low amino acids

[Guest guest]

Beth,

had profoundly low amino acids in his blood as well. The report

said that this was indicative of poor nutritional status. Our intensivist

and I just about flipped at that since is on TPN and lipids, (IV

Nutrition) and we are artificially creating his diet.

The first thing this told us was he is not getting enough protein or that

he is wasting it and needs more than we are giving him. Dr. H ordered

tests to look at the second choice first since by all accounts the amount

of protein we are giving Sam should have been enough. (2.5 grams/kg/day).

(I should say that children receiving non IV nutrition probably have a

different recommended amount of protein )

He ordered 12 hour urine protein, 3-methylhistidine in the urine and stool

tests to look for protein. (I think it is called an alpha trypisin but not

too sure). These showed that Sam wastes small amounts of protein in both

urine and stool but not enough in our estimates to account for the low

amino acids.. (I should note that these were not just somewhat low - they

were extremely low).

We get weekly albumin levels routinely and these were always under 2,

(normal starts at 3.8 at our lab) . But a better test is a pre albumin

which shows how much is actually available to be used. This was low as

well.

Based on that and the fact that Sam is not in liver or kidney failure we

opted to try increasing the protein to 3 g/kg/day. This is more than what

some GI doctor consider safe for a child on TPN but we follow labs very

closely. Since that time his albumin levels have improved and are now

about 2.8 - 3 and seem to go up each week.

Keep in mind if you play with diet and follow labs to track the efficacy

that the pre albumin should go up within 4 days if you are doing the right

thing but the albumin can take months to increase.

Anne