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Estimation of Nitrogen Excretion Based on Abbreviated Urinary Collections in Patients on Continuous Parenteral Nutrition

Nutrition Support Service, Allentown Hospital-Lehigh Valley Hospital Center, Allentown, Pennsylvania

Marian J. Hoffman, R.N., M.S.N., CNSN

Nutrition Support Service, Allentown Hospital-Lehigh Valley Hospital Center, Allentown, Pennsylvania

Joseph F. Lucke, PH.D.

Research Department, Allentown Hospital-Lehigh Valley Hospital Center, Allentown, Pennsylvania

The physiologic response to stress can create a net loss of nitrogen, which is indicative of a catabolic state. Nitrogen balance has been demonstrated to be a useful clinical indicator of a patient's catabolic state and the effectiveness of parenteral nutrition, but requires an estimate of total urinary nitrogen excretion. The standard method for determining total urinary nitrogen excretion is 24-hour urinary urea nitrogen excretion. Unfortunately, the 24-hour urine collection is inconvenient, cumbersome, sometimes inaccurate, and induces a lag in response time to changes in therapy. Although shorter collection times have been proposed, the validity of shorter-timed determinations remains open to question. To evaluate the estimation of 24-hour urine urea excretion from shorter-timed determinations, the urinary urea nitrogen excretion of 4-, 8-, and 12-hour durations was regressed against the 24-hour collection in 56 critically ill adult patients. The 12-hour determination provided satisfactory estimates of the 24-hour nitrogen excretion, but the 4-hour and 8-hour determinations did not. Thus, two times the 12-hour urine urea nitrogen determination can be substituted for the 24-hour determination in calculating nitrogen balance. A 12-hour determination can provide a more rapid turnaround of biochemical analysis, allow more timely nutritional intervention, decrease nursing time, and reduce the frequency of inaccurate or lost specimens. (Journal of Parenteral and Enteral Nutrition 15:148-151, 1991)

Journal of Parenteral and Enteral Nutrition, Vol. 15, No. 2, 148-151 (1991)
DOI: 10.1177/0148607191015002148


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