Nutritional and metabolic assessment of critically ill children
Keywords:
Nutritional assessment, Nutritional support, Nitrogen balance, PrealbuminAbstract
In a prospective study, with the objective of determining the metabolic profile, response to nutrient supply, and role of nutritional and metabolic assessment parameters in children admitted to a pediatric ICU, 11 patients in the age group 2-12 were studied. The assessment was carried out during the first 72 hours of admission, and again seven days later, and included the following parameters: caloric supply; nitrogen supply; prealbumin serum level; urinary urea nitrogen; nitrogen balance and creatinine-height index. The evolution of the parameters in the two stages of the study showed the following results: The urinary urea nitrogen median value at admission was 7.5 g/m² of corporeal surface, and did not present significant changes seven days later. There was a significant increase in caloric supply from 42.9 to 70,3 kcal/kg, and in nitrogen supply, from 4.7 to 10.2 g/m² of corporeal surface p 0.01 . The level of nitrogen balance rose from - 5.6 to 2.5 g/24h (p<0.03), and that of prealbumin, from 16.7 to 26.3 mg/dl (p<0.03). There was a significant reduction in the creatinine-height index, from 86.2 percent to 55.0 percent p 0.01. The magnitude of urinary urea nitrogen excretion at admission varied 2.5-13.8 g/m² of corporeal surface. Based on this parameter, it was not possible to establish a characteristic metabolic profile for the conditions studied. Notwithstanding an increase in the protein and caloric supply, prealbumin level and nitrogen balance observed in the second stage of the study, the patients lost muscle mass and entered into a malnutrition process, probably due to intense protein catabolism and the poor response to nutrition supply that occurs in metabolic stress.
Downloads
References
Cerra B. Hypermetabolism, organ failures and metabolic support. Surgery 1987;101(1):1-13.
Bole JM, Garre MA, Youinou PY. Simple assessment of the nutritional status in the critically ill patient. Resuscitation 1984;11:233-41.
Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy, Pediatrics 1957;19:823-32.
Organizacion Mundial De La Salud. Medición del Cambio del Estado Nutricional. Geneva: OMS, 1983:105.
Batista Filho M, Sigulen DM, Nóbrega FJ. Nomenclatura e classificação da desnutrição. 1ª parte. J Pediatria 1976;41(7-8):45-51.
Waterlow JC. Classification and definition of protein-calorie malnutrition. Br J Med 1972;3:566-9.
Wilmore DW. The metabolic management of the critically ill. New York: Plenun Publishing Corporation, 1980:262.
Merrit RJ, Blackburn GL. Nutritional assesment and metabolic response to illness of the hospitalized child. In: Suskind RM, ed. Textbook of Pediatric Nutrition. New York: Raven Press, 1981.
Siegel, S. In: Trilla, ed. Estadistica no parametrica. Mexico, 1975:346.
Cuthbertson D, Tilstone WJ. Metabolism during the post injury period. Adv Clin Chem 1969;12:1-55.
Velasco N, Long CL, Otto DA, Davis N, Geiger JW, Blakemore, WS. Comparison of three methods for the estimation of total nitrogen losses in hospitalized patients. JPEN 1990;14(5):517-22.
Roubenoff RA, Borel CO, Hanley DF. Hypermetabolism and hypercatabolism in Guillain-Barré Syndrome. JPEN 1992;16(5):464-72.
Mickell JJ. Urea nitrogen excretion in critically ill children. Pediatrics 1982;70(6):949-54.
Haynes RC, Murad F. Hormona adrenocorticotrofica, esteroides adrenocorticales y sus análogos; sintéticos inibidores de la biosíntesis de esteroides corticosuprarenales. In: Goodman y Gilman, eds. Las bases farmacológicas de la terapéutica. Buenos Aires: Panamericana, 1982:1430-58.
Leite HP, Fisberg M, Novo NF, Nogueira EBR, Ueda IK. Nutritional assessment and surgical risk markers in children submitted to cardiac surgery. SPMJ 1995;113(1):706-14.
Chwals WJ, Fernandez E, Charles BJ. Serum visceral protein levels reflect protein-calorie repletion in neonates recovering from major surgery. J Ped Surg 1992; 27(3):317-21.
Thomas MR, Massoudi M, Byrne J, Mitchel MA, Eggert JD, Chan GM, et al. Evaluation of transthyretin as a monitor of protein-energy intake in preterm and sick neonatal infants. JPEN 1988;12(2):162-6.
Leite HP. Avaliação do estado nutricional e indicadores de risco cirúrgico em crianças submetidas a cirurgia cardíaca. São Paulo, 1992. (Master Thesis, Escola Paulista de Medicina).
Fürs P, Stehle P. Are Intravenous Amino Acid Solutions Unbalanced? New Horizons 1994;2(2):215-23.
Shaw J, Wolfe R. An integrated analysis of glucose, fat, and protein metabolism in severely traumatized patients. Ann Surg 1989;209(1):63-72.
