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Proline, lactate and cholesterol metabolism during high-dose branched chain amino acid (BC) support in sepsis
p.13
PROLINE, LACTATE AND CHOLESTEROL METABOLISM DURING HIGH-DOSE BRANCHED CHAIN AMINO ACID (BC) SUPPORT IN SEPSIS. C. Chiarla, I. Giovannini, J.H. Siegel*, G. Boldrini, W.P. Cole man*, M. Castagneto. *MIEMSS: University of Maryland, Baltimore, USA, and Centro di Stur dio per la Fisiopatologia dello Shock, CNR, Catholic University, Rome, Italy. In order to assess the impact of high-dose BC on metabolic abnormalities in sepsis, 360 measurements of plasma proline (PROLI, hepatic proline clearance (PROCL), plasma lactate (LAC), cholesterol (CHOL) and of respiratory quotient (RQI were performed in 16 septic pts undergoing TPN. Randomly, 8 pts received a 49% BC mixture (High-BCI and 8 pts a 16% BC mixture (Low-BC). For similar doses of glucose (5.5 vs 5.71, fat (0.9 vs 0.91, total amino acids (1.5 vs 1.6) and TPN proline (0.06 vs O.O7I(g/Kg/24hrI, High-BC vs Low-BC had a lower PROL (0.15 vs 0.37 mM/L) with increased PROCL (80.8 vs 49.8 units), higher CHOL (2.94 vs 2.27 mM/Ll, lower LAC (1.22 vs 1.93 mM/L) and RQ (0.80 vs 0.861(p
and
Since the decrease in CHOL and PROCL and the increase in PROL in sepsis depend on a defi tit of energy metabolism from shortage of Acetyl-CoA (which is both a substrate for ener gy production and a CHOL synthesis precursor), the data in this study support the concept that a greater oxidation of 8C (RQ=O.7 or lower) may supply readily available Acetyl-CoA and Succinyl-CoA and contribute to reverse the energy deficit of liver and peripheral tissues in sepsis.
P.14
ZINC LOSSES 81 ZINC BALANCES IN BURN PATIENTS. M_M., C. Cavadini’, FLMansourian’, H.Dirren’, ABart’, J.Freeman’. l Dept.of Anesthesiology, Centre Hospitalier Universitaire Vaudois & ‘Nestle Research Centre, Lausanne, Switzerland. CUTANEOUS
Hypermetabolic response and extensive catabolism due to bums increase nutritional requirements. Infections, delayed wound healing and weight loss may be due to Zinc (Zn) deficiency, Zn being involved in most metabolic pathways. We studied the cutaneous Zn losses (CL) due to wound seepage to determine the Zn requirements and Zn balance after burn injury. Five male patients admitted to the Burns Centre (thermal bums 22.533% of body surface, age 23-51 yrs.) were studied from the 1st to the 7th post-burn day (01 to D7). All intakes were analysed for Zn. Urine, gastric & bronchial aspirations and faeces (non cutaneous losses = NCL) were collected over 24-hour periods. Textiles in contactwith the patients were collected and handled with talc-free gloves: Zn was extracted in awasher using HCI 0.1 N. Average textile, water & washer contaminations were substracted. Zn was analysed by means of flame atomic absorption. The shower losses were not studied. Mean daily Zn enteral & parenteral intakes, NCL, CL and balances are shown in Fio.1. Pooled daily mean (pdm) intake was 14.1k7.1 mg/24hr (X-LSD). U&ary output confirmed previous findings: 0.93.4 mg/24hr. Pdm NCL were: 5.0+5.1 mgI24hr. Pdm CL were 339325.9 mg/24hr (Patient 1: 60.3 81 Patient 3: 56.8 mgI24hr). Pdm Zn balances were 24.9k24.5 mq/24hr, and pdm shower duration 56527 min. These results show that an important part of the immediately available Zn body stores (10% of a total Zn content of 1.4-2.3 g), are lost cutaneously after burn injury, leading to strongly negative Zn balances. Since the shower period was not studied, the losses are probably greater.
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PROLINE, LACTATE AND CHOLESTEROL METABOLISM DURING HIGH-DOSE BRANCHED CHAIN AMINO ACID (BC) SUPPORT IN SEPSIS. C. Chiarla, I. Giovannini, J.H. Siegel*, G. Boldrini, W.P. Cole man*, M. Castagneto. *MIEMSS: University of Maryland, Baltimore, USA, and Centro di Stur dio per la Fisiopatologia dello Shock, CNR, Catholic University, Rome, Italy. In order to assess the impact of high-dose BC on metabolic abnormalities in sepsis, 360 measurements of plasma proline (PROLI, hepatic proline clearance (PROCL), plasma lactate (LAC), cholesterol (CHOL) and of respiratory quotient (RQI were performed in 16 septic pts undergoing TPN. Randomly, 8 pts received a 49% BC mixture (High-BCI and 8 pts a 16% BC mixture (Low-BC). For similar doses of glucose (5.5 vs 5.71, fat (0.9 vs 0.91, total amino acids (1.5 vs 1.6) and TPN proline (0.06 vs O.O7I(g/Kg/24hrI, High-BC vs Low-BC had a lower PROL (0.15 vs 0.37 mM/L) with increased PROCL (80.8 vs 49.8 units), higher CHOL (2.94 vs 2.27 mM/Ll, lower LAC (1.22 vs 1.93 mM/L) and RQ (0.80 vs 0.861(p
and
Since the decrease in CHOL and PROCL and the increase in PROL in sepsis depend on a defi tit of energy metabolism from shortage of Acetyl-CoA (which is both a substrate for ener gy production and a CHOL synthesis precursor), the data in this study support the concept that a greater oxidation of 8C (RQ=O.7 or lower) may supply readily available Acetyl-CoA and Succinyl-CoA and contribute to reverse the energy deficit of liver and peripheral tissues in sepsis.
P.14
ZINC LOSSES 81 ZINC BALANCES IN BURN PATIENTS. M_M., C. Cavadini’, FLMansourian’, H.Dirren’, ABart’, J.Freeman’. l Dept.of Anesthesiology, Centre Hospitalier Universitaire Vaudois & ‘Nestle Research Centre, Lausanne, Switzerland. CUTANEOUS
Hypermetabolic response and extensive catabolism due to bums increase nutritional requirements. Infections, delayed wound healing and weight loss may be due to Zinc (Zn) deficiency, Zn being involved in most metabolic pathways. We studied the cutaneous Zn losses (CL) due to wound seepage to determine the Zn requirements and Zn balance after burn injury. Five male patients admitted to the Burns Centre (thermal bums 22.533% of body surface, age 23-51 yrs.) were studied from the 1st to the 7th post-burn day (01 to D7). All intakes were analysed for Zn. Urine, gastric & bronchial aspirations and faeces (non cutaneous losses = NCL) were collected over 24-hour periods. Textiles in contactwith the patients were collected and handled with talc-free gloves: Zn was extracted in awasher using HCI 0.1 N. Average textile, water & washer contaminations were substracted. Zn was analysed by means of flame atomic absorption. The shower losses were not studied. Mean daily Zn enteral & parenteral intakes, NCL, CL and balances are shown in Fio.1. Pooled daily mean (pdm) intake was 14.1k7.1 mg/24hr (X-LSD). U&ary output confirmed previous findings: 0.93.4 mg/24hr. Pdm NCL were: 5.0+5.1 mgI24hr. Pdm CL were 339325.9 mg/24hr (Patient 1: 60.3 81 Patient 3: 56.8 mgI24hr). Pdm Zn balances were 24.9k24.5 mq/24hr, and pdm shower duration 56527 min. These results show that an important part of the immediately available Zn body stores (10% of a total Zn content of 1.4-2.3 g), are lost cutaneously after burn injury, leading to strongly negative Zn balances. Since the shower period was not studied, the losses are probably greater.
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