bile alcohols 27 - nor - 3 alpha, 7 alpha, 12 alpha, 24 xi, 25 xi - pentahydroxy - 5 beta - cholestane and 3 alpha, 7 alpha, 12 alpha, 25 xi, 26 - pentahydroxy - 5 beta - cholestane. Our data suggest a correlation between the excretion rates of these bile alcohols and the serum levels of bilirubin. While the excretion rate of the two bile alcohols in the urine of healthy individuals was approximately 0.24 mg/24 h (0.6 mumol/24 h) a patient with a serum bilirubin of 841 mumol/l excreted 4 mg/24 h (9 mumol/24 h). The accumulation of bile alcohols described in this study possibly indicates alternative pathways of cholic acid formation in liver disease.

Branched chain keto acids, their corresponding amino acids, glucose, glucagon, growth hormone, C-peptide and gastric inhibitory polypeptide were determined in 8 healthy subjects after an intravenous bolus injection of 0.1 U/kg insulin. Branched chain keto acids declined within 60 min, the corresponding amino acids within 20 min or later. Amino acids tended to return towards normal earlier than their keto acids. Blood glucose levels were normal 2 hr after insulin injection while keto and amino acids remained diminished for more than 3 hr. In 8 healthy controls, given physiological saline instead of insulin, the branched chain keto acids did not decline throughout the test. It is suggested that insulin diminishes blood levels of branched chain keto acids, that the intraorgan flux of branched chain keto acids is different from the flux of branched chain amino acids and that branched chain keto acids may serve to correct for hypoglycemia.

The chemical analysis of neutral steroid sulfates by glass capillary gas chromatographymass spectrometry (GC-MS) from the blood of a young girl with acute suicidal paraquat poisoning is described. The steroids had been extracted from an XAD-filter used for immediate hemofiltration treatment of the patient. The steroids analyzed were isomers of known blood and urine components without unusual substituents. It can be concluded that oral intake of paraquat in even large amounts does not cause significant disturbances of steroid metabolism, at least not in the acute state of intoxication.