Abstract
A sixteen year old girl sustained a 35% weight loss (52 to 34 kg) secondary to anorexia nervosa over a 5 month period. Acute renal failure occurred after two consecutive episodes of hypovolemic and hypoglycemic shock. Acute tubular necrosis was confirmed by kidney biopsy. Parenteral feeding with 50% dextrose and 2.1% synthetic amino acid solution at 300 ml per m2 per day plus replacement of urine output was instituted. Intravenous feeding was maintained for 15 days. Diuresis began on the 22nd day and she went on to complete recovery.
To investigate the endogenous acid production under the dual impact of starvation and total intravenous feeding, the technique of estimating endogenous acid production by Relman et al (JCI 40: 1921, 1961) was applied. Mean values for the patient and controls (in brackets) are presented in uEq/min/1.73m2: sulfuric acid production, 7.8 ± 0.8 (25.9 ± 3.5); hydrogen ion production incident to organic anion excreation, 7.8 ± 0.8 (25.9 ± 3.5); urinary sulfur, 1.3 ± 0.1 (7.6 ± 3.8) and the infusate sulfur 2.5 ± 0.5 (7.9 ± 0.1). The data indicate retention by the patient of 50% of the sulfur infused; this suggests that the sulfur was utilized in new tissue formation for this severely malnourished patient.
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Ma, R., Chan, J. & Hung, W. PARENTERAL NUTRITION IN ACUTE TUBULAR NECROSIS AND ANOREXIA NERVOSA. Pediatr Res 8, 383 (1974). https://doi.org/10.1203/00006450-197404000-00260
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DOI: https://doi.org/10.1203/00006450-197404000-00260