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BUN/Cr ratio as an index of gastrointestinal bleeding mass in children
M Urashima1, S Toyoda, T Nakano
1Department of Pediatrics, Tokyo Jikei University School of Medicine, Japan.
Insights
The blood urea nitrogen (BUN) to serum creatinine (Cr) ratio can help pinpoint upper gastrointestinal (GI) bleeding in children. A higher BUN/Cr ratio indicates upper GI bleeding and can estimate blood loss severity.
Area of Science:
- Pediatric Gastroenterology
- Biochemistry
- Clinical Diagnostics
Background:
- Gastrointestinal (GI) bleeding in children requires accurate localization and severity assessment.
- Differentiating upper from lower GI bleeding is crucial for effective management.
Purpose of the Study:
- To evaluate the utility of the blood urea nitrogen (BUN) to serum creatinine (Cr) ratio in identifying the source of GI bleeding in pediatric patients.
- To assess the correlation between the BUN/Cr ratio and the severity of blood loss in upper GI bleeding.
Main Methods:
- Measured BUN and serum Cr levels on admission in pediatric patients with GI bleeding.
- Calculated the BUN/Cr ratio for 16 episodes of upper GI bleeding and 49 episodes of lower GI bleeding.
- Analyzed the statistical difference in BUN/Cr ratios between upper and lower GI bleeding groups.
Main Results:
- A significant difference (p < 0.001) was observed in the BUN/Cr ratio between upper and lower GI bleeding.
- A BUN/Cr ratio of 30 or higher demonstrated 98% specificity for upper GI bleeding with 68.8% sensitivity.
- A linear relationship was established between the BUN/Cr ratio and delta Hemoglobin (Hb) for upper GI bleeding (delta Hb = 0.08 x BUN/Cr +/- 0.8 g/dl).
Conclusions:
- The BUN/Cr ratio is a valuable tool for localizing GI bleeding to the upper tract in children.
- The BUN/Cr ratio serves as a useful indicator for estimating the severity of blood loss in pediatric upper GI bleeding.
Abstract:
Determining the site and severity of blood loss is important in the management of children with gastrointestinal (GI) bleeding. Blood urea nitrogen (BUN) and serum creatinine (Cr) were measured on the day of hospitalization and the ratio of BUN/Cr was calculated in 11 children with 16 episodes of upper GI bleeding and 49 with lower GI bleeding. There was a significant difference between the two GI bleeding groups with regard to BUN/Cr ratio (p less than 0.001). When the ratio was 30 or above, the specificity of upper GI bleeding was 98% with a sensitivity of 68.8%. A linear relationship was found between the BUN/Cr ratio and delta Hb (delta Hb = 0.08 x BUN/Cr +/- 0.8 g/dl) for bleeding originating from the upper GI tract. This study confirms that measurement of the BUN/Cr ratio is useful for localizing the source of bleeding to the upper GI tract and also demonstrates its usefulness as an estimation of the severity of blood loss from the upper GI tract.