Abstract
The actual activity of ionised calcium (Ca2+) in gall bladder bile determined with an ion-selective electrode was significantly higher in patients with gall stone disease (n = 15) than in patients without gall stones (n = 10) (0.43 mmol/kg v 0.31 mmol/kg; p < 0.05). No change in the Ca2+ activity in any of the gall bladder bile samples was observed during equilibration with CO2. During titration with HCl/NaOH, however, the Ca2+ activity fell with increasing pH in a biphasic manner, with the breaking point occurring at a significantly lower median pH in patients with gall stones than in patients without (pH 7.1 v 8.2; p < 0.0001). The combination of a higher activity of calcium in bile and precipitation of bile salts taking place at a lower pH in patients with gall stone disease than in patients without gall stones suggests a major role for calcium and pH in the pathogenesis of gall stones. Strict anaerobic sampling is not necessary for the measurements of Ca2+ in gall bladder bile, because the Ca2+ was not significantly affected by the changes in pCO2. The metabolic studies suggest, however, that simultaneous measurements of the activity of Ca2+ and pH is important in order to interpret data for the calcium activity in gall bladder bile.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Dawes L. G., Nahrwold D. L., Rege R. V. Increased total and free ionized calcium in a canine model of pigment gallstones. Surgery. 1988 Jul;104(1):86–90. [PubMed] [Google Scholar]
- Dawes L. G., Rege R. V. Calcium and calcium binding in human gallstone disease. Arch Surg. 1990 Dec;125(12):1606–1609. doi: 10.1001/archsurg.1990.01410240088017. [DOI] [PubMed] [Google Scholar]
- Magnuson T. H., Lillemoe K. D., Peoples G. E., Pitt H. A. Oral calcium promotes pigment gallstone formation. J Surg Res. 1989 Apr;46(4):286–291. doi: 10.1016/0022-4804(89)90188-1. [DOI] [PubMed] [Google Scholar]
- Neithercut W. D. Effect of calcium, magnesium and sodium ions on in vitro nucleation of human gall bladder bile. Gut. 1989 May;30(5):665–670. doi: 10.1136/gut.30.5.665. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rege R. V., Moore E. W. Pathogenesis of calcium-containing gallstones. Canine ductular bile, but not gallbladder bile, is supersaturated with calcium carbonate. J Clin Invest. 1986 Jan;77(1):21–26. doi: 10.1172/JCI112278. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Siggaard-Andersen O., Thode J., Fogh-Andersen N. What is "ionized calcium"? Scand J Clin Lab Invest Suppl. 1983;165:11–16. [PubMed] [Google Scholar]
- Strichartz S. D., Abedin M. Z., Abdou M. S., Roslyn J. J. Increased biliary calcium in cholesterol gallstone formation. Am J Surg. 1988 Jan;155(1):131–137. doi: 10.1016/s0002-9610(88)80270-8. [DOI] [PubMed] [Google Scholar]
- Sutor D. J., Wooley S. E. A statistical survey of the composition of gallstones in eight countries. Gut. 1971 Jan;12(1):55–64. doi: 10.1136/gut.12.1.55. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Thode J. The calcium ion activity and the standardized excretion rate of calcium in urine of healthy adults. Scand J Clin Lab Invest. 1985 Jun;45(4):327–334. doi: 10.3109/00365518509161015. [DOI] [PubMed] [Google Scholar]
- Thode J., Wandrup J., Aas F., Siggaard-Andersen O. Evaluation of a new semiautomatic electrode system for simultaneous measurement of ionized calcium and pH. Scand J Clin Lab Invest. 1982 Sep;42(5):407–415. [PubMed] [Google Scholar]
- Williamson B. W., Percy-Robb I. W. Contribution of biliary lipids to calcium binding in bile. Gastroenterology. 1980 Apr;78(4):696–702. [PubMed] [Google Scholar]