A Metabolic Study Following Oral Calcium45 Administration in a Patient with Non-Tropical Sprue

Abstract

Measuring the intake and output of a given nutrient by the metabolic technique provides valuable information on the metabolic balances. How­ ever, it does not yield direct information on the absorption of a given nutrient, since the amount present in the feces includes an endogenous (digestive juice) portion in addition to that quantity of the ingested nutrient which was not absorbed. A measurement of the fraction which is actually absorbed following ingestion would be of value to nutritionists in their study of how best to meet nutritional requirements under different physiologic conditions such as growth, pregnancy, lactation and aging. Such information would also be of value to the clinician, especially in the study and treatment of patients with gastroin­ testinal disease, by providing information on the mechanisms of nutritional loss, and possible indications of the effectiveness of therapy. A technique is now available which makes it possible to determine how much of an element present in the feces is of dietary origin (unabsorbed) and how much originated in the digestive juice. This technique, utilizing simultaneous metabolic balances and isotopic tracer studies, has been applied to the study of calcium utilization in cattle l and in normal human subjects,2 and to the study of phosphorus utilization in man. 3 This technique was applied in this investigation to the stdy of a patient with non-tropical sprue (idiopathic steatorrhea) and hypocalcemia. The purpose of the study was to determine to what extent the defect in calcium metabolism which occurs in non-tropical sprue is due to poor absorption of dietary calcium. This is of special interest since recent studies on a patient following extensive small bowel resection,4 and on patients with sprue using metaholic balance techniques and the calcium tolerance test,5 have suggested that the main defect in sprue is one of excessive loss of digestive juice constituents rather than one of defective absorption of ingested nutrients. An attempt was also made in this study to elucidate the mechanism of the beneficial effect of cortisone on patients with non-tropical sprue.