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Amino acids kinetics and infection
Burns,
5, 143-l
46
Printed
in Great
Britain
143
Abstracts CLINICAL Anaemia
STUDIES
The relationship between metabolism, oxygen transport and anaemia was assessed in 7 patients with burns covering between 20 and 50 per cent of the body surface. A significant negative correlation was found between erythrocyte 2,3 DPG, the major modulator of oxygen transport and synthesis of erythropoietin. Simultaneous bioassay and radioimmunoassay for erythropoietin showed elevated values in the anaemic burned patients. Elevated 2,3 DPG values during convalescence from burns may remove the ‘anaemic hypoxia’ stimulus to erythropoietin production, resulting in persistence of the anaemia. Sheldon G. F., Sanders R., Fuchs R. et al. (1978) Metabolism, oxygen transport and erythropoietin synthesis in the anaemia of thermal injury. Am. J. Surg.
135, 406.
Lung water
changes
Pulmonary extravascular water volume was measured as lung thermal volume in a group of 9 patients with burns covering between 20 and 80 per cent of the body surface. Central injection of a bolus of iced hypertonic saline and an appropriate transducer sensitive to temperature and conductivity allowed frequent measurements of pulmonary extravascular water volume. Concurrent measurements were made of the cardiac output and the pulmonary wedge pressure. Moderate elevation of the lung thermal volume was seen in all patients, reaching a maximum value before peripheral oedema formation was complete. Left heart filling pressures and the plasma albumin concentration were subnormal. Clinical pulmonary oedema occurred in one patient, treated mainly with crystalloid solutions. In several patients a secondary increase in pulmonary extravascular water volume occurred at the time of mobilization of the oedema. Morgan A., Knight D. and O’Connor N. (1978) Lung water changes after thermal burns: an observational study. Ann. Surg. 187, 288.
phosphate. A lowering of the serum phosphate level was regularly observed between the third and ninth days after burning. The lowest mean serum phosphate value observed was 0.57 + 0.2 (s.d.) mmol/l, which should be compared with the range of values found in normal individuals of OS-l.5 mmol/l. After these low values found on the fifth day after burning, the serum phosphate levels then returned to normal except in the 3 patients who died. These 3 patients were among the 4 who showed the lowest serum phosphate values, less than 0.32 mmol/l, and their deaths coincided with these observed low values. The urinary excretion of phosphate decreased in parallel with the serum phosphate concentrations to a lowest mean value of 11 mmol/l per day (normal range O-40 mmol/l per day). It is suggested that hypophosphataemia may be of significance. in the fatal outcome of some patients with severe burns. Nordst&m H., Lennquist S., Lindell B. et al. (1978) Hypophosphataemia in severe burns. Acta Chir. Stand. 143, 395.
Amino
acid kinetics
and infection
Hypophosphataemia
The flow of phenylalanine, the essential amino acid precursor of thyroid hormone and catecholamines, was severely elevated in 5 septic burned patients (6.70+ 1.07 mg/kg) and 6 non-septic burned patients (5.00+_044 mg/kg) when compared with 7 normal controls (2.10+ 0.33 mg/kg). Fasting serum concentrations of phenylalanine were elevated in the septic burned patients (2.33 _+0.37 mg/lOO ml of serum) relative to the non-septic patients (1.28_+0.21 mg] 100 ml) and the controls (1.01 + 0.15 mg/iOO ml). The rate of appearance of the phenylalanine metabolite, tyro ine, after an oral phenylalanine dose was normal in all burn patients. Increased Serum concentrations and increased flow of phenylalanine are an index of rapid protein catabolism, further augmented by sepsis in the burned patient, and not a reflection of decreased hepatic conversion of phenylalanine to tyrosine. Herndon D. N., Wilmore D. W., Mason A. D. et al. (1978) Abnormalities of phenylalanine and tyrosine kinetics. Significance in septic and non-septic burned patients. Arch. Surg. 113, 133.
A %rospective study has been made in 17 patients with burns covering between 20 and 85 per cent of the body surface, 35-70 per cent being full-thickness skin loss, with special reference to serum and urinary
In West Germany there are about 4500 severe electrical injuries per year, of which about 10 per cent
Electrical
injuries
5, 143-l
46
Printed
in Great
Britain
143
Abstracts CLINICAL Anaemia
STUDIES
The relationship between metabolism, oxygen transport and anaemia was assessed in 7 patients with burns covering between 20 and 50 per cent of the body surface. A significant negative correlation was found between erythrocyte 2,3 DPG, the major modulator of oxygen transport and synthesis of erythropoietin. Simultaneous bioassay and radioimmunoassay for erythropoietin showed elevated values in the anaemic burned patients. Elevated 2,3 DPG values during convalescence from burns may remove the ‘anaemic hypoxia’ stimulus to erythropoietin production, resulting in persistence of the anaemia. Sheldon G. F., Sanders R., Fuchs R. et al. (1978) Metabolism, oxygen transport and erythropoietin synthesis in the anaemia of thermal injury. Am. J. Surg.
135, 406.
Lung water
changes
Pulmonary extravascular water volume was measured as lung thermal volume in a group of 9 patients with burns covering between 20 and 80 per cent of the body surface. Central injection of a bolus of iced hypertonic saline and an appropriate transducer sensitive to temperature and conductivity allowed frequent measurements of pulmonary extravascular water volume. Concurrent measurements were made of the cardiac output and the pulmonary wedge pressure. Moderate elevation of the lung thermal volume was seen in all patients, reaching a maximum value before peripheral oedema formation was complete. Left heart filling pressures and the plasma albumin concentration were subnormal. Clinical pulmonary oedema occurred in one patient, treated mainly with crystalloid solutions. In several patients a secondary increase in pulmonary extravascular water volume occurred at the time of mobilization of the oedema. Morgan A., Knight D. and O’Connor N. (1978) Lung water changes after thermal burns: an observational study. Ann. Surg. 187, 288.
phosphate. A lowering of the serum phosphate level was regularly observed between the third and ninth days after burning. The lowest mean serum phosphate value observed was 0.57 + 0.2 (s.d.) mmol/l, which should be compared with the range of values found in normal individuals of OS-l.5 mmol/l. After these low values found on the fifth day after burning, the serum phosphate levels then returned to normal except in the 3 patients who died. These 3 patients were among the 4 who showed the lowest serum phosphate values, less than 0.32 mmol/l, and their deaths coincided with these observed low values. The urinary excretion of phosphate decreased in parallel with the serum phosphate concentrations to a lowest mean value of 11 mmol/l per day (normal range O-40 mmol/l per day). It is suggested that hypophosphataemia may be of significance. in the fatal outcome of some patients with severe burns. Nordst&m H., Lennquist S., Lindell B. et al. (1978) Hypophosphataemia in severe burns. Acta Chir. Stand. 143, 395.
Amino
acid kinetics
and infection
Hypophosphataemia
The flow of phenylalanine, the essential amino acid precursor of thyroid hormone and catecholamines, was severely elevated in 5 septic burned patients (6.70+ 1.07 mg/kg) and 6 non-septic burned patients (5.00+_044 mg/kg) when compared with 7 normal controls (2.10+ 0.33 mg/kg). Fasting serum concentrations of phenylalanine were elevated in the septic burned patients (2.33 _+0.37 mg/lOO ml of serum) relative to the non-septic patients (1.28_+0.21 mg] 100 ml) and the controls (1.01 + 0.15 mg/iOO ml). The rate of appearance of the phenylalanine metabolite, tyro ine, after an oral phenylalanine dose was normal in all burn patients. Increased Serum concentrations and increased flow of phenylalanine are an index of rapid protein catabolism, further augmented by sepsis in the burned patient, and not a reflection of decreased hepatic conversion of phenylalanine to tyrosine. Herndon D. N., Wilmore D. W., Mason A. D. et al. (1978) Abnormalities of phenylalanine and tyrosine kinetics. Significance in septic and non-septic burned patients. Arch. Surg. 113, 133.
A %rospective study has been made in 17 patients with burns covering between 20 and 85 per cent of the body surface, 35-70 per cent being full-thickness skin loss, with special reference to serum and urinary
In West Germany there are about 4500 severe electrical injuries per year, of which about 10 per cent
Electrical
injuries