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Biomedical subjects

W S Krasker

Publications and source records attributed to W S Krasker.

5 recordsLinked to original sources
PubMed1986

Weight maintenance in pediatric burned patients.

Weight change, defined as the difference between the preadmission and discharge weights, has often been used as an indicator of the adequacy of nutrition support. Weight change has been found to be uninterpretable in burned patients because excision and grafting contribute to weight loss but do not reflect systemic physiology. Also, normal growth during hospitalization contributes to weight gain but is not included in traditional methods of assessing weight change of children. We examined weight change corrected for escharectomies and growth in 42 adult and pediatric burned patients. Thirty-five of the patients had weight loss within 10% of their premorbid weight. Moreover, weight loss was correlated with three observable patient characteristics: age, percent initial burn size, and preburn weight. It was concluded that the dietary regimen of providing twice the predicted basal metabolic rate in terms of calories, based on ideal body weight, was adequate to prevent significant weight loss in most patients but that further refinement is necessary to improve individual reliability. Furthermore, significant weight losses may not affect morbidity/mortality as previously thought.

Adolescent↗
PubMed1985

Prediction of total urinary nitrogen from urea nitrogen for burned patients.

Although many of the current nutrition assessment techniques are inappropriate for burned patients, we have found nitrogen balance to be a helpful measure of the effectiveness of nutrition therapy if it is used in conjunction with other measures of nutritional status. Many clinicians suggest that a 24-hour urinary urea nitrogen (UUN) measurement, in addition to a correction term of 2 to 4 gm nitrogen, will accurately represent all nitrogen losses (urinary non-urea nitrogen, fecal, integumental). However, since no burned patients were used in the development of that method, its use may not be appropriate for burned patients. As an alternative to total urinary nitrogen (TUN), which is costly and time consuming, we have developed a simple way to predict TUN from UUN, percent initial total body surface area burn, and age for pediatric and adult burned patients. We propose that nitrogen balance may then be determined from the predicted TUN by an equation showing that nitrogen balance equals daily nitrogen intake minus predicted TUN plus fecal and normal nitrogen loss.

Adolescent↗
PubMed1984

Dietary compliance for pediatric burned patients.

Physician diet orders written for pediatric burned patients frequently differ from the diets patients actually receive. At Shriners Burns Institute in Boston, such deviations from the diet order were generally not recognized for at least two days. In order to increase compliance with physician diet orders, changes in the nutritional support program were implemented which included physician diet orders containing specific macronutrient requirements in addition to the caloric goal, which was changed in response to recent research demonstrating that the previously used formula provided excessive calories; introduction of modular diets for parenteral and enteral feedings; institution of daily nutrition flow sheets; and a change of the time at which daily caloric intake records were calculated. In order to assess the benefits of the new measures, the average deviation from the caloric goal was calculated for patients who did not receive the new assessment tools (control group, N = 51), compared with those who did (study group, N = 50). Least squares regression analysis indicated a trend toward improved compliance and less deviation from the calculated caloric goal following implementation of the four measures.

Adolescent↗