Essential and non-essential amino acid requirement in injured patients receiving total parenteral nutrition

• Published in: Intensive care medicine 1988-01, Vol.14 (4), p.399-405
• Main Authors: IAPICHINO, G, RADRIZZANI, D, DAMIA, G, SCHERINI, A, MALACRIDA, R, BONETTI, G, LEONI, L, DELLA TORRE, P, RONZONI, G, COLOMBO, A, MARENGO, M
• Format: Article
• Language: English
• Subjects: Adult; Amino Acids; Amino Acids, Essential; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Critical Care; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Female; Humans; Intensive care medicine; Male; Medical sciences; Nutritional Requirements; Parenteral Nutrition, Total; Wounds and Injuries - metabolism
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/BF00262896

The metabolic derangements of injury are known to influence nitrogen (N) requirements whilst less is known about individual amino acid (AA) requirements. This study was designed to investigate prospectively N vs AA requirement in 36 injured patients treated with total parenteral nutrition (TPN). The non-protein caloric input was 30 kcal kg-1 day-1 and three AA solutions were assessed containing the same AAs but in different proportion. Overall N intake was set at 0.35 g N kg-1 day-1 for solution A and B and 0.24 g N kg-1 day-1 for solution C. Solution B was similar to A, both being enriched in branched chain AAs (BCAA: 0.69 g kg-1 day-1 in B compared with 0.55 g kg-1 day-1 in A) while decreased in aromatic and sulphurated forms (1.75 times the normal need). Solution C was designed to maintain a daily input of BCAA similar to A (0.52 g kg-1 day-1) but with the supply of aromatic and sulphurated AA between solutions A and B, the supply of other AAs (lysine, theonine, histidine, arginine, glycine) being dependent on the selected N intake. For all the essential AAs the supply was always greater than normal allowances. Increasing BCAA over 0.55 g kg-1 day-1 did not improve N balance when N intake was 0.35 g kg-1 day-1, whilst nutrition with solution C was unable to maintain N balance. Moreover we found indirect evidence that this N intake, 0.52 g kg-1 day-1 was more sparing than 0.37 g kg-1 day-1 of BCAA.