Abstract: SA-PO509
A Rare Case of Calcium Tartrate Nephrolithiasis
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Case Reports
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders
- 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical
Authors
- Chung, Madeline S., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
- Yau, Amy, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
Introduction
Calcium tartrate tetrahydrate nephrolithiasis is rare with only a handful of cases noted in the literature. Initially reported in rats with a high tartrate diet, the stone spectra was later identified in 6% of previously unidentified human kidney stones with a general incidence of 0.007%.
Case Description
We present a 39-year-old woman with no significant past medical history who presented with flank pain due to a 5 mm distal left ureteral stone at the ureterovesical junction. She underwent uncomplicated ureteroscopy with basket stone extraction with removal of two kidney stones (2mm and 5mm in diameter).
Stone analysis was significant for 50% calcium tartrate tetrahydrate, 30% calcium oxalate monohydrate, and 20% calcium phosphate. Metabolic evaluation was unremarkable with normal 25-OH vitamin D, intact parathyroid hormone, and calcium levels. 24-hour urine samples were significant for low urine volume and hypercalciuria (Table 1). She had no previous history of kidney stones. Upon further questioning, she admitted to consuming 1-2 scoops of Spark energy drink mix daily for the past 5 years. Each scoop of this drink mix contains 10mg of L-carnitine as tartrate and 500mg of choline as bitartrate and citrate. She denied any other supplements nor high consumption of tartrate-containing substances such as wine or free baking powder. She was encouraged to avoid AdvoCare Spark, increase her fluid intake and re-assess hypercalciuria in 6 months.
Discussion
This is the fourth reported case of a calcium tartrate tetrahydrate stone with an associated history. The first was a patient in Africa with unknown history. Later retrospective analysis of the Mayo Clinic database revealed 35 stones consistent with calcium tartrate tetrahydrate in 27 unique patients, but only three had available history. All three also consumed AdvoCare Spark energy drink mix regularly. We believe that excessive tartrate intake via the Spark Energy Drink mix is what precipitated the kidney stone in our patient. Her case is a cautious reminder to obtain a full social and dietary history in patients with unknown or rare stone profile and those with or recurrent stones despite appropriate risk factor modification.
Table 1
| Date | Vol 24 | Ca 24 | Ox 24 | Cit 24 | pH | UA 24 | Na 24 | Mg 24 |
| 11/30/21 | 2.00 | 452 | 16 | 646 | 5.638 | 0.580 | 149 | 115 |
| 12/1/21 | 1.76 | 373 | 23 | 794 | 5.889 | 0.648 | 140 | 101 |
| Ref Range | 0.5-4L | <200 mg | 20-40 mg | >550 mg | 5.8-6.2 | <0.750 g | 50-150 mmol | 30-120 mg |