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Metabolic Response to Injury and Illness: Estimation of Energy and Protein Needs from Indirect Calorimetry and Nitrogen Balance
Calvin L. Long, Ph.D.
From the Department of Surgery, Medical College of Ohio, Toledo, Ohio 43699
Neal Schaffel, B.S.
From the Department of Surgery, Medical College of Ohio, Toledo, Ohio 43699
John W. Geiger, B.A.
From the Department of Surgery, Medical College of Ohio, Toledo, Ohio 43699
William R. Schiller, M.D.
From the Department of Surgery, Medical College of Ohio, Toledo, Ohio 43699
William S. Blakemore, M.D.
From the Department of Surgery, Medical College of Ohio, Toledo, Ohio 43699
The metabolic response to injury and illness as manifested by increases in energy expenditure and nitrogen losses makes it difficult for the clinician to evaluate calorie and protein needs. A method for determining daily calorie needs in hospitalized patients is presented. Average increases in resting metabolic expenditure for a group of patients following elective operation, skeletal trauma, skeletal trauma with head injury, blunt trauma, sepsis and burns were determined by indirect calorimetry and protein need by urinary nitrogen losses over extended time periods. Total daily calorie needs were then calculated, using the Harris-Benedict equation and adjusting this value upward using a previously measured activity and injury factor to arrive at the daily needs. Protein requirements may be determined on periodic 24 hour urine samples analyzed for the urinary urea nitrogen and adjusting this to a total nitrogen or protein equivalent. This approach to estimating the calorie nitrogen needs of the hospitalized patient under various degrees of stress more closely approximates the patient's variable needs at the height of the catabolic response and during convalescence.
Journal of Parenteral and Enteral Nutrition, Vol. 3, No. 6,
452-456 (1979)
DOI: 10.1177/014860717900300609
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H. Gilder
Parenteral Nourishment of Patients Undergoing Surgical or Traumatic Stress
JPEN J Parenter Enteral Nutr,
January 1, 1986;
10(1):
88 - 99.
[Abstract]
[PDF]
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D. S. Gray, J. B. Crider, C. Kelley, and L. C. Dickinson
Accuracy of Recumbent Height Measurement
JPEN J Parenter Enteral Nutr,
November 1, 1985;
9(6):
712 - 715.
[Abstract]
[PDF]
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C. Mendenhall, G. Bongiovanni, S. Goldberg, B. Miller, J. Moore, S. Rouster, D. Schneider, C. Tamburro, T. Tosch, R. Weesner, et al.
VA Cooperative Study on Alcoholic Hepatitis III: Changes in Protein-Calorie Malnutrition Associated with 30 Days of Hospitalization with and without Enteral Nutritional Therapy
JPEN J Parenter Enteral Nutr,
September 1, 1985;
9(5):
590 - 596.
[Abstract]
[PDF]
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J. M. Kosanovich, F. Dumler, M. Horst, C. Quandt, J. A. Sargent, and N. W. Levin
Use of Urea Kinetics in the Nutritional Care of the Acutely III Patient
JPEN J Parenter Enteral Nutr,
March 1, 1985;
9(2):
165 - 169.
[Abstract]
[PDF]
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J. M. Mirtallo, P. J. Fabri, K. Radcliffe, C. Shaw-Regan, J. A. Johnson, and R. L. Ruberg
Evaluation of Nitrogen Utilization in Patients Receiving Total Parenteral Nutrition
JPEN J Parenter Enteral Nutr,
March 1, 1983;
7(2):
136 - 141.
[Abstract]
[PDF]
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B. Messing, P.J. Pontal, and J.J. Bernier
Metabolic Study during Cyclic Total Parenteral Nutrition in Adult Patients with and without Corticosteroid-induced Hypercatabolism: Comparison with Standard Total Parenteral Nutrition
JPEN J Parenter Enteral Nutr,
January 1, 1983;
7(1):
21 - 25.
[Abstract]
[PDF]
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J. J. Cottrell, B. E. Pennock, A. Grenvik, and R. M. Rogers
Critical Care Computing
JAMA,
November 12, 1982;
248(18):
2289 - 2291.
[Abstract]
[PDF]
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E. J. Quebbeman and R. K. Ausman
Estimating Energy Requirements in Patients Receiving Parenteral Nutrition
Arch Surg,
October 1, 1982;
117(10):
1281 - 1284.
[Abstract]
[PDF]
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C. Gay Rainey-MacDonald, R. L. Holliday, and G.A. Wells
Nomograms for Predicting Resting Energy Expenditure of Hospitalized Patients
JPEN J Parenter Enteral Nutr,
January 1, 1982;
6(1):
59 - 60.
[Abstract]
[PDF]
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M. A. Mccamish, R. E. Dean, and T. R. Ouellette
Asssessing Energy Requirements of Patients on Respirators
JPEN J Parenter Enteral Nutr,
November 1, 1981;
5(6):
513 - 516.
[Abstract]
[PDF]
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L. R. Barot, J. L. Rombeau, J. J. Steinberg, L. O. Crosby, I. D. Feurer, and J. L. Mullen
Energy Expenditure in Patients With Inflammatory Bowel Disease
Arch Surg,
April 1, 1981;
116(4):
460 - 462.
[Abstract]
[PDF]
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H. R. Bassili and M. Deitel
Effect of Nutritional Support on Weaning Patients Off Mechanical Ventilators
JPEN J Parenter Enteral Nutr,
March 1, 1981;
5(2):
161 - 163.
[Abstract]
[PDF]
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