RESISTANCE OF NITROGEN-METABOLISM TO GROWTH-HORMONE TREATMENT IN THE EARLY PHASE AFTER INJURY OF PATIENTS WITH MULTIPLE INJURIES

Objectives and Design: Several studies have shown an anticatabolic eff ect of recombinant human growth hormone (r-GH) in surgical patients. W e investigated, in a prospective, randomized, double blind, and placeb o-controlled study, the effect of r-hGH on hormone and nitrogen metabo lism in 14 patients with multiple injuries in the early phase of injur y. Materials and Methods: All patients were treated in the intensive c are unit, had mechanical ventilation, and were highly catabolic, with a mean daily nitrogen loss of 13.2 +/- 1.8 g. r-hGH was given subcutan eously (once a day, at 8 PM) in a dosage of 0.2 IU/kg.d for seven days , starting on the second day after injury. Results: Administration of r-hGH evoked a significant increase in plasma concentrations of GH, in sulin-like growth factor-I (IGF-I), and insulin-like growth factor bin ding-protein-3 (IGFBP-3). No significant differences were found for ei ther daily or cumulative nitrogen balances (-103.1 +/- 14 g for patien ts receiving r-hGH and -92.1 +/- 18.1 for those with placebo). r-hGH t herapy did not affect skeletal muscle extracellular water, nor did it affect plasma or muscle concentrations of total free amino acids or gl utamine. Plasma albumin, prealbumin, and retinol-binding protein conce ntrations were also unchanged by r-hGH therapy, as were the urinary ex cretion of potassium and urea. Conclusions: We conclude that elevated plasma levels of GH, insulin, and IGF-I are unable to effect a protein anabolic drive in patients with multiple injuries during the early po stinjury phase and assume that this r-hGH resistance to nitrogen metab olism takes place at the level distal to IGF-I.