ENERGY-COST OF FEVER IN CHILDREN ON TOTAL PARENTERAL-NUTRITION

The aim of the study was to measure the changes in energy expenditure (EE) and respiratory quotient (RQ) induced by fever in children receiv ing total parenteral nutrition (TPN). Ten children aged 1-16 years (we ight for height: 104.5 +/- 13%) were included. They underwent two EE r ecordings of 3 h duration using indirect calorimetry, during a febrile (38.9 +/- 0.5 degrees C) and afebrile conditions, after parameters (n utritional intake, ambient temperature) being equal. The EE1 (febrile phase) was significantly higher than the EE2 (afebrile) (2.13 +/- 0.48 vs 1.78 +/- 0.42 kcal/kg/h; P<0.01), Increase in EE was significantly correlated with body temperature (r = 0.92, P<0.001). The slope of th e regression line indicates an increase of 16.2% in EE per degree of f ever. By dividing the individual increase in EE by the individual incr ease in temperature, the energy expenditure during fever is 11.3% per unit rise (degrees C). During the febrile phase urinary nitrogen excre tion was significantly higher (280 +/- 90 vs 210 +/- 70 mg/kg fat free mass/day, P<0.02). The RO during the febrile phase (0.90 +/- 0.13) di d not differ significantly from mean RO during the afebrile phase (0.9 5 +/- 0.07). Fever due to infection or inflammatory process is partly responsible for an hypermetabolic state including increased EE.