Skip to main content

Metabolic Alkalosis from Chloride-Deficient Infant Formula

  • Chapter

Abstract

The metabolic consequences of chloride deficiency have recently been reviewed by Simopoulos and Bartter (1980). Chloride-depletion syndromes include cystic fibrosis with excessive chloride loss through sweating, gastrointestinal chloride loss resulting from congenital hypertrophic pyloric stenosis, surreptitous vomiting, laxative abuse or congenital chloride diarrhea, and urinary chloride loss secondary to diuretic use or abuse or in Bartter’s syndrome. Salt deprivation in man can result in metabolic alkalosis but the effect of chloride deprivation alone, though studied in rats (Holliday et al, 1961; Levine et al., 1974), has not been reported in man. Hypochloremic metabolic alkalosis with failure to thrive resulting from the feeding of chloride deficient infant formulas (Neo-Mull-Soy and CHO-Free) (Roy and Arant, 1979) is a new syndrome of chloride deficiency which further emphasizes the importance of the chloride ion in acid-base balance and in nutrition.

Keywords

  • Infant Formula
  • Metabolic Alkalosis
  • Infant Food
  • Hypokalemic Metabolic Alkalosis
  • Chloride Loss

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-1-4613-3359-3_46
  • Chapter length: 11 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   84.99
Price excludes VAT (USA)
  • ISBN: 978-1-4613-3359-3
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   109.00
Price excludes VAT (USA)

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Atkins, E. L., and Schwartz, W. B., 1962, Factors governing correction of the alkalosis associated with potassium deficiency: The critical role of chloride in the recovery process, J. Clin. Invest. 41: 218.

    CrossRef  CAS  Google Scholar 

  • Bank, N., and Schwartz, W. B., 1960, The influence of anion penetrating ability on urinary acidification and the excretion of titratable acid, J. Clin. Invest. 39: 1516.

    CrossRef  CAS  Google Scholar 

  • Barness, L. A., 1980, Formula manufacture and infant feeding, J. Am. Med. Assoc. 243: 1075.

    CrossRef  CAS  Google Scholar 

  • Berglund, G., and Rabo, E., 1973, A long-term follow-up investigation of patients with hypertrophic pyloric stenosis—with special reference to the physical and mental development, Acta Paediatr. Scand. 62: 125.

    CrossRef  CAS  Google Scholar 

  • Bull, M. B., Hillman, R. S., Cannon, P. J., and Laragh, J. H., 1970, Renin and aldosterone secretion in man as influenced by changes in electrolyte balance and blood volume, Circ. Res. 27: 953.

    CAS  Google Scholar 

  • Center for Disease Control, 1979, Infant metabolic alkalosis and soy-based formula—United States, Morbidity Mortality Weekly Report 28: 358.

    Google Scholar 

  • Center for Disease Control, 1980, Follow-up on formula-associated illness in children, Morbidity Mortality Weekly Report 29: 124.

    Google Scholar 

  • Committee on Nutrition, American Academy of Pediatrics, 1976, Commentary on breast feeding and infant formulas, including proposed standards for formulas, Pediatrics 57: 278.

    Google Scholar 

  • Finberg, L., 1979, One milk for all—not ever likely and certainly not yet, J Pediatr. 96: 240.

    Google Scholar 

  • Fomon, S. J., Filer, L. J., Anderson, T. A., and Ziegler, E. E., 1979, Recommendations for feeding normal infants, Pediatrics 65: 52.

    Google Scholar 

  • Garin, E. H., Geary, D., and Richard, G. A., 1979, Soybean formula (Neo-Mull-Soy) metabolic alkalosis in infancy, J. Pediatr. 95: 985.

    CrossRef  CAS  Google Scholar 

  • Hellerstein, G., Guggan, E., Grossman, H. M., McCamman, S., Sharma, P., and Welchert, E., 1979, Metabolic alkalosis and Neo-Mull-Soy, J. Pediatr. 95: 1083.

    CrossRef  CAS  Google Scholar 

  • Holliday, M. A., 1980, Alkalosis in infancy and commercial formulas, Pediatrics 65: 639.

    CAS  Google Scholar 

  • Holliday, M. A., Bright, N. H., Schultz, D., and Oliver, J., 1961, The renal lesions of electrolyte imbalance. III. The effect of acute chloride depletion and alkalosis on the renal cortex, J. Exp. Med. 113: 971.

    CrossRef  CAS  Google Scholar 

  • Kassirer, J. P., Berkman, P.M., Lawrenz, D. R., and Schwartz, W. B., 1965, The critical role of chloride in the correction of hypokalemic alkalosis in man, Am. J. Med. 38: 172.

    CrossRef  CAS  Google Scholar 

  • Klein, P. S., Forbes, G. B., and Hader, P. R., 1975, Effects of starvation in infancy (pyloric stenosis) on subsequent learning abilities, J. Pediatr. 87: 8.

    CrossRef  CAS  Google Scholar 

  • Levine, D. Z., Roy, D., Tolnai, G., Nash, L., and Shah, B. G., 1974, Chloride depletion and nephrocalcinosis, Am. J. Physiol. 227: 878.

    CAS  Google Scholar 

  • Lindshaw, M. A., Harrison, H. L., Gruskin, A. B., Prebis, J., Harris, J., Stein, R., Jayaram, M. R., Preston, D., DiLiberti, J., Baluarte, H. J., Elzouki, A., and Carroll, N., 1980, Hypochloremic alkalosis in infants associated with soy-protein formula, J. Pediatr. 96: 635.

    CrossRef  Google Scholar 

  • Macy, I. G., and Kelly, H. J., 1961, Human milk and cow’s milk in infant nutrition, in Milk: The Mammary Gland and its Secretion ( S. K. Kon and A. T. Cowie, eds.), pp. 359, Academic Press, New York.

    Google Scholar 

  • Malnic, G., Mello-Aires, M., and Giebisch, G., 1971, Potassium transport across renal distal tubule during acid-base disturbances, Am. J. Physiol. 221: 1192.

    CAS  Google Scholar 

  • Roy, S., III, and Arant, B. S., Jr., 1979, Alkalosis from chloride-deficient Neo-Mull-Soy, N. Engl. J. Med. 301: 615.

    Google Scholar 

  • Roy, S., III, and Arant, B. S., Jr., 1981, Hypokalemic metabolic alkalosis in normotensive infants with elevated plasma renin activity and hyperaldosteronism: The role of dietary chloride deficiency, Pediatrics 67: 423.

    Google Scholar 

  • Roy, S., III, Stapleton, F. B., and Arant, B. S., Jr., 1980, Hypochloremic metabolic alkalosis in infants fed a chloride-deficient formula, Pediatr. Res. 14: 509.

    Google Scholar 

  • Schwartz, W. B., Jenson, R. L., and Relman, A. S., 1955, Acidification of the urine and increased ammonium excretion without change in acid-base equilibrium. Sodium reabsorption as a stimulus to the acidifying process, J. Clin. Invest. 34: 673.

    CrossRef  CAS  Google Scholar 

  • Seldin, D. W., and Rector, F. C., Jr., 1972, The generation and maintenance of metabolic alkalosis, Kidney Int. 1: 306.

    CrossRef  CAS  Google Scholar 

  • Simopoulos, A. P., and Bartter, F. C., 1980, The metabolic consequences of chloride deficiency, Nutr. Rev. 38: 201.

    CrossRef  CAS  Google Scholar 

  • Van Goidsenhoven, G. M. T., Gray, O. V., Price, A. V., and Sanderson, P. H., 1954, The effect of prolonged administration of large doses of sodium bicarbonate in man, Clin. Sci. 13: 383.

    Google Scholar 

  • Winters, R. W., 1973, Maintenance fluid therapy, in: The Body Fluids in Pediatrics, ( R. W. Winters, ed.), p. 113, Little, Brown, Boston.

    Google Scholar 

  • Wolfsdorf, J. E., and Senior, B., 1980, Failure to thrive and metabolic alkalosis. Adverse effects of a chloride-deficient formula in two infants, J. Am. Med. Assoc. 243: 1068.

    CrossRef  CAS  Google Scholar 

  • Ziegler, E. E., and Fomon, S. J., 1974, Major minerals, in: Infant Nutrition 2nd ed. ( S.J. Fomon, ed.), p. 267, W. B. Saunders, Philadelphia.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 1982 Plenum Press, New York

About this chapter

Cite this chapter

Roy, S. (1982). Metabolic Alkalosis from Chloride-Deficient Infant Formula. In: Jelliffe, E.F.P., Jelliffe, D.B. (eds) Adverse Effects of Foods. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-3359-3_46

Download citation

  • DOI: https://doi.org/10.1007/978-1-4613-3359-3_46

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-3361-6

  • Online ISBN: 978-1-4613-3359-3

  • eBook Packages: Springer Book Archive