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Metabolic Effects of Amino Acid vs Dextrose Infusion in Surgical Patients

Metabolic Effects of Amino Acid vs Dextrose Infusion in Surgical Patients Abstract We tested the hypothesis that during infusion of amino acids without dextrose, there is less insulin stimulation, which, in turn, permits lipolysis. The results suggest that dextrose infusion stimulates insulin and inhibits lipolysis. During administration of crystalline amino acids without dextrose, nitrogen balance improved substantially from control values obtained during dextrose infusion, while the level of serum-free fatty acids and ketone bodies rose and that of serum immunoreactive insulin fell. Infusion of amino acids at 1.7 gm/kg appeared slightly more efficient than infusion at 1.0 gm/kg and did not stimulate insulin or inhibit lipolysis. Protein sparing may be useful in certain specific clinical situations. However, the results must be interpreted cautiously, primarily because it is difficult to establish the relationship between improvement in nitrogen balance and the derived clinical benefit. Absolute proof of the efficacy of this technique awaits further studies using indexes that more accurately measure protein synthesis. References 1. Dudrick SJ, Long JM, Steiger E, et al: Intravenous hyperalimentation . Med Clin North Am 54:577-589, 1970. 2. Freeman JB, Lemire A, MacLean LD: Intravenous alimentation and septicemia . Surg Gynecol Obstet 135:708-712, 1972. 3. Blackburn GL, Flatt JP, Clowes GHA, et al: Protein sparing therapy during periods of starvation with sepsis or trauma . Ann Surg 177:588-594, 1973.Crossref 4. Floyd JC, Fajans SS, Conn JW, et al: Insulin secretion in response to protein ingestion . J Clin Invest 45:1479-1486, 1966.Crossref 5. Freeman JB, Stegink LD, Fry LK, et al: Evaluation of amino acid infusions as protein sparing agents in normal adult subjects. Am J Clin Nutr, to be published. 6. Bergmeyer HH (ed): Methods of Enzymatic Analysis . New York, Academic Press Inc, 1965. 7. Dole VP, Meinertz H: Microdetermination of long-chain fatty acids in plasma and tissues . J Biol Chem 235:2595-2599, 1960. 8. Hales CN, Randle PJ: Immunoassay of insulin with insulin-antibody precipitate . Biochem J 88:137-146, 1963. 9. Goodhart RS, Shils ME (eds): Modern Nutrition in Health and Disease . Philadelphia, Lea & Febiger, 1973, p 63. 10. Cahill GF, Herrera MG, Morgan AP, et al: Hormone-fuel interrelationships during fasting . J Clin Invest 45:1751-1769, 1966.Crossref 11. Elman R: Acute starvation following operation or injury with special reference to caloric and protein needs . Ann Surg 120:350-361, 1944.Crossref 12. Chen WJ, Ohashi E, Kasai M: Amino acid metabolism in parenteral nutrition: With special reference to the calorie:nitrogen ratio and the blood urea nitrogen level . Metabolism 23:1117-1123, 1974.Crossref 13. Forbes GB: Another source of error in the metabolic balance method . Nutr Rev 31:297-300, 1973.Crossref 14. 3-methyl histodine excretion in starvation . Nutr Rev 32:206-208, 1974. 15. O'Keefe SJD, Sender PM: "Catabolic" loss of body nitrogen in response to surgery . Lancet 2:1035-1038, 1974.Crossref 16. Goldmann DA, Martin WT, Worthington JW: Growth of bacteria and fungi in total parenteral nutrition solutions . Am J Surg 126:314-318, 1973.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Metabolic Effects of Amino Acid vs Dextrose Infusion in Surgical Patients

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Publisher
American Medical Association
Copyright
Copyright © 1975 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1975.01360140060013
Publisher site
See Article on Publisher Site

Abstract

Abstract We tested the hypothesis that during infusion of amino acids without dextrose, there is less insulin stimulation, which, in turn, permits lipolysis. The results suggest that dextrose infusion stimulates insulin and inhibits lipolysis. During administration of crystalline amino acids without dextrose, nitrogen balance improved substantially from control values obtained during dextrose infusion, while the level of serum-free fatty acids and ketone bodies rose and that of serum immunoreactive insulin fell. Infusion of amino acids at 1.7 gm/kg appeared slightly more efficient than infusion at 1.0 gm/kg and did not stimulate insulin or inhibit lipolysis. Protein sparing may be useful in certain specific clinical situations. However, the results must be interpreted cautiously, primarily because it is difficult to establish the relationship between improvement in nitrogen balance and the derived clinical benefit. Absolute proof of the efficacy of this technique awaits further studies using indexes that more accurately measure protein synthesis. References 1. Dudrick SJ, Long JM, Steiger E, et al: Intravenous hyperalimentation . Med Clin North Am 54:577-589, 1970. 2. Freeman JB, Lemire A, MacLean LD: Intravenous alimentation and septicemia . Surg Gynecol Obstet 135:708-712, 1972. 3. Blackburn GL, Flatt JP, Clowes GHA, et al: Protein sparing therapy during periods of starvation with sepsis or trauma . Ann Surg 177:588-594, 1973.Crossref 4. Floyd JC, Fajans SS, Conn JW, et al: Insulin secretion in response to protein ingestion . J Clin Invest 45:1479-1486, 1966.Crossref 5. Freeman JB, Stegink LD, Fry LK, et al: Evaluation of amino acid infusions as protein sparing agents in normal adult subjects. Am J Clin Nutr, to be published. 6. Bergmeyer HH (ed): Methods of Enzymatic Analysis . New York, Academic Press Inc, 1965. 7. Dole VP, Meinertz H: Microdetermination of long-chain fatty acids in plasma and tissues . J Biol Chem 235:2595-2599, 1960. 8. Hales CN, Randle PJ: Immunoassay of insulin with insulin-antibody precipitate . Biochem J 88:137-146, 1963. 9. Goodhart RS, Shils ME (eds): Modern Nutrition in Health and Disease . Philadelphia, Lea & Febiger, 1973, p 63. 10. Cahill GF, Herrera MG, Morgan AP, et al: Hormone-fuel interrelationships during fasting . J Clin Invest 45:1751-1769, 1966.Crossref 11. Elman R: Acute starvation following operation or injury with special reference to caloric and protein needs . Ann Surg 120:350-361, 1944.Crossref 12. Chen WJ, Ohashi E, Kasai M: Amino acid metabolism in parenteral nutrition: With special reference to the calorie:nitrogen ratio and the blood urea nitrogen level . Metabolism 23:1117-1123, 1974.Crossref 13. Forbes GB: Another source of error in the metabolic balance method . Nutr Rev 31:297-300, 1973.Crossref 14. 3-methyl histodine excretion in starvation . Nutr Rev 32:206-208, 1974. 15. O'Keefe SJD, Sender PM: "Catabolic" loss of body nitrogen in response to surgery . Lancet 2:1035-1038, 1974.Crossref 16. Goldmann DA, Martin WT, Worthington JW: Growth of bacteria and fungi in total parenteral nutrition solutions . Am J Surg 126:314-318, 1973.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Aug 1, 1975

References