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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #161687
Title: SODIUM BROMIDE BY INSTRUMENTAL NEUTRON ACTIVATION ANALYSIS QUANTIFIES CHANGE IN EXTRACELLULAR WATER SPACE WITH WOUND CLOSURE IN SEVERELY BURNED CHILDREN

Author
item PRELACK, KATHY - TUFTS-HNRCA
item DWYER, JOHANNA - TUFTS-HNRCA
item SHERIDAN, R - SHRINERS HOSP FOR CHLDRN
item YU, Y - SHRINERS HOSP FOR CHLDRN
item LYDON, M - SHRINERS HOSP FOR CHLDRN
item PETRAS, L - SHRINERS HOSP FOR CHLDRN
item STAMATELATOS, I - NCSR DEMOCRITOS, GREECE
item KEHAYIAS, JOSEPH - TUFTS-HNRCA

Submitted to: Journal of General Surgery
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/8/2002
Publication Date: 4/1/2003
Citation: Prelack, K., Dwyer, J., Sheridan, R., Yu, Y.M., Lydon, M., Petras, L., Stamatelatos, I.E., Kehayias, J.J. 2003. Sodium bromide by instrumental neutron activation analysis quantifies change in extracellular water space with wound closure in severely burned children. Journal Of General Surgery 2003;133:396-403.

Interpretive Summary: Total body water makes up approximately 60% of body weight in humans. Body water exists both within the cells and extracellularly, primarily in plasma and interstitial fluid. Extracellular water is altered under various physiologic conditions including critical illness and aging. The ability to measure extracellular water can greatly enhance our understanding of nutritional status, body composition, and response to nutritional therapy in population groups where hydration may be altered. Extracellular water (ECW) can be determined by measuring particles that are known to be contained primarily within the extracellular water. Bromide is one such ion that can be used. We measured bromide space to determine change in ECW with wound closure among 15 acutely burned children. Plasma samples were obtained at baseline and 4 hours after receiving a measured amount of sodium bromide and quantified by instrumental neutron activation analysis (INAA). Our results showed that ECW decreased with wound closure (9.1 +/ -4.1 vs 7.9 +/- 3.9 liters; P=0.04), indicating a significant decrease in ECW over the course of recovery. A decline in weight also occurred over the same period (32.4 +/- 15.2 vs 29.1 +/- 13.5 kg; P=0.007), however change in CBS as a proportion of weight was not statistically significant. These findings indicate that weight loss observed in patients following wound closure largely represents a losses in ECW as opposed to body cell mass. The clinical relevance of this is that tradition markers for monitoring nutritional status in these patients may be obscured and therefore invalid due to abnormal state of hydration.

Technical Abstract: The ability to measure extracellular water (ECW) in critically ill patients can significantly enhance current methods of assessing fluid homeostasis, body composition, and response to nutritional therapy. We measures corrected bromide space (CBS) to determine change in ECW with wound closure among acutely burned children. Fifteen children with burns over 30% of their total body surface area had their ECW determined following hemodynamic stabilization and when wound closure was complete. Plasma samples were obtained at baseline and 4 hours after receiving 25 mg/kg of sodium bromide. Plasma bromide was quantified by instrumental neutron activation analysis (INAA). Mean Corrected Bromide Space (CBS) decreased with wound closure (9.1 +/- 4.1 vs 7.9 +/- 3.9 liters; P=0.04), indicating a significant decrease in ECW over the course of recovery. A decline in weight also occurred over the same period (32.4 +/- 15.2 vs 29.1 +/- 13.5 kg; P=0.007), however change in CBS as a proportion of weight was not statistically significant. A significant decrease in ECW accompanies the weight loss observed in patients following wound closure. Measurement of Br dilution space is a convenient method for monitoring ECW that can be done at the bedside.