Effect of the Energy Source on Changes in Energy Expenditure, Respiratory Quotient, and Nitrogen Balance during Total Parenteral Nutrition in Children

Abstract

ABSTRAa. The effects of three isocaloric intravenous nutritional regimens were studied in seven infants and children, ages 2 months to 9 yr, with congenital gastrointestinal anomalies (four patients) or with prior history of malignant disease admitted in remission for bone marrow transplantation (three patients). Energy metabolism, as measured by the basal metabolic rate (BMR), and substrate utilization, as measured by the respiratory quotient (RQ), were studied to determine the effect of different levels of carbohydrate and fat on nitrogen retention in each patient. Solution A provided 8% of energy as amino acids, 87% as carbohydrate, and 5% as fat. Solution B provided 8% of energy as amino acids, 60% as carbohydrate, and 32% as fat. Solution C provided 8% of energy as amino acids, 34% as carbohydrate, and 58% as fat. Administration of solution A (high carbohydrate, low fat) was associated with moderately increased mean (fSD) BMR and RQ and with low nitrogen retention (19.1 f 12.7%, 1.06 f 0.14, and 98 f 28 mg N/kg/day). Both the BMR and the RQ decreased when less carbohydrate and more lipid was given: BMR 4.3 2 11.6% ( p < 0.005), RQ 0.92 f 0.09 ( p < 0.001) for solution B; BMR 3.94 k 10.6% ( p < 0.005), RQ 0.86 f 0.09 ( p < 0.001) for solution C. Among the solutions tested, optimal nitrogen retention 1163 f 60 mg N/kg/day ( p < 0.01)j was noted with solution B. Our data support the conclusion that a physiologic balance of fat and carbohydrate results in optimal nitrogen retention. (Pediatr Res 21: 538-541, 1987) Abbreviations TPN, total parenteral nutrition CBC, complete blood count V02, oxygen consumption VCOz, carbon dioxide production RQ, respiratory quotient FeC02, measured C 0 2 concentration of expired air FeOz, measured Oz concentration of expired air FiOz, O2 concentration in room air VE, flow rate BMR, basal metabolic rate ANOVA, two-way analysis of variance and children with short bowel syndrome, seriously damaged intestinal mucosa, or failure to develop intestinal villi. Several reports (1-4) have assessed the relationship between nitrogen balance and the energy sources. In adult patients with severe catabolic states, most of the patients were recovering from severe injuries or had septic complications of accidental or surgical trauma. However, no similar studies are available in infants or children. The present study examined, in children, the metabolic effects, including nitrogen retention, of three different isocaloric TPN solutions which varied only in the proportion of calories derived from fat and carbohydrate. PATIENTS AND METHODSPatients. Seven patients were studied over a period of 15 days (Table 1). Four were infants, ages 2 to 5 months, with congenital gastrointestinal anomalies. They had been stable on TPN at least 10 days after the acute postoperative period. Three others were children, 3 to 9 yr of age, with arrested malignant disease (one had acute lymphoblastic leukemia and two had neuroblastoma). All had been on chemotherapy and were presently hospitalized for bone marrow transp...

Indications and complications of inpatient parenteral nutrition prescribed to children in a large tertiary referral hospital

“…Hyperglycaemia is associated with a higher infection rate [ 41 ], can lead to overfeeding [ 42 , 43 ] and even death [ 44 – 46 ]. A glucose intake exceeding the maximal oxidation rate promotes fat synthesis and deposition [ 47 , 48 ] with a large increase in CO2 production [ 49 ]. Hypercapnia, which was found in 8.9% of our patients, is compensated by increasing the respiratory rate or depth of breathing, which is well tolerated by stable patients but may lead to complications in patients with respiratory compromise [ 49 ].…”

Standardised neonatal parenteral nutrition formulations – an Australasian group consensus 2012

“…Maximal glucose oxidation has been reported in preterm infants to be 8.3 mg/kg per min (12 g/kg per day) [32,33], and in term infants 13 mg/kg per min (18 g/kg per day) [34,35]. Elevated neonatal blood glucose concentration has been linked to adverse outcomes including death [36,37], intraventricular haemorrhage [36], late onset bacterial infection [38], fungal infection [39,40], retinopathy of prematurity [41-43] and necrotizing enterocolitis [38].…”

Neonatology/Paediatrics – Guidelines on Parenteral Nutrition, Chapter 13

“…7 mg/kg/min (10 g/kg/day) [37], [38] in premature infants and approx. 12 mg/kg/min (18 g/kg/day) in full-term newborns and infants under long-term PN [39], [40], [41]. In critically ill children with burns, maximum glucose oxidation of 5 mg/kg/min has been described [41].…”