The effect of increasing the calcium, magnesium and sodium concentration in gall bladder bile samples from 21 patients with gall stones and nine controls on the in vitro rate of formation of cholesterol microcrystals and numbers of cholesterol microcrystals formed was examined. Addition of these cations to raise the mean maximum concentration of calcium ions to 19.8 mmol/l, of magnesium ions to 20 mmol/l and sodium ions to 998 mmol/l did not trigger nucleation in control bile samples or samples from patients with gall stones. Increasing the mean concentration of calcium ions to 8.6 mmol/l and of sodium to 320 mmol/l increased the numbers of cholesterol monohydrate crystals/0.1 mm3 counted by light polarisation phase contrast microscopy at the time of nucleation in samples from patients with gall stones from a median of 2 (range 1-10) in control portions to 18 (range 2-128) for calcium ions and 10 (range 2-141) for sodium ions (p less than 0.001). Calcium and magnesium ions were more effective than sodium ions, and calcium ions could increase crystal numbers at concentrations found in samples from patients with gall stones, median 4.6 mmol/l (range 2.7-16.9 mmol/l). The concentrations of calcium and magnesium present in bile may therefore influence the rate of development of gall stones.
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