MASSIVE NITROGEN LOSS IN CRITICAL SURGICAL ILLNESS - EFFECT ON CARDIAC MASS AND FUNCTION

Objective The authors measured cardiac mass and function to determine whether these changed in patients who were critically ill who were los ing large amounts of nitrogen from the body. Summary Background Data T he large losses of body nitrogen that occur in patients with protein-e nergy malnutrition are associated with a loss of cardiac mass and func tion. It is not known if this also occurs in patients who were critica lly ill who are losing massive amounts of nitrogen. Methods Once hemod ynamically stable, 13 patients who were critically ill underwent seque ntial measurements of left ventricular mass (LVM) and function, total body nitrogen (TBN), total body potassium, body weight, fat-free mass, and limb muscle mass. Results Over a 21-day study period, there was n o change in LVM or function despite falls of 14% and 21% in TBN and to tal body potassium, respectively, a 21% fall in limb muscle mass, and a deterioration in skeletal muscle function by approximately 40%. Conc lusions In patients who were critically ill, cardiac mass does not dec rease and function does not deteriorate after hemodynamic stability ha s been achieved despite massive losses of protein from the body.