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Ref #977 : Nitrogen and energy balance in septic and injured intensive care patients: response to parenteral nutrition
Author(s):
Pitkanen O, Takala J, Poyhonen M, Kari A.
Date:
1991
Reference Type:
Journal
Periodical:
Clinical Nutrition
Issue:
10
Volume:
5
Page range:
258 - 265
Keywords:
Acids, Amino-acids, Catabolism, Control, Energy, Energy-balance, Energy-intake, Glucose, Infusion, Injuries, Intake, Intensive-care, Losses, Nitrogen, Nitrogen-balance, Nutrition, Parenteral-feeding, Patients, Reduction, Sepsis, Trauma, Treatment.
Abstract / Notes:
Energy and nitrogen balance was studied in 50 intensive care patients with sepsis (n = 18) or multiple trauma (n = 32). Most patients were mechanically ventilated during the study. Within 72 h of admission the patients received one of 5 infusion regimens for 48 h. The control group received hypoenergetic glucose, 2 groups received amino acids 1.5 g/kg daily with hypoenergetic glucose on both days or with energy adjusted to pre-nutrition resting energy expenditure (REE) on the second day. The fourth group received amino acids 0.6 g/kg daily and energy at REE, and the fifth group a high N (18 g/day) regimen with a stepwise increase in energy intake from day 1 to day 2. Baseline REE was 118+-18.9% of predicted. There were no significant differences in REE between the diagnostic groups, treatments or measurements performed during mechanical or spontaneous ventilation. N balance in the control group was - 250.3+-83.3 on day 1 and -218.6+-95.3 mg/kg on day 2. N balance remained negative in all groups throughout the study (range of group means -218.6 to - 48.5 mg/kg daily). Increasing energy intake equal to prenutrition REE at an amino-acid dosage of 1.5 g/kg daily decreased the negative N balance by 66%. Further increase in energy balance had only a marginal effect on N balance. It is concluded that N equilibrium can not be achieved with conventional TPN programmes during acute catabolism in intensive care patients. Clinically acceptable reduction of N loss can be obtained with an amino acid intake of 1.5 g/kg daily and non-protein energy at levels close to energy expenditure.978