Nephrology Dialysis Transplantation, Vol 12, Issue 10 2087-2092, Copyright © 1997 by Oxford University Press
F Yu, K Lu, S Lin, G Chen, P Chu, G Gao and Y Lin
Background: Heat stroke is the clinical syndrome
produced when the body overheats. It can develop in the army and in healthy
civilian populations who physically exert themselves in a hot and humid
environment during the summer, and may result in a significant number of
heat-related deaths. Since strenuous exercise is one of the major
exacerbating and precipitating factors, the incidence of exertional heat
stroke (ExHS) is high among military personnel undergoing military
training. Furthermore, acute renal failure (ARF) may occur in 25% of
patients with ExHS and it can cause metabolic alterations that affect amino
acid, carbohydrate, and lipid metabolism. Adequate nutritional support is
essential for the treatment of ARF. The most important determinant of
nutrient requirement in ARF is the degree of hypercatabolism caused by
disease associated with renal function impairment. Indirect calorimetry
(IDCM) is the method by which metabolic rate is estimated from measurement
of oxygen consumption and carbon dioxide production. It can also provide
information about the type and rate of substrate utilization in
vivo (protein, carbohydrate, and fat).
Method: The present clinical study is a comprehensive
analysis of metabolic changes which includes energy expenditure (EE) and
substrate utilization in 10 patients with exertional heat exhaustion (ExHE)
by the use of IDCM. Results: Serum urea nitrogen,
creatinine, peak creatine phosphokinase levels and heart rate were
significantly increased in ExHS patients during ARF stage. Serum albumin
levels were significantly decreased in ExHS patients with ARF. Resting
energy expenditure (REE) was increased in patients with ExHS induced ARF
and was not correlated with body temperature (r=0.421). The average
increase in EE during ARF stage was about 24%. The respiratory quotient in
patients with ExHS induced ARF was lower than that in normal subjects and
also in patients with ExHE. Urea nitrogen appearance rate increased in
patients with ExHS induced ARF and in patients with ExHE without ARF. The
percentage of total REE derived from fat in ExHS induced ARF and ExHE
increased, while in patients with ExHS induced ARF and ExHE, the
percentages of total REE derived from carbohydrate and protein were lower
than those in control subjects. Conclusions: The
present results suggest that patients with exertional heat injury (both
ExHS and ExHE) have hypermetabolism during the acute state. Furthermore,
patients with exertional heat-induced rhabdomyolysis and ARF have a
moderately higher hypermetabolism than those without ARF during the acute
stage. We believe that this mainly reflects a more pronounced reduction of
the vital cell mass (muscle) in relation to body weight, and/or a
compromised substrate oxidation in ExHS with ARF. Whether or not this
subgroup of patients will require a higher energy/caloric support merits
further investigation. Keywords: acute renal failure;
energy expenditure; exertional heat exhaustion; exertional heat stroke;
indirect calorimetry; substrate oxidation
ORIGINAL ARTICLES
Energy metabolism in exertional heat stroke with acute renal failure
Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, No 8, Sec 3, Ting-Chow Road, Taipei, Taiwan; Corresponding author
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  Y.-F. Lin, J.-Y. Wang, T.-C. Chou, and S.-H. Lin Vasoactive mediators and renal haemodynamics in exertional heat stroke complicated by acute renal failure QJM, March 1, 2003; 96(3): 193 - 201. [Abstract] [Full Text] [PDF]
|
|