Clinical and metabolic observations on osteomalacia following ureterosigmoidostomy.

Abstract

SUMMARYThree cases of osteomalacia following ureterosigmoidostomy are described. At the time of diagnosis all had a hyperchlorzmic acidosis, a low plasma inorganic phosphate, a low or normal plasma calcium, and a raised plasma alkaline phosphatase.Radiological evidence of osteomalacia was present in all three cases. In two cases the presence of a long‐continued acidosis could be confirmed by biochemical investigations; in one there was strong presumptive evidence that such a state had also existed.Methods of obtaining calcium balance data are described and the results of calcium balance studies recorded.The absence of nephrocalcinosis and the impossibility of separating urine and fzcal calcium outputs are discussed in relation lo pathogenesis. The evidence is in favour of the view that osteomalacia is the result of a long‐continued acidosis, and the calcium balance studies lend some support to this view.The early symptoms of osteomalacia are not pathognomonic of the disease, and diagnosis depends on biochemical and radiological investigations.Treatment consists in correction of the acidosis and administration of vitamin D. The balance studies reveal the importance of vitamin D in treatment.