Bicarbonate kinetics and predicted energy expenditure in critically ill children

Sy, Jama; Gourishankar, Anand; Gordon, William E.; Griffin, Debra; Zurakowski, David; Roth, Rachel; Coss‐Bu, Jorge A.; Jefferson, Larry S.; Heird, William C.; Castillo, Leticia

doi:10.1093/ajcn/88.2.340

Cited by 19 publications

(16 citation statements)

References 25 publications

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“…Analyses of blood samples for 13 CO2 enrichment were all conducted as previously described (38). In brief, the carbon dioxide was liberated from the blood bicarbonate by adding 2 ml of 85% (vol/vol) phosphoric acid into the evacuated tube and the contents vortexed.…”

Section: Methodsmentioning

confidence: 99%

“…The 13 CO2 enrichment was then measured by isotope ratio mass spectrometry (ThermoQuest Finnigan Delta plus XL Isotope Ratio Mass Spectrometer coupled with Gasbench-II; Bremen, Germany; Ref. 38). The plasma enrichment of the methionine tracers given was determined as previously described (25).…”

Section: Methodsmentioning

confidence: 99%

“…Samples of 0.5 ml were transferred from the collection syringe into a 3-ml sodium-heparin-coated, capped, evacuated tube and were maintained at room temperature. Samples were then processed as previously described (38). For the plasma isotopic enrichment of the methionine tracers given and of derived homocysteine, blood samples were kept on ice immediately centrifuged, and plasma was then withdrawn and stored at Ϫ80C until used for analysis.…”

Section: Tracer Study Protocolmentioning

confidence: 99%

“…For determination of methionine oxidation in critically ill children using the enteral L-[1-13 C]methionine tracer, it was necessary to establish a factor to be used for the retention of 13 CO2 liberated from enterally supplied methionine, during its oxidative decarboxylation via ␣-ketobutyrate (19,37). For this purpose, we used previous data by our group obtained in enterally fed critically ill children receiving a primed, constant infusion of NaH 13 CO3 that showed bicarbonate recovery of 69.80% (38). Although the bicarbonate tracer in the latter studies was provided by the parenteral route (38), there is no difference on bicarbonate recovery when the tracer is given through the enteral vs. the parenteral routes (34).…”

Section: Splanchnic Methionine Oxidation (Transulfuration Of Homocystmentioning

confidence: 99%

“…For this purpose, we used previous data by our group obtained in enterally fed critically ill children receiving a primed, constant infusion of NaH 13 CO3 that showed bicarbonate recovery of 69.80% (38). Although the bicarbonate tracer in the latter studies was provided by the parenteral route (38), there is no difference on bicarbonate recovery when the tracer is given through the enteral vs. the parenteral routes (34). Therefore the mean value of 69.80 was used to estimate methionine oxidation in the patients.…”

Section: Splanchnic Methionine Oxidation (Transulfuration Of Homocystmentioning

confidence: 99%

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Ontogeny of methionine utilization and splanchnic uptake in critically ill children

Verbruggen

Gordon

et al. 2009

American Journal of Physiology-Endocrinology and Metabolism

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-To determine the rates of methionine splanchnic uptake and utilization in critically ill pediatric patients we used two kinetic models: the plasma methionine enrichment and the "intracellular" homocysteine enrichment. Twenty four patients, eight infants, eight children, and eight adolescents, were studied. They received simultaneous, primed, constant, intravenous infusions of L-[ 2 H3]methylmethionine and enteral L-[1-13 C]methionine. The ratio of [13 C]homocysteine to [ 13 C]methionine enrichment was 1.0 Ϯ 0.15, 0.80 Ϯ 0.20, and 0.66 Ϯ 0.10, respectively, for the infants, children, and adolescents, and it was different between the infants and adolescents (P Ͻ 0.01). Methionine splanchnic uptake was 63, 45, and 36%, respectively, in the infants, children, and adolescents, and it was higher (P Ͻ 0.01) in the infants compared with the adolescents. The infants utilized 73% of methionine flux for nonoxidative disposal, while 27% was used for transulfuration (P Ͻ 0.001). Conversely, in the adolescents, 40% was utilized for nonoxidative disposal, while 60% was used for transulfuration. There is ontogeny on the rates of methionine splanchnic uptake and on the fate of methionine utilization in critically ill children, with greater methionine utilization for synthesis of proteins and methionine-derived compounds (P Ͻ 0.01) and decreased transulfuration rates in the infants (P Ͻ 0.01), while the opposite was observed in the adolescents. The plasma model underestimated methionine kinetics in children and adolescents but not in the infants, suggesting lesser dilution and greater compartmentation of methionine metabolism in the infant population. All patients were in negative methionine balance, indicating that the current enteral nutritional support is inadequate in these patients.isotopes; transulfuration; oxidation; kinetic model THE PORTAL-DRAINED VISCERA involving the liver, stomach, and intestines is profoundly deranged during critical illness. Altered splanchnic function, whether elicited by hypoperfusion, hypoxia, or inflammation, has been associated with systemic inflammatory response syndrome and multiple organ dysfunction syndrome (10, 29). Under physiological conditions, the splanchnic tissues are important for whole body amino acid metabolism and selectively modify the pattern of absorbed amino acids that is subsequently presented to the peripheral circulation (9). Thus the pattern of amino acids in the diet is different from that in portal venous blood and does not reflect their availability to extraintestinal tissues. This concept has important implications for defining protein and amino acid requirements for nutritional and functional purposes. An extensive catabolism and/or utilization of dietary amino acids in the first pass by the small intestine results in decreased nutritional efficiency and will influence their requirements.The sulfur amino acids serve important protein and nonprotein functions (16,18,36,37). Methionine, an indispensable sulfur amino acid, serves as the precursor in the synthesis of S-...

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Tracer Study Protocolmentioning

confidence: 99%

Section: Splanchnic Methionine Oxidation (Transulfuration Of Homocystmentioning

confidence: 99%

Section: Splanchnic Methionine Oxidation (Transulfuration Of Homocystmentioning

confidence: 99%

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Ontogeny of methionine utilization and splanchnic uptake in critically ill children

Verbruggen

Gordon

et al. 2009

American Journal of Physiology-Endocrinology and Metabolism

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Obesity

Veldhorst

Schierbeek

2017

Mass Spectrometry and Stable Isotopes in Nutritional and Pediatric Research

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Determining energy and protein needs in critically ill pediatric patients: A scoping review

Jotterand Chaparro,

Pabion,

Tume

et al. 2023

Nut in Clin Prac

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IntroductionIn critically ill pediatric patients, optimal energy and protein intakes are associated with a decreased risk of morbidity and mortality. However, the determination of energy and protein needs is complex. The objective of this scoping review was to understand the extent and type of evidence related to the methods used to determine energy and protein needs in critically ill pediatric patients.MethodsAn international expert group composed of dietitians, pediatric intensivists, a nurse, and a methodologist conducted the review, based on the Johanna Briggs Institute methodology. Two researchers searched for studies published between 2008 and 2023 in two electronic databases, screened abstracts and relevant full texts for eligibility, and extracted data.ResultsA total of 39 studies were included, mostly conducted in critically ill children undergoing ventilation, to assess the accuracy of predictive equations for estimating resting energy expenditure (REE) (n = 16, 41%) and the impact of clinical factors (n = 22, 56%). They confirmed the risk of underestimation or overestimation of REE when using predictive equations, of which the Schofield equation was the least inaccurate. Apart from weight and age, which were positively correlated with REE, the impact of other factors was not always consistent. No new indirect calorimeter method used to determine protein needs has been validated.ConclusionThis scoping review highlights the need for scientific data on the methods used to measure energy expenditure and determine protein needs in critically ill children. Studies using a reference method are needed to validate an indirect calorimeter.

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Bicarbonate kinetics and predicted energy expenditure in critically ill children

Cited by 19 publications

References 25 publications

Ontogeny of methionine utilization and splanchnic uptake in critically ill children

Ontogeny of methionine utilization and splanchnic uptake in critically ill children

Obesity

Determining energy and protein needs in critically ill pediatric patients: A scoping review

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