Validation of the deuterium oxide method for measuring average daily milk intake in infants

The deuterium oxide elimination method for measuring average daily milk intake was validated against measured formula intake in 16 studies of 11 infants in a metabolic ward. Deuterium oxide (approximately 0.10 g/kg body wt) was given orally. Deuterium enrichment was measured in urine samples collected predose, as available for 6-h postdose for TBW determination, and at 24 h and 5-10 d postdose for HDO elimination calculated according to the two-point method. Urine samples were vacuum distilled, water was reduced to hydrogen gas, and deuterium enrichment was measured by isotope-ratio mass spectrometry. Milk intake was measured throughout the elimination period from prefeeding and postfeeding bottle weights (n = 12) or volumes (n = 4). Without corrections for atmospheric water influx, milk intake was overestimated by 76 g/d (6%). With corrections for estimated metabolic water production, isotopic fractionation, and atmospheric water influx, deuterium measured 98% +/- 3% or 1300 g milk intake/d compared with actual milk intake of 1329 +/- 206 g/d.