The Effect of an Anabolic Steroid on Postoperative Nitrogen Balance

Tweedle, D. E. F.; Walton, C; Id, Johnston

doi:10.1111/j.1742-1241.1973.tb08998.x

Cited by 33 publications

(1 citation statement)

References 7 publications

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“…The anabolic effects of steroid hormones have been investi-gated in relation to protein catabolism in surgical patients and have been shown to improve nitrogen balance in the postoperative patient [142] but not to improve the response to TPN in the severely stressed patient [143,144]. In contrast, the addition of biosynthetic human growth hormone (rhHGH) to standard TPN has been shown to result in a significant improvement in protein metabolism and improved nitrogen retention in the presence of severe sepsis [145][146][147].…”

Section: Metabolic Interventionmentioning

confidence: 99%

Metabolic basis for management of the septic surgical patient

Shaw

Koea

1993

World j. surg.

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The physiologic events accompanying postoperative septic complications in surgical patients represent a coordinated response to bacterial invasion, which is aimed at maintaining the function of key organ systems. When sepsis is prolonged or overwhelming, physiologic dysfunction and multiorgan failure develop. This review outlines the pathophysiologic response to sepsis and correlates it with recent therapeutic advances in the metabolic management of the postoperative septic patient.

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Section: Metabolic Interventionmentioning

confidence: 99%

Metabolic basis for management of the septic surgical patient

Shaw

Koea

1993

World j. surg.

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Endocrine Consequences of Systemic Disease: Critical Illness

Berghe¹

2005

Clinical Pediatric Endocrinology

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Energy and protein requirements of general surgical patients requiring intravenous nutrition

Hill

Church

1984

Journal of British Surgery

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General surgical patients require intravenous nutrition either because their gastrointestinal tract is blocked, too short or inflamed or because it cannot cope. Such patients can be grouped into four nutritional/metabolic categories: normal and unstressed; normal and stressed; depleted and unstressed; depleted and stressed. The energy requirements of patients in each of these groups vary according to their energy expenditure. Normally nourished and stressed patients have the highest energy expenditure and therefore require the highest energy input (45-55 kcal.kg-1day-1). Other groups of patients rarely require more than 40 kcal.kg-1day-1. Energy can be given mainly as dextrose although calories needed above 40 kcal kg-1day-1 should be given as fat (unless lipogenesis is desirable). In very stressed patients high rates of glucose infusion can themselves constitute a metabolic stress and fat may play a bigger role as a calorie source. For long term feeding, 1 litre of 10 per cent fat emulsion should be given weekly to avoid essential fatty acid deficiency. The level of nitrogen intake required to maintain a positive nitrogen balance is a lot higher in surgical patients than the suggested recommended dietary allowances for normal subjects. It is dependent not only on the nutritional and clinical state of the patient but also on the levels of energy and nitrogen intake given. When energy intake is below energy needs, normally nourished patients cannot retain nitrogen, although depleted patients can. When energy intake exceeds energy needs, both normally nourished and depleted patients retain nitrogen at levels of nitrogen intake ranging from 250 mg kg-1day-1 (depleted and unstressed) to over 400 mg kg-1day-1 (stressed). Depleted patients can maintain a positive nitrogen balance at lower levels of calorie and nitrogen intake than normally nourished patients and in this respect are analogous to a growing child. In all surgical patients, energy and nitrogen intakes can be manipulated to provide for a controlled maintenance or restoration of either wet lean tissue and/or fat. There is little place for protein sparing therapy or the use of insulin and anabolic steroids to promote nitrogen retention in surgical patients requiring intravenous feeding.

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The Effect of an Anabolic Steroid on Postoperative Nitrogen Balance

Cited by 33 publications

References 7 publications

Metabolic basis for management of the septic surgical patient

Metabolic basis for management of the septic surgical patient

Endocrine Consequences of Systemic Disease: Critical Illness

Energy and protein requirements of general surgical patients requiring intravenous nutrition

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