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Journal of Parenteral and Enteral Nutrition
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Clinical Trial

Adjuvant Recombinant Human Growth Hormone Normalizes Plasma Amino Acids in Parenterally Fed Trauma Patients

Malayappa Jeevanandam, PHD

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

Mohammed R. Ali, PHD

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

Nancy J. Holaday, BS

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

Background: The addition of an anabolic stimulant during intensive nutrition therapy in trauma patients seems to be a reasonable adjuvant for minimizing muscle-mass erosion. The plasma free amino acid pattern is the mirror of the net amino acid metabolism, and we have measured the progressive changes resulting from recombinant human growth hormone therapy in trauma victims during nutritional repletion in the early catabolic flow phase of injury. Methods: In 20 severely injured (injury severity scale = 31 ± 2), highly catabolic, and hypermetabolic adult multiple-trauma patients, we have measured the fasting (day 0) plasma amino acid levels (48 to 60 hours after injury before starting the nutrition therapy) and their progressive changes during 7 days of IV nutrition support (total parenteral nutrition, 1.1 x resting energy expenditure calories, 250 mg of nitrogen per kilogram per day) with or without adjuvant recombinant human growth hormone. Group H (n = 10) randomly received daily recombinant human growth hormone (0.15 mg of Somatropin per kilogram per day) and Group C (n = 10) received the vehicle of infusion. Results: Hypoaminoacidemia of trauma is normalized by infusion of recombinant human growth hormone, which indicates its anabolic nature, and this is confirmed in the cumulative nitrogen balance (-281 ± 139 mg of nitrogen per kilogram per 7 days compared with -809 ± 151 mg of nitrogen per kilogram per 7 days without recombinant human growth hormone; p ≤ .005). This improved nitrogen retention is also reflected in the significantly low blood urea nitrogen levels in the recombinant human growth hormone group, which represents the efficient utilization of the infused amino acids for synthesis of proteins. Elevated plasma insulin-like growth factor-1 levels in Group H compared with those in Group C may also account for this altered amino acid metabolism. Conclusions: Recombinant human growth hormone treatment in combination with conventional total parenteral nutrition in the immediate posttraumatic period improved nitrogen metabolism and normalized the plasma free amino acid levels. (Journal of Parenteral and Enteral Nutrition 19:137-144, 1995)

Journal of Parenteral and Enteral Nutrition, Vol. 19, No. 2, 137-144 (1995)
DOI: 10.1177/0148607195019002137
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