From the Guidelines
Hypernitrogenuria in Trauma and Flatulence
Hypernitrogenuria in trauma patients is indeed associated with increased flatulence due to elevated urea production, which leads to an increase in ammonia production by gut flora.
- Specifically, patients with severe injuries may exhibit increased nitrogen excretion due to catabolic states, with urinary urea nitrogen levels exceeding 20 grams per day 1.
- The catabolic state in trauma patients is characterized by protein catabolism, insulin resistance, and increased lipid metabolism, leading to increased energy expenditure and nutritional deterioration 1.
- Administration of medications such as lactulose, 10-20 grams orally, twice daily, for 7-10 days, may help reduce ammonia production and alleviate flatulence symptoms in these patients.
- Additionally, a low-protein diet, with protein intake limited to 0.5-0.7 grams per kilogram body weight per day, may also help mitigate nitrogen excretion and subsequent flatulence, although recent studies suggest that protein targets should be personalized and titrated up over the first 3-5 days to optimize outcomes 1.
- Protein intake should be carefully managed, as high protein doses may not improve outcomes and potentially worsen them in patients with acute kidney injuries and high organ failure scores 1.
- Indirect calorimetry should be used to guide energy targets, as predictive equations have been shown to be highly inaccurate in predicting calorie needs 1.
From the Research
Hypernitrogenuria in Trauma
- Hypernitrogenuria refers to an excess of nitrogen in the urine, which can be caused by various factors, including trauma 2, 3, 4.
- In trauma patients, hypernitrogenuria can lead to an increase in urea production, which is a waste product that the body needs to eliminate 2, 3.
Relationship between Hypernitrogenuria and Flatulence
- There is no direct evidence to suggest that hypernitrogenuria in trauma leads to flatulence 5, 2, 3, 6, 4.
- However, studies have shown that lactulose, a medication used to treat constipation, can increase fecal nitrogen excretion and reduce urea production, which may be related to changes in gut flora and ammonia metabolism 5, 6.
Nitrogen Excretion in Trauma Patients
- Trauma patients often experience increased nitrogen excretion due to muscle catabolism, total parenteral nutrition, and hepatic clearance of amino acids 2, 3, 4.
- The relationship between urinary urea nitrogen excretion and total urinary nitrogen excretion has been studied in trauma patients, with results showing a significant correlation between the two 2.
- However, the mechanisms underlying hypernitrogenuria in trauma patients are complex and multifactorial, and more research is needed to fully understand the relationship between hypernitrogenuria and flatulence 2, 3, 4.