Abstract from the 22nd Clinical Congress of the American Society for Parenteral and Enteral Nutrition, Orlando, FL, January 18-21, 1998

Brown, Rex O.

Dickerson, Roland N.

Gervasio, Jane M.

Hickerson, William L.

Kudsk, Kenneth A.

Sherman, Justin J.

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Butler UniversityDigital Commons @ Butler UniversityScholarship and Professional Work – COPHS College of Pharmacy & Health Sciences1-1998Renal phosphorus regulation in thermally-injuredand multiple trauma patients receiving enteralnutritionJane M. GervasioButler University, jgervasi@butler.eduRex O. BrownJustin J. ShermanWilliam L. HickersonKenneth A. KudskSee next page for additional authorsFollow this and additional works at: http://digitalcommons.butler.edu/cophs_papersPart of the Pharmacy and Pharmaceutical Sciences CommonsThis Article is brought to you for free and open access by the College of Pharmacy & Health Sciences at Digital Commons @ Butler University. It hasbeen accepted for inclusion in Scholarship and Professional Work – COPHS by an authorized administrator of Digital Commons @ Butler University.For more information, please contact fgaede@butler.edu.Recommended CitationGervasio, Jane M.; Brown, Rex O.; Sherman, Justin J.; Hickerson, William L.; Kudsk, Kenneth A.; and Dickerson, Roland N., "Renalphosphorus regulation in thermally-injured and multiple trauma patients receiving enteral nutrition" (1998). Scholarship andProfessional Work – COPHS. Paper 30.http://digitalcommons.butler.edu/cophs_papers/30AuthorsJane M. Gervasio, Rex O. Brown, Justin J. Sherman, William L. Hickerson, Kenneth A. Kudsk, and Roland N.DickersonThis article is available at Digital Commons @ Butler University: http://digitalcommons.butler.edu/cophs_papers/30Renal phosphorus regulation in thermally-injured and multiple trauma patients receiving enteral nutrition !Jane M. Gervasio, Rex O. Brown, Justin J. Sherman, William L. Hickerson, Kenneth A. Kudsk, Roland N. Dickerson !!Profound hypophosphatemia is a common complication in thermally injured patients of which the etiology is unclear. To investigate renal phosphorus regulation, 20 adult thermally injured patients (> 20% BSA) and 20 multiple trauma patients requiring tube feedings were prospectively evaluated. Patients with renal impairment (serum creatinine > 1.6 mg/dl), alkalemia (pH > 7.50), or diabetes mellitus were excluded. Serum phosphorus concentrations (mg/dl) were collected at days 1, 3, 7, and 14 after initiation of tube feeding. Tube feedings were begun within 1-3 days post injury. Management of hypophosphatemia was shared by the nutrition support and respective primary services. A 24 hour urine was collected during week 1 and 2 for urinary phosphorus excretion (mg/d) and phosphate clearance (L/d). Data are given a mean ± SD. Average daily phosphate intake during the 14 day study for thermally injured and multiple trauma patients was 0.72 ± 0.32 mmol/kg/d (34 ± 30% as IV) and 0.32 ± 0.18 mmol/kg/d (20 ± 17% as IV), respectively, p < 0.001. !!Group   P - Day 1 P - Day 3 P - Day 7 P - Day 14 Thermally injured 2.6 ± 0.9 1.9 ± 0.8 * 2.7 ± 1.2 * 3.9 ± 0.6 Multiple trauma  2.5 ± 0.7 3.0 ± 0.8 3.3 ± 0.6 3.7 ± 0.6 P = serum phosphorus concentrations *p < 0.05 between groups !!!Group   UP - Week 1 UP - Week 2 UCL - Week 1 UCL - Week 2 Thermally injured 292 ± 256 377 ± 286 11.8 ± 11.9 14.3 ± 12.1 Multiple trauma  189 ± 178 272 ± 186 8.5 ± 8.9 8.4 ± 5.7 !1UP = urinary phosphorus excretion; UCL = urinary phosphorus clearance Despite a significantly greater intake of phosphorus, thermally injured patients had lower serum phosphorus concentration levels on days 3 and 7. Thermally injured patients had greater urinary phosphate excretion and clearance compared to multiple trauma patients (p = N.S.). Thermally injured patients had a 40% to 55% increase in urinary excretion of phosphorus despite an intake that was 125% more than multiple trauma patients. Renal phosphorus regulation is only partially responsible for the profound hypophosphatemia observed in thermally injured patients. !2

Renal phosphorus regulation in thermally-injured and multiple trauma patients receiving enteral nutrition

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Renal phosphorus regulation in thermally-injured and multiple trauma patients receiving enteral nutrition

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