A 24-patient experience in hyperalimentation for acute renal insufficiency: emphasis on amino acid determination

Since current quantitative and qualitative determination of amino acids in patients receiving hyperalimentation for acute renal insufficiency is not sufficient in covering many possible clinical situations encountered, a mathematic method was thus devised, using biochemical data, to address various clinical conditions.

From July 1991, all patients at the Veterans General Hospital-Taipei with BUN > 50 mg/dL and creatinine > 2.5 mg/dL received hyperalimentation according to the following principles: (1) the quantity of amino acid depended upon the amount of urea nitrogen appearance and urine urea nitrogen; (2) enriched branched-chain amino acids (at 60-70% essential amino acids; 30-40% non-essential amino acids) plus a glucose-base energy balance nutrient were used, according to the patients' metabolic state; (3) all parameters were checked once weekly and the data were compared by paired t-test just before and after one-week treatment.

Over a 15-month period, a total of 24 patients were treated and evaluated. Significant reduction was found after treatment in nitrogen negative balance, blood urea nitrogen, urea nitrogen appearance or daily amino acid requirement. Serum creatinine, urine urea excretion power and hospital survival were slight but non-significantly improved.

This quantitative and qualitative determination of amino acid can be cheap, easy and safe with some beneficial results. It may provide one more choice of treatment in renal hyperalimentation.