Evaluation of the hypothalamic-hypophysial, thyroid, and gonadal axes before and after disulfiram administration in patients with chronic alcoholism.

We studied 14 alcoholic men without evidence of liver damage. After two weeks of alcohol abstinence, the patients were divided into two groups of seven patients each. Hypothalamic-hypophysial, thyroid, and gonadal axis tests were done on group 1 patients before disulfiram administration, and the tests were later repeated while the patients were taking disulfiram. Group 2 patients had initial testing done while taking disulfiram and repeat testing after the drug was stopped. The following abnormalities were found and were not affected by disulfiram: lack of suppression of both growth hormone and glucagon with oral glucose intake, and lack of response of follicle-stimulating hormone after administration of synthetic gonadotropin-releasing hormone. After disulfiram administration, we noticed a blunted response of thyrotropin to thyrotropin-releasing hormone.

Glucose concentration in the dialysate and lipid abnormalities in chronic hemodialysis patients.

In order to assess the effect of varying glucose concentrations on plasma lipids, we first compared the hormonal response of nine non-diabetic patients during dialysis with a high (200 mg/dl) and a low (100 mg/dl) glucose bath. Insulin and growth hormone production increased (p less than 0.05) only with the high glucose bath, and no hemodynamic differences were noted during either dialyses. We then compared lipid profiles of 18 patients for 6 months, changing the glucose dialysate concentrations in each patient after three months. We found that all patients had hypertriglyceridemia, mild hypercholesterolemia, low HDL, normal LDL, and high VLDL cholesterol. We therefore conclude that episodic hyperinsulinemia and episodic excessive growth hormone secretion do not contribute significantly to the lipid abnormalities of the dialysis patients.

Longitudinal follow-up of chronic hemodialysis patients without vitamin supplementation.

Vitamin supplementation for dialysis patients is still controversial. In our study, we followed longitudinally over a period of a year, 15 patients on chronic hemodialysis who were deprived of vitamin supplementation. Microbiological assays were used to determine the levels of five vitamins of the B group (folate, niacin, B12, B6, and thiamine). Vitamin C was measured chemically. During the observation period when vitamins were not supplemented, a marked drop of many of these vitamins in blood levels were encountered. For vitamins B12 and C, the plasma levels remained within the normal range in all the subjects studied. For the other vitamins, the blood levels were found to be low in a few patients. Our data suggest that vitamin supplementation is probably not needed in most stable hemodialysis patients as it is recommended now, and that perhaps, if supplementation is indicated, less should be given than is presently prescribed. Further research is needed in this area.

The role of glucose in hemodialysis: the effects of glucose-free dialysate.

Glucose-free dialysate has been traditionally used in patients on chronic hemodialysis, reportedly without any side effects. Although hypoglycemia is not produced, several other metabolic changes must occur to maintain the euglycemic state. We studied ten patients on chronic hemodialysis using both a glucose-free bath and a glucose bath. Without glucose, a drop in osmolality of 20 mosm/kg H2O occurred, whereas a change of only 10 mosm/kg H2O was observed using a glucose bath. Abnormal EEG changes were observed after dialysis without glucose that were not present or were minimal with a glucose bath.

The plasma and red cell vitamin B levels of chronic hemodialysis patients: a longitudinal study.

Plasma B12, folate, B6 and thiamine, and red blood cell folate, thiamine and niacin levels were monitored for a period of 6 months in 15 clinically stable, chronic hemodialysis patients who were not supplemented with the water-soluble vitamins. Microbiological assays were used to determine the blood levels of the water-soluble vitamins. Over the period of 6 months, none of the patients had plasma or red cell vitamin levels below the normal range. No appreciable changes were observed in the plasma and red blood cell vitamin levels before and after dialysis in 5 patients. This study showed that chronic hemodialysis patients are able to maintain normal plasma and red cell levels of some water-soluble vitamins without daily supplementation.

Bromocriptine and the hypothalamic hypophyseal function in patients with chronic renal failure on chronic hemodialysis.

Ten patients with chronic renal failure on chronic hemodialysis had the following tests to evaluate the integrity of the hypothalamic hypophyseal axis: (A) glucose tolerance test, (B) thyrotropin releasing hormone stimulation test, (C) clonidine stimulation test, (D) insulin induced hypoglycemia, and (E) LH/RH stimulation test. The majority of those tests were abnormal and prolactin values were found to be moderately elevated in all the patients. Bromocriptine (1.25 mg twice a day) was given to all the patients for 1 month and then, while on bromocriptine, the tests were repeated. Although there is a decrement in the concentration of serum prolactin level, none of the hypothalamic hypophyseal abnormalities were corrected. However, five of the ten patients reported an improvement of their impotence with bromocriptine. The patients who responded had high levels of FSH and LH with levels of testosterone above 1 mg/mL. The nonresponders had low FSH and LH levels and very low testosterone levels. Therefore, bromocriptine, although possibly beneficial in some dialysis patients, is not a drug that can normalize abnormal functioning of hormones in the dialysis population.