Milk alkali syndrome and the dynamics of calcium homeostasis.
Department of Medicine, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA.Clinical Journal of the American Society of Nephrology (Impact Factor: 5.07). 08/2006; 1(4):641-54. DOI:10.2215/CJN.01451005
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ABSTRACT: This paper examines the assessed competency and performance of 100 British private sector managers and 120 Singaporean public sector managers. Factor models derived from managerial competencies considered important within different cultural and work environments are compared and faster career-progressing managers are differentiated from their peers. Research findings suggest that managerial competencies are broadly similar in importance across cultural environments. Competency differences are apparent where the work environment differs. Assessed competencies associated with planning, organizing and motivating others distinguish more rapid career-advancing managers regardless of their culture or work environment. While these competencies are necessary, findings indicate that they are not sufficient for career advancement.Highlights► Managerial competencies are similar in importance across cultural environments. ► Competency differences are apparent where the work environment differs. ► There are common competencies across different cultural and work environments. ► Planning, organizing and motivating competencies result in rapid career advancement.Journal of Business Research. 03/2013;
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ABSTRACT: Metabolic acidosis is a common complication associated with progressive loss of kidney function. The diminishing ability of the kidneys to maintain acid-base homeostasis results in acid accumulation, leading to various complications such as impairment in nutritional status, worsened uremic bone disease and an association with increased mortality. In addition to these adverse effects which are related to acid retention, metabolic acidosis may also cause kidney damage, possibly through the stimulation of adaptive mechanisms aimed at maintaining acid-base homeostasis in the face of decreasing kidney function. Recent clinical trials have suggested that correction or prevention of metabolic acidosis by alkali administration is able to attenuate kidney damage and to slow progression of chronic kidney disease (CKD), and may hence offer an effective, safe and affordable renoprotective strategy. We review the physiology and pathophysiology of acid-base homeostasis in CKD, the mechanisms whereby metabolic acidosis may be deleterious to kidney function, and the results of clinical trials suggesting a benefit of alkali therapy, with special attention to details related to the practical implementation of the results of these trials.Nephrology Dialysis Transplantation 08/2012; 27(8):3056-62. · 3.37 Impact Factor
Article: The calcium-alkali syndrome.[show abstract] [hide abstract]
ABSTRACT: The milk-alkali syndrome was a common cause of hypercalcemia, metabolic alkalosis, and renal failure in the early 20th century. It was caused by the ingestion of large quantities of milk and absorbable alkali to treat peptic ulcer disease. The syndrome virtually vanished after introduction of histamine-2 blockers and proton pump inhibitors. More recently, a similar condition called the calcium-alkali syndrome has emerged as a common cause of hypercalcemia and alkalosis. It is usually caused by the ingestion of large amounts of calcium carbonate salts to prevent or treat osteoporosis and dyspepsia. We describe a 78-year-old woman who presented with weakness, malaise, and confusion. She was found to have hypercalcemia, acute renal failure, and metabolic alkalosis. Upon further questioning, she reported use of large amounts of calcium carbonate tablets to treat recent heartburn symptoms. Calcium supplements were discontinued, and she was treated with intravenous normal saline. After 5 days, the calcium and bicarbonate levels normalized and renal function returned to baseline. In this article, we review the pathogenesis of the calcium-alkali syndrome as well as the differences between the traditional and modern syndromes.Proceedings (Baylor University. Medical Center) 04/2013; 26(2):179-81.
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