Determinants of urea nitrogen production in sepsis. Muscle catabolism, total parenteral nutrition, and hepatic clearance of amino acids

Archives of Surgery
M PittirutiR Placko

Abstract

The major determinants of urea production were investigated in 26 patients with multiple trauma (300 studies). The body clearances (CLRs) of ten amino acids (AAs) were estimated as a ratio of muscle-released AAs plus total parenteral nutrition-infused AAs to their extracellular pool. While clinically septic trauma (ST) patients without multiple-organ failure syndrome (MOFS) had a higher level of urea nitrogen production (25.6 +/- 13.4 g of N per day) compared with nonseptic trauma (NST) patients (14 +/- 7.5 g of N per day) and with ST patients with MOFS (4.28 +/- 1.5 g of N per day), in all groups urea N production was found to be a function of muscle protein degradation (catabolism), total parenteral nutrition-administered AAs, and the ratio between leucine CLR and tyrosine CLR (L/T) (r2 = .82, P less than .0001). Since tyrosine is cleared almost exclusively by the liver, the L/T ratio may be regarded as an index of hepatic function. The significant differences between urea N production in ST and NST patients lay in an increased positive dependence on muscle catabolism and increased negative correlation with L/T in the ST group. At any L/T ratio, urea N production was increased in ST patients over NST patients, but in ST patie...Continue Reading

Citations

Feb 9, 2005·Liver International : Official Journal of the International Association for the Study of the Liver·Susanne Schouw NielsenHendrik Vilstrup
Oct 15, 2005·JPEN. Journal of Parenteral and Enteral Nutrition·Roland N DickersonRex O Brown
Jul 20, 2012·The American Journal of Clinical Nutrition·L John Hoffer, Bruce R Bistrian
Apr 13, 2019·American Journal of Physiology. Gastrointestinal and Liver Physiology·Gabriëlla A M Ten HaveNicolaas E P Deutz
Feb 12, 2020·JPEN. Journal of Parenteral and Enteral Nutrition·Ilya LeydermanStanislaw Klek
Jan 22, 1998·The American Journal of Physiology·M HolecekM Pecka
May 3, 2001·The American Journal of Clinical Nutrition·W DrumlG Kleinberger
Jan 1, 1995·The American Journal of Physiology·D A FryburgE J Barrett
Mar 1, 1996·Clinics in Chest Medicine·G M Matuschak

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