Abstract
Twenty mechanically ventilated patients with acute renal failure were studied on 31 occasions to determine their energy expenditure (EE) during a 2 h period before a hemodialysis. Oxygen consumption and CO2 elimination were measured continuously with a mass spectrometer system. EE (1660±48 kcal day-1) was close to the total caloric intake (1682±83 kcal day-1) and represented 1.19±0.03 times the predicted resting energy expenditure (PREE) with large inter-individual variations (0.7-1.7 PREE). EE/PREE was higher when sepsis was present (1.31±0.03 versus 1.14±0.02; p<0.05). Glucose oxidation rate (4.35 mg kg-1 min-1) exceeded glucose intake (2.6 mg kg-1 min-1). Respiratory quotient was 1.02±0.01. Nitrogen loss was 17.3±1.7 g day-1 and nitrogen balance-11.9±1.9 g day-1. In conclusion, EE values were scattered but never exceeded 1.7 times the PREE. Sepsis increased EE. With a nutritional support covering EE, nitrogen balance remained markedly negative and a preferential utilisation of glucose and lipogenesis occurred.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Beisel WR, Wannemacher RW (1980) Glucogenesis, ureagenesis and ketogenesis during sepsis. JPEN 4:277
Bertrand O, Viale JP, Annat G, Sebes F, Delafosse B, Percival C, Bui Xuan B, Motin J (1986) A mass spectrometer system for long term continuous measurement of VO2 and VCO2 during artificial ventilation. Med Biol Eng Comput 24:174
Blumenkrantz MJ, Kople JD, Gutman RA, Chan YK, Barbour GL, Roberts C, Shen FH, Ganghi VC, Tucker CT, Curtis FK, Coburn JW (1980) Methods for assessing nutritional status of patients with renal failure. Am J Clin Nutr 33:1567
Braun U, Berger C, Kunze E, Martell J, Schwarzkopf J, Trapp V, Kramer P (1985) Daily energy and nitrogen balance in acute catabolic renal failure. In: Continuous arterio-venous hemofiltration. International conference on CAVH, Aachen 1984. Karger, Basel, p 219
Bursztein S, Glaser P, Trichet B, Taitelman U, Nedey R (1980) Utilization of protein, carbohydrate and fat in fasting and post absorptive subjects. Am J Clin Nutr 33:998
Carlsson M, Thorne A, Forsberg E (1985) Energy expenditure and thermogenic effect of nutrition in long term critically ill trauma sepsis patients. 7th Congress of European Society of Parenteral and Enteral Nutrition, Munich. Abstract 0.116
Elwyn DM (1980) Nutritional requirements of adult surgical patients. Crit Care Med 8:9
Feinstein EI, Blumenkrantz MJ, Healy M, Koffler A, Silberman H, Massry SG, Kopple JD (1981) Clinical and metabolic responses to parenteral nutrition in acute renal failure. Medicine 60:124
Giovannini I, Boldrini G, Chiarla C, Castagneto M, Castiglioni GL (1985) Hypermetabolism and substrate utilization in sepsis and trauma. 7th Congress of European Society of Parenteral and Enteral Nutrition, Munich. Abstract 0.32
Grodstein GP, Blumenkrantz MJ, Kopple JD (1980) Nutritional and metabolic response to catabolic stress in uremia. Am J Clin Nutr 33:1411
Hunker FD, Bruton CW, Hunker EM, Durham RM, Krumdieck CL (1980) Metabolic and nutritional evaluation of patients supported with mechanical ventilation. Crit Care Med 8:628
Kalhan SC, Ricanati ES, Tserng KY, Savin SM (1983) Glucose turnover in chronic uremia: increased recycling with diminished oxidation of glucose. Metabolism 32:1155
Kosanovich JM, Dumler F, Horst M, Quandt C, Sargent JA, Levin NW (1985) Use of urea kinetics in the nutritional care of acutely ill patient. JPEN 9:165
Mann S, Westenskow DR, Houtchens BA (1985) Measured and predicted caloric expenditure in the acutely ill. Crit Care Med 13:173
Miller RL, Taylor WR, Gentry W, Day AT, Gazzaniga AB (1983) Indirect calorimetry in post operative patients with acute renal failure. Am Surg 49:494
Roza AM, Shizgal HM (1984) The Harris Benedict equation reevaluated: resting energy requirements and the body cell mass. Am J Clin Nutr 40:168
Saffle JR, Medina E, Raymond J, Westenskow D, Kravitz M Warden GD (1985) Use of indirect calorimetry in the nutritional management of burned patients. J Trauma 25:32
Shenkin A (1979) Monitoring the nutritional status of critically ill patients. Intensive Care Med 5:165
Spreiter SC, Myers BD, Swenson RS (1980) Protein energy requirements in subjects with acute renal failure receiving intermittent hemodialysis. Am J Clin Nutr 33:1433
Weissman C, Kemper M, Damask MC, Askanazi J, Hyman AI, Kinney JM (1985) Metabolic rate in the post-operative critical care patient (Abstract) Crit Care Med 13:280
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bouffard, Y., Viale, J.P., Annat, G. et al. Energy expenditure in the acute renal failure patient mechanically ventilated. Intensive Care Med 13, 401–404 (1987). https://doi.org/10.1007/BF00257684
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00257684