A method of determining daily nitrogen requirements

Lee, H. A.; Hartley, T. F.

doi:10.1136/pgmj.51.597.441

Cited by 83 publications

(12 citation statements)

References 4 publications

(4 reference statements)

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“…(1) No changes in nitrogen intake, calorie intake, or vital signs for a minimum of 24 hr prior to the study, and during the 24-hr study period. (2) Parenteral or enteral nutrition infused at a constant rate. (3) No difference in blood urea nitrogen concentrations measured at the beginning and end of the study period.…”

Section: Methodsmentioning

confidence: 99%

The Estimation of 24‐Hour Urine Urea Nitrogen Excretion from Urine Collections of Shorter Duration in Continuously Alimented Patients

Sorkness

1984

J Parenter Enteral Nutr

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Urine urea nitrogen excreted in 24 hr is used to estimate nitrogen balance in patients. Normal diurnal variation of urea excretion may be less pronounced in patients alimented continuously, and a urine collection of shorter duration may be representative of the 24-hr excretion. Five stabilized trauma center patients on continuous enteral or parenteral alimentation were studied with six consecutive 4-hr urine collections analyzed for urine urea nitrogen content. Excretion rates for various lengths of urine collection were compared with the 24-hr excretion rate. Urine collections spanning 4 or 8 hr frequently exceeded an error of 10% in predicting 24-hr urea nitrogen excretion, while collections of 12 hr or more had small errors. A comparison of three consecutive 8-hr collections was suggestive of diurnal variation existing under these conditions.

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Section: Methodsmentioning

confidence: 99%

The Estimation of 24‐Hour Urine Urea Nitrogen Excretion from Urine Collections of Shorter Duration in Continuously Alimented Patients

Sorkness

1984

J Parenter Enteral Nutr

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“…Twenty-four-hour urinary urea excretion, with allowance for extrarenal losses, is commonly used to estimate daily protein requirements in patients receiving parenteral nutrition. 35 Although urea represents about 90% of total urinary nitrogen loss (about 15 g/day in the adult man) in health, this is not so in other circumstances. In all forms of PEM there is an adaptive conservation of nitrogen with a fall in urinary urea.36 This is also seen within a day or two in healthy subjects deprived of protein and in prolonged starvation urinary urea falls below that of ammonia.…”

Section: -Hr Nitrogenmentioning

confidence: 99%

Nutritional Assessment at the Crossroads

McLaren

Meguid

1983

J Parenter Enteral Nutr

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&dquo;Sciences not underpinned by theory are not much more than kitchen arts.&dquo; Sir Peter Medawar &dquo;The Art of the Soluble&dquo;Necessity is the mother of invention, and it was the general recognition of two quite separate but widespread malnutrition problems that gave birth to interest in nutritional assessment. Malnutrition is any disorder of nutrition and besides that relating to protein and energy may also concern a number of vitamins and essential elements. In both the problems referred to below, protein-energy malnutrition (PEM) is the major concern and attention here will be confined to this.The first problem is that of PEM as the major form of childhood malnutrition throughout developing countries and at any one time affects hundreds of millions of preschool age children. Growth failure is its earliest manifestation and various schemes, based on weight, height, and other measurements have been used to assess the extent of the problem in population groups' and to classify the degree of PEM in sick children.2, 3 Several simple lessons have been learned from this experience. The application of standards based on crosssectional data should be confined to large population groups. Longitudinal growth data should be collected for the individual child and any failure to maintain its own growth tract should sound a warning of impending PEM. The severe degree of PEM is characterized not only by growth failure but also by biochemical abnormalities and clinical signs. Depending on the pathogenesis' these changes vary markedly, resulting in a spectrum of syndromes composed of marasmus, kwashiorkor, and intermediate forms, marasmic-kwashiorkor 5.1The second problem contributing to the impetus to nutritional assessment has come more recently from the general recognition that a considerable proportion of hospitalized surgical and medical adult patients throughout the world is also suffering from PEM, secondary to their underlying diseases. The proportions have been varyingly reported to be anywhere between 20 and 65%, but as will be seen later, these figures should be regarded with considerable skepticism as the tests and the ways in which they have been used in making the diagnosis are open to criticism.It is doubtful the current interest would have been generated if effective means of preventing or alleviating PEM under these circumstances had not been developed. Parenteral nutrition and improved enteral nutrition have provided the necessary spur. Unfortunately, the lessons to be learned from the childhood PEM experience have in general been overlooked, and as we shall see the area of adult medicine has many additional problems of its own. GENERAL POINTSNumbers are usually small in clinical studies, and hence, standards meant for large population groups are not applicable. Hospitalized patients form very heterogeneous groups with wide variations in age, types, and stages of disease, modalities of treatment, complications, etc.In surgical patients especially, the judgmental basis for the decision to operate will...

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“…It was rapidly corrected by neutral phosphate infusion. Blood urea correction for nitrogen balance according to Lee and Hartley (1975) formula. Nitrogen balance improved with additional nitrogen provision after day 21.…”

Section: Casementioning

confidence: 99%

Hypophosphataemia and phosphorus requirements during intravenous nutrition

Tovey

Benton

Lee

1977

Postgraduate Medical Journal

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Summary Seven patients with acute illnesses developed hypophosphataemia whilst receiving intravenous nutrition which included a fat emulsion, Intralipid, a possible source of phosphorus. The authors' observations cast doubt on the bio-availability of the phosphorus contained in the phospholipid content of the fat emulsion. The currently recommended allowance of phosphorus for this type of patient appears to be too low and it is suggested that 0-5-0-75 mmol/kg body weight be provided, preferably as a neutral phosphate solution. Sine hypophosphataemia can occur at various time intervals after starting intravenous nutrition and precede clinical sequelae it is recommended that routine serum phosphate measurements are made in all patients receiving this treatment.

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A method of determining daily nitrogen requirements

Cited by 83 publications

References 4 publications

The Estimation of 24‐Hour Urine Urea Nitrogen Excretion from Urine Collections of Shorter Duration in Continuously Alimented Patients

The Estimation of 24‐Hour Urine Urea Nitrogen Excretion from Urine Collections of Shorter Duration in Continuously Alimented Patients

Nutritional Assessment at the Crossroads

Hypophosphataemia and phosphorus requirements during intravenous nutrition

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