title: Barbiturate therapy reduces nitrogen excretion in acute head injury.
abstract: The effect of pentobarbital on nitrogen and energy metabolism was evaluated in seven severely head-injured patients (Glasgow Coma Scale 4.7 +/- 1.7) within the first week postinjury. Measured energy expenditure (% of predicted) was significantly lower in the pentobarbital group (n = 4) versus control (n = 3) (76 +/- 23% versus 132 +/- 28%, respectively, p less than 0.01). Similarly, 24-hour urinary nitrogen excretion was lower for the barbiturate group compared to control (11.2 +/- 4.0 gm versus 19.5 +/- 3.3 gm, respectively, p less than 0.01). No statistical difference was noted for urinary 3-methylhistidine excretion between the barbiturate and control groups (43 +/- 12 mcg/day versus 47 +/- 14 mcg/day, respectively, p = N.S.). Barbiturate therapy decreases measured energy expenditure and reduces nitrogen excretion without significantly altering 3-methylhistidine excretion in head-injured patients. The metabolic effects of pentobarbital may enable the ability to achieve energy and nitrogen equilibrium during metabolic support of acutely head-injured patients.
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: R C
authors.initials: RC
authors.lastname: Fried
authors.forename: R N
authors.initials: RN
authors.lastname: Dickerson
authors.forename: P A
authors.initials: PA
authors.lastname: Guenter
authors.forename: T P
authors.initials: TP
authors.lastname: Stein
authors.forename: T A
authors.initials: TA
authors.lastname: Gennarelli
authors.forename: D T
authors.initials: DT
authors.lastname: Dempsey
authors.forename: G P
authors.initials: GP
authors.lastname: Buzby
authors.forename: J L
authors.initials: JL
authors.lastname: Mullen
mesh_terms: D000293:Adolescent; D000328:Adult; D006259:Craniocerebral Trauma / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D002149:Energy Intake; D004734:Energy Metabolism / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008762:Methylhistidines / Q000652:urine; D009584:Nitrogen / Q000652:urine*; D010424:Pentobarbital / Q000627:therapeutic use*
chemical_list: D008762:Methylhistidines; D010424:Pentobarbital; C028118:3-methylhistidine; D009584:Nitrogen