The effect of parenteral nitrogen and energy intake on electrolyte balance in the preterm infant.
Summary of "The effect of parenteral nitrogen and energy intake on electrolyte balance in the preterm infant."
Background/Objectives:Recent guidelines for preterm parenteral nutrition (PN) recommend an earlier and higher intake of amino acids (AA) and energy to avoid postnatal catabolism and approximate normal fetal growth. Few investigations explored how early PN may affect electrolyte and water homeostasis. We performed a prospective observational trial to assess the effect of nutrient intake on electrolyte homeostasis and balance.Subjects/Methods:During 16 months, all infants 32 weeks were eligible. In the first week of life, we recorded the following daily: electrolytes (plasma and 8-h urine collection), nutritional intake, urine output, body weight, and we calculated sodium (Na) and potassium (K) balance. Infants were divided, for analysis, into three groups of AA intake: low <1.5 g/kg/day (LAA), medium 1.5-2 g/kg/day (MAA) and high >2 g/kg/day (HAA).Results:A total of 154 infants were included. HAA group presented lower weight loss. Na balance was influenced by urine output and postnatal age, with little contribution of nutrition. Kalemia and K balance were mainly influenced by AA intake. K balance differed among groups: LAA, -2.3 mmol/kg/week; MAA, 1.1 mmol/kg/week; and HAA 2.6 mmol/kg/week (P<0.0001). In the HAA group, plasma and urine K were significantly lower and non-oliguric hyperkalemia was reduced.Conclusions:Na homeostasis was very slightly modified by early nutrition, suggesting that a negative Na balance is obligatory after birth. We showed that AA intake strongly affects K balance, minimize hyperkalemia and reduces weight loss. As K balance is strictly linked to cellular metabolism, we speculate that early nutrition may inhibit cellular catabolism and reduce the contraction of intracellular water compartment.European Journal of Clinical Nutrition advance online publication, 18 May 2011; doi:10.1038/ejcn.2011.79.
Affiliation
Neonatal Intensive Care Unit-Pediatric Department, University Hospital of Dijon, Dijon Cedex, France.
Journal Details
This article was published in the following journal.
Name: European journal of clinical nutrition
ISSN: 1476-5640
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21587281
- DOI: http://dx.doi.org/10.1038/ejcn.2011.79
Medical and Biotech [MESH] Definitions
Energy Intake
Total number of calories taken in daily whether ingested or by parenteral routes.
Water-electrolyte Balance
The balance of fluid in the BODY FLUID COMPARTMENTS; total BODY WATER; BLOOD VOLUME; EXTRACELLULAR SPACE; INTRACELLULAR SPACE, etc., maintained by processes in the body that regulate the intake and excretion of WATER and ELECTROLYTES, particularly SODIUM and POTASSIUM.
Water-electrolyte Imbalance
Disturbances in the body's WATER-ELECTROLYTE BALANCE.
Leptin
A 16-kDa peptide hormone secreted from WHITE ADIPOCYTES. Leptin serves as a feedback signal from fat cells to the CENTRAL NERVOUS SYSTEM in regulation of food intake, energy balance, and fat storage.
Mineralocorticoids
A group of CORTICOSTEROIDS primarily associated with the water and electrolyte balance. This is accomplished through the effect on ION TRANSPORT in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by PLASMA VOLUME, serum potassium, and ANGIOTENSIN II.
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