Open AccessThe Effect of Burn Wound Size on Ureagenesis and Nitrogen Balance
Author(s) -
Richard J. Kagan,
Takayoshi Matsuda,
Marella Hanumadass,
Bernard Castillo,
Olga Jonasson
Publication year - 1982
Publication title -
annals of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.153
H-Index - 309
eISSN - 1528-1140
pISSN - 0003-4932
DOI - 10.1097/00000658-198201001-00011
Subject(s) - nitrogen balance , medicine , blood urea nitrogen , body surface area , calorie , nitrogen , total body surface area , urea , zoology , excretion , urine , creatinine , burn injury , surgery , biochemistry , chemistry , biology , organic chemistry
Hypermetabolic burn patients are frequently in negative nitrogen balance despite provision of estimated caloric needs. We studied 18 thermally injured adult patients in order to evaluate the relationship of burn wound size to urea production and nitrogen balance. We selected data from 147 patient-days when the patients received 100 +/- 25% of their estimated caloric needs. Three significantly different burn size groups (by body surface area [BSA]) were identified by calculation of the catabolic index (CI): group 1, 0-10% BSA (CI = -0.1); group 2, 11-30% BSA (CI = 6.4); and group 3,31-60% BSA (CI = 10.5). The urine urea nitrogen (UUN) for groups 1,2, and 3 was 11.1, 18.9, and 25.3 gm/day, and nitrogen balance was 1.0, -3.9, and -5.8 gm/day, respectively. When nitrogen was given in a calorie:nitrogen ratio of 150:1, only those patients in group I were able to achieve positive balance. We conclude that large burn wounds are associated with increased ureagenesis and impaired nitrogen retention. The protein intake, at the customary calorie:nitrogen ratio of 150:1, may not provide adequate nitrogen to achieve equilibrium, even when energy demands have been met, in patients with burn wounds greater than 10% BSA.