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  • Title: Monitoring protein requirements of the patient receiving hemodialysis and total parenteral nutrition.
    Author: Mirtallo JM, Schneider PJ, Ruberg RL, Fabri PJ.
    Journal: Am J Hosp Pharm; 1981 Oct; 38(10):1483-6. PubMed ID: 6794363.
    Abstract:
    A method of determining nitrogen balance in patients receiving total parenteral nutrition (TPN) and hemodialysis was evaluated. Daily nitrogen intake (NI), pre- and postdialysis weight, BUN, and creatinine values were determined. Urea-nitrogen accumulation (UNA) was calculated as the increase in total body urea-nitrogen (g) between two consecutive hemodialysis procedures. Urea-nitrogen accumulation was substituted for urine urea-nitrogen excretion in the nitrogen balance formula, and nitrogen balance was estimated as NI minus UNA. The results from eight patients were evaluated separately based on the TPN formulations administered. Group 1 received solutions containing 15 g of amino acids and 350 g of dextrose. Group 2 received solutions with 42.5 g of amino acids and 350 g of dextrose. The nitrogen intake of Group 2 (9.4 +/- 4.4 g/day, mean +/- S.D.) was greater than Group 1 (2.3 +/- 1.2 g/day), but the UNA was approximately the same for both groups (10.6 +/- 6.5 and 9.8 +/- 7.9 g/day for Groups 2 and 1, respectively). Nitrogen balance estimates for Group 2 (-0.9 +/- 8.4 g/day) were greater than for Group 1 (-7.4 +/- 7.1 g/day) with four of the seven patients in Group 2 and none of the patients in Group 1 achieving a positive nitrogen balance. The rate of rise of BUN (19 mg/dl/day) was the same for both groups. By using estimated nitrogen balance values and changes in BUN levels and BUN-to-creatinine ratios, nitrogen use by patients receiving both TPN and hemodialysis can be monitored and adequate doses of amino acids can be provided.
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