Assessment of whole body protein metabolism in critically ill children: can we use the [15N]glycine single oral dose method?
OBJECTIVE
Most stable-isotope methods to evaluate whole body protein metabolism in patients are invasive and difficult to use in children. In this study protein metabolism was evaluated with the non-invasive [15N]glycine single oral dose method in critically ill children and the value of the method is discussed.


METHODS
[15N]glycine (100mg) was given orally to children (mean age 5.5 years; range 0.6-15.5 years) with meningococcal septic shock (MSS, n = 8), pneumonia (n = 5), and to healthy, fed and post-absorptive children (n = 10). Urine was collected during 9h, total amount of NH(3), labelled NH(3) and nitrogen were measured, and protein turnover, synthesis and breakdown were calculated using urinary NH(3) as end-product.


RESULTS
Mean protein turnover in children with MSS, pneumonia and fed and post-absorptive healthy children was 0.63+/-0.13, 0.38+/-0.10, 0.28+/-0.03 and 0.28+/-0.02g N/kg/9h, respectively. Mean protein synthesis was 0.55+/-0.12, 0.29+/-0.09, 0.18+/-0.02, 0.20+/-0.02g N/kg/9h, respectively. Mean protein breakdown was 0.56+/-0.14, 0.28+/-0.12, 0.08+/-0.03, 0.28+/-0.02g N/kg/9h, respectively. Protein turnover, synthesis and breakdown were significantly increased in MSS patients compared to fed healthy children (P <0.01) and post-absorptive children (P <0.05). Protein turnover, protein synthesis, protein breakdown were significantly correlated with disease severity and body temperature (P <0.05).


CONCLUSIONS
Results of whole body protein metabolism measured with the [15N]glycine single oral dose method in children with MSS and in healthy children were in line with expectations based on results obtained in earlier reports and with different methods.
van Waardenburg
Dick A
DA
Department of Paediatrics, University Hospital Maastricht, P Debeyelaan 25, 6202 AZ Maastricht, The Netherlands. d.vanwaardenburg@paed.azm.nl
Deutz
Nicolaas E P
NE
Hoos
Marije B
MB
Jansen
Nicolaas J G
NJ
van Kreel
Bernard K
BK
Vos
Gijs D
GD
Wagenmakers
Anton J
AJ
Forget
Pierre-Philippe
PP
D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D005998:Glycine / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D008297:Male; D008589:Meningococcal Infections / Q000378:metabolism; D009587:Nitrogen Isotopes / Q000008:administration & dosage; D018410:Pneumonia, Bacterial / Q000378:metabolism; D011506:Proteins / Q000378:metabolism*; D012772:Shock, Septic / Q000378:metabolism / Q000382:microbiology
D009587:Nitrogen Isotopes; D011506:Proteins; D005998:Glycine