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Peripheral, visceral and body nitrogen balance of catabolic patients, without and with parenteral nutrition

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Abstract

The effect of major trauma and sepsis on skeletal muscle, central tissue and whole body nitrogen (N) metabolism was investigated in 5 patients before and during TPN (30 kcal, 0.30 g N kg-1 day-1). Fasting 3-methylhistidine (MEH) urinary excretion was elevated (407.9±67.6 μmol m-2 day-1), muscle and body N balances (NB) were markedly negative (-28.2±4.6 g m-2 day-1 and-15.7±3.1 g m-2 day-1), while central tissue NB was positive (13.0±2.4 g m-2 day-1). TPN effected a reduction in MEH excretion (261.8±27.5 mmol m-2 day-1-p<0.05) and decreased the release of almost all amino acids from muscle tissue, some of them acting as catabolic markers. Muscle (-7.2±1.2 g m-2 day-1-p<0.01) as well as body NB (-4.8±1.4 g m-2 day-1-p<0.01) improved, whilst central tissue NB worsened, even though still positive (3.1±1.6 g m-2 day-1-p<0.05). Gathering fasting and TPN data MEH excretion was significantly related to both body (r=0.89) and muscle (r=0.73) NB, that were highly related to each other (r=0.93), being muscle always worse than body NB. In conclusion, the anticatabolic activity of TPN is confirmed, although our setting did not achieve muscle NB, it was consistently improved and seems to be the major determinant of body NB, in contrast central NB and central N utilization (46.4%±5.4 vs 15.8%±8.4-p<0.05) worsened.

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Authors and Affiliations

  1. Reparto di Rianimazione, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Maggiore di Milano, Milano, Italy

    D. Radrizzani, G. Iapichino & G. Ronzoni

  2. Istituto di Anestesia e Rianimazione e, Torino, Italy

    A. Colombo

  3. Istituto di Igiene dell'Università, Torino, Italy

    M. Cambisano

  4. Servizio di Ricerche Cliniche Ospedale R, Margherita, Torino, Italy

    G. Bonetti

Authors
  1. D. Radrizzani
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  2. G. Iapichino
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  3. M. Cambisano
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  4. G. Bonetti
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  5. G. Ronzoni
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  6. A. Colombo
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Radrizzani, D., Iapichino, G., Cambisano, M. et al. Peripheral, visceral and body nitrogen balance of catabolic patients, without and with parenteral nutrition. Intensive Care Med 14, 212–216 (1988). https://doi.org/10.1007/BF00717991

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  • DOI: https://doi.org/10.1007/BF00717991

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