Evaluate the following 24-hour urine data: 24-hour urinary nitrogen for 12/20: 18.4 grams. By using the daily input/output record for 12/20 that records the amount of PN received, calculate Mr. Page's nitrogen balance on 12/20
How would you interpret this information? Should you be concerned? Are there problems with the accuracy of nitrogen balance studies? Explain.
Nitrogen balance = N intake (g/24 hr) – (urinary N [g/24 hr] + 3 g/24 hr)
N intake: 1600 mL TPN x 0.0425 g protein/cc = 68 g protein
68 ÷ 6.25 = 10.88 g nitrogen intake
10.88 – (18.4 + 3) = -10.5 g
• Mr. Page is in negative nitrogen balance, indicating he continues to be catabolic.
• He has only been on nutritional support for 4 days and it will likely take much longer to reverse his catabolic state.
• It would be wise to repeat the nitrogen balance to ensure the amount of catabolism is decreasing.
• Any test that relies on the collection of urine over a 24-hour period is at risk for inaccuracies.
• Nitrogen balance studies in this situation, however, are much easier because the amount of nitrogen in the parenteral nutrition is known and his urine is being collected via a catheter, which decreases the risk of losses.
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