INFLUENCE OF DIET WITH OR WITHOUT AMINO-ACIDS ON POLYAMINE EXCRETION IN MULTIPLE TRAUMA VICTIMS

Elevated levels of urinary polyamines (PA) in severely injured trauma patients are further enhanced by total parenteral nutrition (TPN) that contains both glucose and amino acids (AAs). Since TPN solutions cont ain arginine, the AA precursor of PA, it is not certain whether the in creased urinary PA are due to this substrate. Nutritional factors can evidently modify PA metabolism. We measured the daily excretion of the PA, putrescine (PU) and spermidine (SD) in 18 multiply injured (injur y severity score [ISS], 32 +/- 2), hypermetabolic (resting energy expe nditure [REE]/basal energy expenditure [BEE], 1.41 +/- 0.06), and high ly catabolic (daily N loss, 17.2 +/- 1.8 g N/d) acute trauma patients for 5 days in the early flow phase of injury. The patients were fed on ly maintenance fluids without calories or nitrogen for the first day 6 0 to 72 hours after injury, and then were randomized to receive glucos e alone ([GLUC] 4.1 mg/kg/min, 80% measured REE, n = 8) or the same am ount of glucose with AAs (TPN, 275 mg N/kg/d, n = 10) for the followin g 4 days. There was no significant difference in the enhanced daily PA excretion either in the free or acetylated form between the two dieta ry regimens. The addition of AAs in the TPN mixture did not seem to fu rther stimulate PA metabolism in the trauma patients. The source of th e nutrient content of the diet appears to be important for enhancing t otal PA excretion in critically ill patients. Copyright (C) 1994 by W. B. Saunders Company