This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Jeevanandam, M. Articles by Petersen, S. R. Search for Related Content PubMed PubMed Citation Articles by Jeevanandam, M. Articles by Petersen, S. R. Social Bookmarking                         What's this?

Substrate Efficacy in Early Nutrition Support of Critically Ill Multiple Trauma Victims

Trauma Center, St. Joseph's Hospital and Medical Center, Phoenix, Arizona

Raymond F. Shamos, MD, FRCS, FACS

Trauma Center, St. Joseph's Hospital and Medical Center, Phoenix, Arizona

Scott R. Petersen, MD, FACS

Trauma Center, St. Joseph's Hospital and Medical Center, Phoenix, Arizona

The metabolic consequences of excessive nutrition support in patients have been increasingly recognized in recent years. Time-dependent optimal nutrition support is desired for an early and uncomplicated recovery after severe injury or illness. Metabolic effects of adding balanced amino acids to glucose infusion during total parenteral nutrition were investigated in 18 patients after major trauma (injury severity score 32 ± 2). Two studies were conducted on each subject, one in the early "flow" phase of injury (40-60 hours postinjury) in the basal state without any dietary intake and then after 4 to 6 days of intravenous nutrition provided solely as glucose (24 ± 2 kcal/kg per day, 80% resting energy expenditure, n = 8) or isocaloric glucose (28 ± 3 kcal/kg per day) with amino acids (275 ± 28 mg of nitrogen per kilogram per day, n = 10). Whole-body fuel substrate kinetics were studied for energy metabolism (indirect calorimetry), protein kinetics (primed-constant infusion of ¹⁵N glycine), and lipid mobilization (two-stage infusion of 10% glycerol). Injury-induced hypoaminoacidemia was equally modulated whether the glucose-based nutrition had amino acids or not. The negative nitrogen balance is reduced similarly in both groups. Protein breakdown rate is significantly (p = .025) decreased in both groups and it is more so (30% us 18%) in patients receiving total parenteral nutrition. Intravenous nutrition could not stimulate protein synthesis. Whole-body lipolysis rate as well as net fat oxidation rate are suppressed more when glucose alone is given, and this also results in less reesterification. Provision of intravenous glucose alone, not to exceed the resting energy expenditure, seems to be superior to isocaloric glucose with amino acids during this early catabolic flow phase of injury because the injured body could not assimilate this exogenous amino acid. (Journal of Parenteral and Enteral Nutrition 16:511-520, 1992)

Journal of Parenteral and Enteral Nutrition, Vol. 16, No. 6, 511-520 (1992)
DOI: 10.1177/0148607192016006511


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				Z. Rusavy, I. A. Macdonald, V. Sramek, S. Lacigova, P. Tesinsky, and I. Novak Glycemia Influences on Glucose Metabolism in Sepsis During Hyperinsulinemic Clamp JPEN J Parenter Enteral Nutr, May 1, 2005; 29(3): 171 - 175. [Abstract] [Full Text] [PDF]

				M. J. Bruins, P. B. Soeters, and N. E. P. Deutz Endotoxemia Affects Organ Protein Metabolism Differently during Prolonged Feeding in Pigs J. Nutr., December 1, 2000; 130(12): 3003 - 3013. [Abstract] [Full Text] [PDF]

				Y. Devaux, S. Grosjean, C. Seguin, C. David, B. Dousset, F. Zannad, C. Meistelman, N. De Talance, P.-M. Mertes, and D. Ungureanu-Longrois Retinoic acid and host-pathogen interactions: effects on inducible nitric oxide synthase in vivo Am J Physiol Endocrinol Metab, November 1, 2000; 279(5): E1045 - E1053. [Abstract] [Full Text] [PDF]

				C. J. Klein Effect of Energy Loads on Nitrogen Balance JPEN J Parenter Enteral Nutr, July 1, 1998; 22(4): 249 - 249. [PDF]

				R. Chiolero, P. Schneiter, C. Cayeux, E. Temler, E. Jequier, C. Schindler, and L. Tappy Metabolic and Respiratory Effects of Sodium Lactate During Short IV Nutrition in Critically III Patients JPEN J Parenter Enteral Nutr, July 1, 1996; 20(4): 257 - 263. [Abstract] [PDF]