- Email: [email protected]
The effect of increased protein intake on nitrogen balance in mechanically ventilated critically ill patients receiving total parenteral nutrition
Section 4 - NUTRITION
Date: Monday, September 7 13.30-l Chair: J.W. Alexander (USA)
IN THE CRITICALLY
ILL
protein content. Twenty-one mechanically ventilated critically ill patients were studied. After at least two days of standard TPN, patients were randomly assigned to either the low protein diet (LPD) or the high protein diet (HPD). Ten patients were studied on LPD and 11 on HPD. Nonprotein energy was supplied according to estimated energy requirements. During five consecutive days the N balance was measured daily. Total urinary nitrogen (TUN) was analysed using the Kjeldahl method. This method was compared to calculation of TUN from urinary urea nitrogen. Unpaired Student’s t-test showed no difference in N balance between the groups. On LPD nitrogen balance was -0.113 + 0.088 g N/g/day and on HPD -0.113 f 0.109 g N/kg/day. Results of a previous pilot study show that in 20 similar patients the nitrogen balance became 80% less negative when protein intake increased from 0.9 to 1.5 g/kg/day. Since these results are consistent with other studies, we conclude that there seems to be an optimal range of protein supply in this type of critically ill patients of approximately 1.2-1.5 g protein/kg/day. Estimation of TUN from urinary urea underestimated TUN measured with the Kjeldahl method with 17.7 k 25.6%. indicating that urea cannot be used for estimating TUN in this type of patient.
4.30
van der Heijden, A. (Utrecht) The Effect of Increased Protein Intake on Nitrogen Balance in Mechanically Ventilated Critically III Patients Receiving Total Parenteral Nutrition Radrizzani, D. (Milan) Changes of Nitrogen (N) Excretion induced by Glucose and Insulin Infusion in Traumatized Patients Zanello, M. (Bologna) A Comparison of Enteral and Parenteral Nutrition in Critically III Patients: Metabolic Results and Effects on Body Composition Tarasov, A. (Moscow) Prevention of Stress Gastro-Intestinal Erosions in Burned Patients De Oca, J. (Barcelona) Selective Bowel Decontamination (SBD), Nutritional Therapy (NT) and Bacterial Translocation (BT) after Burn Injury Rooyackers, 0. (Maastricht) Changes in Protein Metabolism in an Zymosan Induced Rat Model of Sepsis
P.33 Changes of nitrogen (N) excretion induced by glucose and insulin infusion in traumatized patients
Wagenmakers, A. (Maastricht) Decreases in Cytochrome C Oxidase Activities in Muscle of a Zymosan Induced Rat Model of Sepsis
D. Radrizzani, C. Guarnerio, G. Pasetti, G. Ronzoni and G. lapichino ICU E. Vecla, IRCCS Ospedale Maggiore, Milano. Italy
Wagenmakers, A. (Maastricht) Increased Branched-Chain 2-0~0 Acid Dehydrogenase Activities in Muscle in a Zymosan Induced Rat Model of Sepsis
Aim of this study was to investigate the variation of N excretion induced by the infusion of glucose and insulin to maintain normoglicemia. Six patients (pts) (age 18-67, weight 40-87) admitted to our ICU for major accidental or surgical trauma were studied, all pts were ventilated because of respiratory insufficiency and/or flail chest. After a 24 hrs period of minimal nutritional intake (less than 350 kcal as glucose), pts received parenteral glucose (1956 + 197 kcal/day) about 97% of their resting energy expenditure as measured in the last hr of the basal period, the infusion was maintained for the following 24 hrs. Urine was collected in a bag, a sample was taken every 4 hrs starting at 21st hr of the basal period and ending at 24th hr after the end of the glucose infusion, for a total of 13 samples. Samples were frozen at -70 degrees and then analyzed for total N (N Analyzer-Carlo Erba) and urea content, both N and urea elimination during the four hrs period were computed from the concentration time the urine volume. Blood urea was measured every 24 hrs and did not change. During the whole study period pts did not receive amino acids. Pts resulted to be severely catabolic as assessed by the N excretion during the basal period. N excretion begins to significantly decrease only from the 13th hr of glucose infusion, values remained lower than basal ones for 12 hrs after the stop of glucose infusion, reaching a minimum of 0.67 times the basal value, and then rose progressively (see table). Urea excretion fairly followed N losses, being about 80% of total N. In conclusion glucose plus insulin infusion is able to reduce N losses with a lag time of about 12 hrs, this action is reversible and takes another 12 hrs to vanish. This delay could depend upon the N transit time and on the time necessary for complete activation of metabolic pathways.
Alnor, D. (Copenhagen) The Hepatic Nitrogen Metabolism in Rats with lntraperitoneal Sepsis Jennings, G. (Cambridge) Effect of Dietary Restriction on the Acute Phase Protein Response in Rats Maeda, J. (Tokyo) Effect of Different Types of Fat Emulsion and Carnitine on Protein Metabolism in Septic Rats P.32 The effect of increased protein intake on nitrogen balance in mechanically ventilated critically ill patients receiving total parenteral nutrition A. van der Heijden’,‘, M.J.F. Verbeek’,2, V.V.A.M. Schreurs’, L.M.A. Akkermans’,2 and A. Vos’ Dept. of Physiology’, Wageningen Agricultural University, Dept. of Surger?, Utrecht University Hospital, The Netherlands The amount of protein required to minimise nitrogen loss in critically ill patients receiving total parenteral nutrition (TPN) varies in literature. Therefore, we studied the effect of increased protein intake on the N balance, administering TPN with either a low (1.2 g/kg/day) or a high (1.8 g/kg/day) 56
Date: Monday, September 7 13.30-l Chair: J.W. Alexander (USA)
IN THE CRITICALLY
ILL
protein content. Twenty-one mechanically ventilated critically ill patients were studied. After at least two days of standard TPN, patients were randomly assigned to either the low protein diet (LPD) or the high protein diet (HPD). Ten patients were studied on LPD and 11 on HPD. Nonprotein energy was supplied according to estimated energy requirements. During five consecutive days the N balance was measured daily. Total urinary nitrogen (TUN) was analysed using the Kjeldahl method. This method was compared to calculation of TUN from urinary urea nitrogen. Unpaired Student’s t-test showed no difference in N balance between the groups. On LPD nitrogen balance was -0.113 + 0.088 g N/g/day and on HPD -0.113 f 0.109 g N/kg/day. Results of a previous pilot study show that in 20 similar patients the nitrogen balance became 80% less negative when protein intake increased from 0.9 to 1.5 g/kg/day. Since these results are consistent with other studies, we conclude that there seems to be an optimal range of protein supply in this type of critically ill patients of approximately 1.2-1.5 g protein/kg/day. Estimation of TUN from urinary urea underestimated TUN measured with the Kjeldahl method with 17.7 k 25.6%. indicating that urea cannot be used for estimating TUN in this type of patient.
4.30
van der Heijden, A. (Utrecht) The Effect of Increased Protein Intake on Nitrogen Balance in Mechanically Ventilated Critically III Patients Receiving Total Parenteral Nutrition Radrizzani, D. (Milan) Changes of Nitrogen (N) Excretion induced by Glucose and Insulin Infusion in Traumatized Patients Zanello, M. (Bologna) A Comparison of Enteral and Parenteral Nutrition in Critically III Patients: Metabolic Results and Effects on Body Composition Tarasov, A. (Moscow) Prevention of Stress Gastro-Intestinal Erosions in Burned Patients De Oca, J. (Barcelona) Selective Bowel Decontamination (SBD), Nutritional Therapy (NT) and Bacterial Translocation (BT) after Burn Injury Rooyackers, 0. (Maastricht) Changes in Protein Metabolism in an Zymosan Induced Rat Model of Sepsis
P.33 Changes of nitrogen (N) excretion induced by glucose and insulin infusion in traumatized patients
Wagenmakers, A. (Maastricht) Decreases in Cytochrome C Oxidase Activities in Muscle of a Zymosan Induced Rat Model of Sepsis
D. Radrizzani, C. Guarnerio, G. Pasetti, G. Ronzoni and G. lapichino ICU E. Vecla, IRCCS Ospedale Maggiore, Milano. Italy
Wagenmakers, A. (Maastricht) Increased Branched-Chain 2-0~0 Acid Dehydrogenase Activities in Muscle in a Zymosan Induced Rat Model of Sepsis
Aim of this study was to investigate the variation of N excretion induced by the infusion of glucose and insulin to maintain normoglicemia. Six patients (pts) (age 18-67, weight 40-87) admitted to our ICU for major accidental or surgical trauma were studied, all pts were ventilated because of respiratory insufficiency and/or flail chest. After a 24 hrs period of minimal nutritional intake (less than 350 kcal as glucose), pts received parenteral glucose (1956 + 197 kcal/day) about 97% of their resting energy expenditure as measured in the last hr of the basal period, the infusion was maintained for the following 24 hrs. Urine was collected in a bag, a sample was taken every 4 hrs starting at 21st hr of the basal period and ending at 24th hr after the end of the glucose infusion, for a total of 13 samples. Samples were frozen at -70 degrees and then analyzed for total N (N Analyzer-Carlo Erba) and urea content, both N and urea elimination during the four hrs period were computed from the concentration time the urine volume. Blood urea was measured every 24 hrs and did not change. During the whole study period pts did not receive amino acids. Pts resulted to be severely catabolic as assessed by the N excretion during the basal period. N excretion begins to significantly decrease only from the 13th hr of glucose infusion, values remained lower than basal ones for 12 hrs after the stop of glucose infusion, reaching a minimum of 0.67 times the basal value, and then rose progressively (see table). Urea excretion fairly followed N losses, being about 80% of total N. In conclusion glucose plus insulin infusion is able to reduce N losses with a lag time of about 12 hrs, this action is reversible and takes another 12 hrs to vanish. This delay could depend upon the N transit time and on the time necessary for complete activation of metabolic pathways.
Alnor, D. (Copenhagen) The Hepatic Nitrogen Metabolism in Rats with lntraperitoneal Sepsis Jennings, G. (Cambridge) Effect of Dietary Restriction on the Acute Phase Protein Response in Rats Maeda, J. (Tokyo) Effect of Different Types of Fat Emulsion and Carnitine on Protein Metabolism in Septic Rats P.32 The effect of increased protein intake on nitrogen balance in mechanically ventilated critically ill patients receiving total parenteral nutrition A. van der Heijden’,‘, M.J.F. Verbeek’,2, V.V.A.M. Schreurs’, L.M.A. Akkermans’,2 and A. Vos’ Dept. of Physiology’, Wageningen Agricultural University, Dept. of Surger?, Utrecht University Hospital, The Netherlands The amount of protein required to minimise nitrogen loss in critically ill patients receiving total parenteral nutrition (TPN) varies in literature. Therefore, we studied the effect of increased protein intake on the N balance, administering TPN with either a low (1.2 g/kg/day) or a high (1.8 g/kg/day) 56