M. Jeevanandam et al., ADJUVANT RECOMBINANT HUMAN GROWTH-HORMONE NORMALIZES PLASMA AMINO-ACIDS IN PARENTERALLY FED TRAUMA PATIENTS, JPEN. Journal of parenteral and enteral nutrition, 19(2), 1995, pp. 137-144
Background: The addition of an anabolic stimulant during intensive nut
rition therapy in trauma patients seems to be a reasonable adjuvant fo
r minimizing muscle-mass erosion. The plasma free amino acid pattern i
s the mirror of the net amino acid metabolism, and we have measured th
e progressive changes resulting from recombinant human growth hormone
therapy in trauma victims during nutritional repletion in the early ca
tabolic 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 nu
trition therapy) and their progressive changes during 7 days of IV nut
rition support (total parenteral nutrition, 1.1 x resting energy expen
diture calories, 250 mg of nitrogen per kilogram per day) with or with
out adjuvant recombinant human growth hormone. Group H (n = 10) random
ly received daily recombinant human growth horn-tone (0.15 mg of Somat
ropin per kilogram per day) and Group C (n = 10) received the vehicle
of infusion. Results: Hypoaminoacidemia of trauma is normalized by inf
usion of recombinant human growth hormone, which indicates its anaboli
c nature, and this is confirmed in the cumulative nitrogen balance (-2
81 +/- 139 mg of nitrogen per kilogram per 7 days compared with -809 /- 151 mg of nitrogen per Idiogram per 7 days without recombinant huma
n growth hormone; p less than or equal to .005). This improved nitroge
n retention is also reflected in the significantly low blood urea nitr
ogen levels in the recombinant human growth hormone group, which repre
sents the efficient utilization of the infused amino acids for synthes
is of proteins. Elevated plasma insulin-like growth factor-1 levels in
Group H compared with those in Group C may also account for this alte
red amino acid metabolism. Conclusions: Recombinant human growth hormo
ne treatment in combination with conventional total parenteral nutriti
on in the immediate posttraumatic period improved nitrogen metabolism
and normalized the plasma free amino acid levels.