Viral Kumar Patel’s Publications & Presentations

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Intestinal and renal effects of low-volume phosphate and sulfate cathartic solutions designed for cleansing the colon: pathophysiological studies in five normal subjects.

Ingestion of a concentrated low-volume phosphate solution produces copious diarrhea, which cleanses the colon, but it occasionally causes renal failure due to calcium phosphate precipitation in renal tubules. We hypothesized that a concentrated low-volume sulfate solution would be an equally effective cathartic, and that urine produced after sulfate would have less tendency to precipitate calcium salts than urine produced after phosphate.

Hydrated subjects ingested 75 ml of phosphosoda or an equimolar dose of sulfate salts in a small volume of solution. Four liters of PEG (polyethylene glycol) lavage solution was the control. All solutions were administered in split doses, 10 h apart. Propensity of urine to precipitate at pH 6.4 (the pH of renal tubular fluid) was assessed by determining the minimal calcium concentration that caused precipitation.

Average diarrheal stool weight was 2,004 g after phosphate, 2,854 g after sulfate, and 3,021 g after PEG (P<0.001). Average calcium concentration (in mg/dl) required to induce urine precipitation at pH 6.4 was 43 after PEG, 10 after PO(4), and 187 after SO(4) (P=0.009).

(i) In equimolar doses, sulfate produced 42% more diarrheal stool weight than phosphate. (ii) Phosphate increased the propensity for calcium salt precipitation in urine at pH 6.4, whereas sulfate did not. (iii) These results suggest that a hypertonic low-volume sulfate solution would be an effective cathartic for colon cleansing and that sulfate-induced catharsis would be less likely than phosphate catharsis to produce calcium salt deposition in renal tubules.

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Increased anion gap metabolic acidosis as a result of 5-oxoproline (pyroglutamic acid): a role for acetaminophen.

The endogenous organic acid metabolic acidoses that occur commonly in adults include lactic acidosis; ketoacidosis; acidosis that results from the ingestion of toxic substances such as methanol, ethylene glycol, or paraldehyde; and a component of the acidosis of kidney failure. Another rare but underdiagnosed cause of severe, high anion gap metabolic acidosis in adults is that due to accumulation of 5-oxoproline (pyroglutamic acid). Reported are four patients with this syndrome, and reviewed are 18 adult patients who were reported previously in the literature. Twenty-one patients had major exposure to acetaminophen (one only acute exposure). Eighteen (82%) of the 22 patients were women. Most of the patients were malnourished as a result of multiple medical comorbidities, and most had some degree of kidney dysfunction or overt failure. The chronic ingestion of acetaminophen, especially by malnourished women, may generate high anion gap metabolic acidosis. This undoubtedly is an underdiagnosed condition because measurements of serum and/or urinary 5-oxoproline levels are not readily available.

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The femoral gateway.

A patient who abused cocaine intravenously had an abscess in the groin, which healed to form a sinus tract leading directly to the wall of the femoral vein. She used this “gateway” as her primary means of venous access for the next 5 years. It was both “painless and brainless” and led to femoral vein thrombosis and sepsis. This is the second reported case of such a unique means of venous access.

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Patient Reviews

Dr. Patel was wonderful! He was very informative, taking the time to explain my health conditions and symptoms. He took perfect care of me before and after the surgery! His staff was also wonderful as well. The nurse was also very caring and genuine. I recommend Dr. Patel highly for anyone!!

Anne D.Fort Worth, TX

Dr. Patel took the time to listen and understand my concerns. He then made sure that I understood. He didn’t seem in a hurry either.

Timothy S.Rowlett, Texas

I was referred to Dr. Patel in 2011 by my ENT. I had gone with a sore throat that lasted 4 months. The ENT said that my sore throat was caused by acid reflux. It was very easy to get an appointment with Dr. Patel. His bedside manner made me very at ease and comfortable with him. After treating the acid reflux, Dr. Patel requested I have several other tests. After that, I was diagnosed with Gastro paresis. I have been a patient for more than 6 years. I highly recommend him.

Joyce LaneTerrell, TX

I recommend Dr Patel to all my family and friends. He had an incredible bedside manner that made me feel very comfortable and confident in his excellent care


Great doctor and so very caring, I felt very comfortable with him.

I have had three procedures performed by Dr. Patel over the last seven years. His office is in my community. I have been made at ease by his explanations and knowledge. I have confidence in his decisions and abilities in regard to my gastrointestinal health and well being!

Diana ThrashRowlett, TX

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