MP24-19 ENTERAL NUTRITION FORMULAS WITH HIGHER OXALATE CONTENT MAY CONTRIBUTE TO HIGHER OXALATE ABSORPTION AND URINARY EXCRETION IN PATIENTS REQUIRING NUTRITION SUPPORT

Abstract

You have accessJournal of UrologyStone Disease: Basic Research & Pathophysiology II1 Apr 2018MP24-19 ENTERAL NUTRITION FORMULAS WITH HIGHER OXALATE CONTENT MAY CONTRIBUTE TO HIGHER OXALATE ABSORPTION AND URINARY EXCRETION IN PATIENTS REQUIRING NUTRITION SUPPORT Kristina L. Penniston, Eve A. Palmer, Riley C. Medenwald, Sarah N. Johnson, Leema M. John, David J. Beshensky, and Ibrahim A. Saeed Kristina L. PennistonKristina L. Penniston More articles by this author , Eve A. PalmerEve A. Palmer More articles by this author , Riley C. MedenwaldRiley C. Medenwald More articles by this author , Sarah N. JohnsonSarah N. Johnson More articles by this author , Leema M. JohnLeema M. John More articles by this author , David J. BeshenskyDavid J. Beshensky More articles by this author , and Ibrahim A. SaeedIbrahim A. Saeed More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.772AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients requiring oral and/or enteral nutrition support for nutritional needs can form calcium oxalate (CaOx) kidney stones. Dietary oxalate, if excessive, can contribute to CaOx stones when unopposed by appropriate calcium. The oxalate concentration of oral/enteral nutrition formulas is not known. We assessed various formulas for oxalate. METHODS Adult and pediatric oral/enteral nutrition formulas commonly used in hospitals as well as in home feeding regimens were selected. Formulas designed for oral and enteral consumption (or either) were included (table); completely elemental (hydrolyzed) or modular formula products were not. Multiple samples (N, table) of each formula were acidified, heated, and centrifuged. Supernatants were filtered and analyzed for oxalate by ion chromatography. Oxalate concentration (mg/L±SD), relative standard deviation (SD) between samples (coefficient of variation; CV), and calcium:oxalate ratios (mg:mg/L of formula) were calculated. RESULTS Of 35 formulas analyzed, 9 were excluded due to inconsistent results and high CVs. Results for the 26 remaining formulas are shown (table). Oxalate concentration ranged from 4-140 mg oxalate/L of formula. Due to highly variable calcium content, calcium:oxalate ratios varied widely between formulas (from 0-286) with lower ratios suggesting higher potential for oxalate absorption. There was no difference between mean oxalate concentration of enteral vs. oral formulas (45 vs. 46 mg/L; P=0.92). Formulas designated for enteral use tended to have lower relative SDs (mean CV 16% vs. 21% for oral formulas), likely due to the generally more complex matrix of oral formulas, which contributed to more analytical variability. Depending on the formula, a patient requiring 1.5 L daily could obtain anywhere from 12-150 mg oxalate. CONCLUSIONS Patients requiring oral and/or enteral nutrition support are at risk for a high exogenous oxalate load depending on the formula ingested and on the bioavailability of oxalate. Patients with a history of or at high risk for urolithiasis would benefit from strategies to reduce the bioavailability of oxalate and urinary oxalate excretion, which may include supplemental calcium with feedings or use of an appropriate lower oxalate formula. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e297-e298 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Kristina L. Penniston More articles by this author Eve A. Palmer More articles by this author Riley C. Medenwald More articles by this author Sarah N. Johnson More articles by this author Leema M. John More articles by this author David J. Beshensky More articles by this author Ibrahim A. Saeed More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...