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Urinary Oxalate Excretion Increases in Home Parenteral Nutrition Patients on a Higher Intravenous Ascorbic Acid Dose

Background: Vitamin C can be metabolized to oxalate. Case reports have suggested an association between IV vitamin C and urinary oxalate excretion. Recently, the US Food and Drug Administration required the dose of vitamin C in IV multivitamin preparations to be increased from 100 mg to 200 mg/d. We...

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Published in:JPEN. Journal of parenteral and enteral nutrition 2004-11, Vol.28 (6), p.435-438
Main Authors: de la Vega, Lourdes Peña, Lieske, John C., Milliner, Dawn, Gonyea, Janelle, Kelly, Darlene G.
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container_title JPEN. Journal of parenteral and enteral nutrition
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creator de la Vega, Lourdes Peña
Lieske, John C.
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description Background: Vitamin C can be metabolized to oxalate. Case reports have suggested an association between IV vitamin C and urinary oxalate excretion. Recently, the US Food and Drug Administration required the dose of vitamin C in IV multivitamin preparations to be increased from 100 mg to 200 mg/d. We compared the urinary oxalate excretion level in stable home total parenteral nutrition (TPN) patients receiving both doses of vitamin C. Methods: Each participant provided a 24-hour urine sample for oxalate determination on the vitamin C dose (100 mg/d), and again after at least 1 month on the increased vitamin C dose (200 mg/d). A 2-day diet diary was completed covering the day before and the day of the urine collection and was analyzed for oxalate and vitamin C content. Comparisons were made using Student paired t test and Wilcoxon signed rank. Results: Thirteen patients (7 males/6 females) aged 63.1 ± 12.2 years who had no history of nephrolithiasis and had received TPN for 55.9 ± 78.8 months were enrolled. The most common indication for TPN was short bowel syndrome (38.5%). Eight patients had an intact colon. Urinary oxalate excretion increased on the 200-mg vitamin C dose, from 0.34 ± 0.13 to 0.44± 0.17 mmol/d (mean increase = 0.10 mmol/d; p = .04; 95% confidence interval 0.004 to 0.19 mmol/d). Oral intake of vitamin C and oxalate did not differ between the 2 collection periods. Conclusions: In therapeutically used doses, IV vitamin C increases urinary oxalate excretion, potentially predisposing susceptible individuals to nephrolithiasis. This factor should be considered in patients receiving home TPN. Urinary oxalate increased from 0.34 ± 0.13 to 0.44 ± 0.17 mmol/d (p = .04) when the dose of IV vitamin C was increased from 100 to 200 mg/d in a group of patients (63.1 ± 12.2 years) without a history of nephrolithiasis receiving chronic home total parenteral nutrition (duration 55.9 ± 78.8 months).
doi_str_mv 10.1177/0148607104028006435
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Case reports have suggested an association between IV vitamin C and urinary oxalate excretion. Recently, the US Food and Drug Administration required the dose of vitamin C in IV multivitamin preparations to be increased from 100 mg to 200 mg/d. We compared the urinary oxalate excretion level in stable home total parenteral nutrition (TPN) patients receiving both doses of vitamin C. Methods: Each participant provided a 24-hour urine sample for oxalate determination on the vitamin C dose (100 mg/d), and again after at least 1 month on the increased vitamin C dose (200 mg/d). A 2-day diet diary was completed covering the day before and the day of the urine collection and was analyzed for oxalate and vitamin C content. Comparisons were made using Student paired t test and Wilcoxon signed rank. Results: Thirteen patients (7 males/6 females) aged 63.1 ± 12.2 years who had no history of nephrolithiasis and had received TPN for 55.9 ± 78.8 months were enrolled. The most common indication for TPN was short bowel syndrome (38.5%). Eight patients had an intact colon. Urinary oxalate excretion increased on the 200-mg vitamin C dose, from 0.34 ± 0.13 to 0.44± 0.17 mmol/d (mean increase = 0.10 mmol/d; p = .04; 95% confidence interval 0.004 to 0.19 mmol/d). Oral intake of vitamin C and oxalate did not differ between the 2 collection periods. Conclusions: In therapeutically used doses, IV vitamin C increases urinary oxalate excretion, potentially predisposing susceptible individuals to nephrolithiasis. This factor should be considered in patients receiving home TPN. Urinary oxalate increased from 0.34 ± 0.13 to 0.44 ± 0.17 mmol/d (p = .04) when the dose of IV vitamin C was increased from 100 to 200 mg/d in a group of patients (63.1 ± 12.2 years) without a history of nephrolithiasis receiving chronic home total parenteral nutrition (duration 55.9 ± 78.8 months).</description><identifier>ISSN: 0148-6071</identifier><identifier>EISSN: 1941-2444</identifier><identifier>DOI: 10.1177/0148607104028006435</identifier><identifier>PMID: 15568291</identifier><identifier>CODEN: JPENDU</identifier><language>eng</language><publisher>Silver Spring, MD: SAGE Publications</publisher><subject>Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Antioxidants - administration &amp; dosage ; Antioxidants - metabolism ; Ascorbic Acid - administration &amp; dosage ; Ascorbic Acid - metabolism ; Biological and medical sciences ; Clinical death. Palliative care. Organ gift and preservation ; Dose-Response Relationship, Drug ; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition ; Emergency and intensive postoperative care (general aspects). Pathophysiology of surgery ; Female ; Humans ; Intensive care medicine ; Intestinal Absorption ; Male ; Medical sciences ; Middle Aged ; Oxalates - urine ; Parenteral Nutrition, Home - adverse effects</subject><ispartof>JPEN. 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Journal of parenteral and enteral nutrition</title><addtitle>JPEN J Parenter Enteral Nutr</addtitle><description>Background: Vitamin C can be metabolized to oxalate. Case reports have suggested an association between IV vitamin C and urinary oxalate excretion. Recently, the US Food and Drug Administration required the dose of vitamin C in IV multivitamin preparations to be increased from 100 mg to 200 mg/d. We compared the urinary oxalate excretion level in stable home total parenteral nutrition (TPN) patients receiving both doses of vitamin C. Methods: Each participant provided a 24-hour urine sample for oxalate determination on the vitamin C dose (100 mg/d), and again after at least 1 month on the increased vitamin C dose (200 mg/d). A 2-day diet diary was completed covering the day before and the day of the urine collection and was analyzed for oxalate and vitamin C content. Comparisons were made using Student paired t test and Wilcoxon signed rank. Results: Thirteen patients (7 males/6 females) aged 63.1 ± 12.2 years who had no history of nephrolithiasis and had received TPN for 55.9 ± 78.8 months were enrolled. The most common indication for TPN was short bowel syndrome (38.5%). Eight patients had an intact colon. Urinary oxalate excretion increased on the 200-mg vitamin C dose, from 0.34 ± 0.13 to 0.44± 0.17 mmol/d (mean increase = 0.10 mmol/d; p = .04; 95% confidence interval 0.004 to 0.19 mmol/d). Oral intake of vitamin C and oxalate did not differ between the 2 collection periods. Conclusions: In therapeutically used doses, IV vitamin C increases urinary oxalate excretion, potentially predisposing susceptible individuals to nephrolithiasis. This factor should be considered in patients receiving home TPN. Urinary oxalate increased from 0.34 ± 0.13 to 0.44 ± 0.17 mmol/d (p = .04) when the dose of IV vitamin C was increased from 100 to 200 mg/d in a group of patients (63.1 ± 12.2 years) without a history of nephrolithiasis receiving chronic home total parenteral nutrition (duration 55.9 ± 78.8 months).</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Antioxidants - administration &amp; dosage</subject><subject>Antioxidants - metabolism</subject><subject>Ascorbic Acid - administration &amp; dosage</subject><subject>Ascorbic Acid - metabolism</subject><subject>Biological and medical sciences</subject><subject>Clinical death. Palliative care. Organ gift and preservation</subject><subject>Dose-Response Relationship, Drug</subject><subject>Emergency and intensive care: metabolism and nutrition disorders. 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Recently, the US Food and Drug Administration required the dose of vitamin C in IV multivitamin preparations to be increased from 100 mg to 200 mg/d. We compared the urinary oxalate excretion level in stable home total parenteral nutrition (TPN) patients receiving both doses of vitamin C. Methods: Each participant provided a 24-hour urine sample for oxalate determination on the vitamin C dose (100 mg/d), and again after at least 1 month on the increased vitamin C dose (200 mg/d). A 2-day diet diary was completed covering the day before and the day of the urine collection and was analyzed for oxalate and vitamin C content. Comparisons were made using Student paired t test and Wilcoxon signed rank. Results: Thirteen patients (7 males/6 females) aged 63.1 ± 12.2 years who had no history of nephrolithiasis and had received TPN for 55.9 ± 78.8 months were enrolled. The most common indication for TPN was short bowel syndrome (38.5%). Eight patients had an intact colon. Urinary oxalate excretion increased on the 200-mg vitamin C dose, from 0.34 ± 0.13 to 0.44± 0.17 mmol/d (mean increase = 0.10 mmol/d; p = .04; 95% confidence interval 0.004 to 0.19 mmol/d). Oral intake of vitamin C and oxalate did not differ between the 2 collection periods. Conclusions: In therapeutically used doses, IV vitamin C increases urinary oxalate excretion, potentially predisposing susceptible individuals to nephrolithiasis. This factor should be considered in patients receiving home TPN. Urinary oxalate increased from 0.34 ± 0.13 to 0.44 ± 0.17 mmol/d (p = .04) when the dose of IV vitamin C was increased from 100 to 200 mg/d in a group of patients (63.1 ± 12.2 years) without a history of nephrolithiasis receiving chronic home total parenteral nutrition (duration 55.9 ± 78.8 months).</abstract><cop>Silver Spring, MD</cop><pub>SAGE Publications</pub><pmid>15568291</pmid><doi>10.1177/0148607104028006435</doi><tpages>4</tpages></addata></record>
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subjects Adult
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Antioxidants - administration & dosage
Antioxidants - metabolism
Ascorbic Acid - administration & dosage
Ascorbic Acid - metabolism
Biological and medical sciences
Clinical death. Palliative care. Organ gift and preservation
Dose-Response Relationship, Drug
Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition
Emergency and intensive postoperative care (general aspects). Pathophysiology of surgery
Female
Humans
Intensive care medicine
Intestinal Absorption
Male
Medical sciences
Middle Aged
Oxalates - urine
Parenteral Nutrition, Home - adverse effects
title Urinary Oxalate Excretion Increases in Home Parenteral Nutrition Patients on a Higher Intravenous Ascorbic Acid Dose
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