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Massive Azoturia and Failure to Achieve Positive Nitrogen Balance in a Botulism Patient
Author(s) -
Cashman Michael D.,
Wightkin William T.,
Madden Janet E.,
Phillips Ramona S.
Publication year - 1986
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607186010003316
Subject(s) - nitrogen balance , botulism , parenteral nutrition , enteral administration , medicine , lean body mass , paralysis , balance (ability) , starvation , protein catabolism , intensive care medicine , anesthesia , nitrogen , surgery , physical therapy , body weight , biology , chemistry , biochemistry , genetics , organic chemistry , amino acid
Observations of a patient with botulism requiring mechanical ventilatory support for 59 days and hospitalization for approximately 3 months are reported. During the time of greatest muscular paralysis, urinary urea nitrogen excretion exceeded 20 g per day. This degree of azoturia was thought to be due to obligate loss of lean body tissue secondary to paralysis and not to stress or starvation related demands. A contributing factor to the magnitude of azoturia was the presence of a large premorbid body frame and muscle mass. The nutritional goal was not to achieve nitrogen balance but to maintain visceral protein stores. As the patient improved neurologically, the azoturia decreased allowing a positive nitrogen balance with a rebuilding of skeletal muscle. ( Journal of Parenteral and Enteral Nutrition 10 :316–318, 1986)