Chronic metabolic acidosis increases the serum concentration of 1,25-dihydroxyvitamin D in humans by stimulating its production rate. Critical role of acidosis-induced renal hypophosphatemia.

Chronic metabolic acidosis results in metabolic bone disease, calcium nephrolithiasis, and growth retardation. The pathogenesis of each of these sequelae is poorly understood in humans. We therefore investigated the effects of chronic extrarenal metabolic acidosis on the regulation of 1,25-(OH)2D, parathyroid hormone, calcium, and phosphate metabolism in normal humans. Chronic extrarenal metabolic acidosis was induced by administering two different doses of NH4Cl [2.1 (low dose) and 4.2 (high dose) mmol/kg body wt per d, respectively] to four male volunteers each during metabolic balance conditions. Plasma [HCO3-] decreased by 4.5 +/- 0.4 mmol/liter in the low dose and by 9.1 +/- 0.3 mmol/liter (P < 0.001) in the high dose group. Metabolic acidosis induced renal hypophosphatemia, which strongly correlated with the severity of acidosis (Plasma [PO4] on plasma [HCO3-]; r = 0.721, P < 0.001). Both metabolic clearance and production rates of 1,25-(OH)2D increased in both groups. In the high dose group, the percentage increase in production rate was much greater than the percentage increase in metabolic clearance rate, resulting in a significantly increased serum 1,25-(OH)2D concentration. A strong inverse correlation was observed for serum 1,25-(OH)2D concentration on both plasma [PO4] (r = -0.711, P < 0.001) and plasma [HCO3-] (r = -0.725, P < 0.001). Plasma ionized calcium concentration did not change in either group whereas intact serum parathyroid hormone concentration decreased significantly in the high dose group. In conclusion, metabolic acidosis results in graded increases in serum 1,25-(OH)2D concentration by stimulating its production rate in humans. The increased production rate is explained by acidosis-induced hypophosphatemia/cellular phosphate depletion resulting at least in part from decreased renal tubular phosphate reabsorption. The decreased serum intact parathyroid hormone levels in more severe acidosis may be the consequence of hypophosphatemia and/or increased serum 1,25-(OH)2D concentrations.

[Sideroblastic anemia: clinical and hematological study on 57 patients]. / Anémies sidéroblastiques: étude clinique et hématologique de 57 patients.

Sideroblastic anemias (SA) are a heterogeneous group of hematologic disorders marked by a defect of heme synthesis, disturbance of iron metabolism and the presence of ringed sideroblasts. 57 cases of SA, including 23 primary and 34 secondary forms, are discussed. In the group of secondary SA 13 patients were alcoholics, 3 had received chloramphenicol, 2 had lead poisoning, 2 had received busulfan and 2 had immune hemolytic anemia. In some cases serum ferritin was found to be excessively high. The caryotype of one patient presented deletion of the long arm on chromosome 20. None of the patients with primary SA responded to vitamin treatment, and 3 developed a myeloproliferative syndrome.

[Pseudothrombopenia (proceedings)]. / Pseudothrombopénies.

Two cases of spurious thrombocytopenia are reported, one induced by platelet satellitism and the other by platelet aggregation. These phenomena occur in vitro, only in the presence of EDTA and are linked with the presence of IgG in the patients' sera.