Severe loss of protein is a major contributor to morbidity and mortality in many disease states involving infection, sepsis and surgery.
Preservation of normal body composition by preventing extensive loss of protein is a prici-pal goal of nutritional therapy.
This approach relies essentially on the mass actions of nutrients delivered in hyperosmolar solutions in amounts exceeding the caloric expenditure so as to counteract the strong catabolic-trend associated with disease.
Hydrolysate of casein and fibrin have received the most widespread clinical use, but recently synthetic crystalline amino-acid has became available and is reported to offer improved effic iency of nitrogen utilization.
More efficient utilization of nitrogen take place in the abscence of peptide fragments and amino-acid isomers which cannot be utilized when administered by the direct intravenous-route.
Furthermore, the amino-acid content of the hydrolysate solution fall short of an ideal mixture-as predicted by serum amino-acid analysis.
Rcognizing the importance of rapid fat mibilization and favorable effects of starvation ket--osis during negative caloric, balance, we have attempted to avoid anti-lipolytic action of insulin whose secretion is stimulated by infusion of glucose. We therefore studied the protein-sparing effect of amino-acid infusate (Aminofucin) free of or low of glucose with the expectation that the combined effect of lowed insulin and glucose levels, together with elevated level of free fatty acid and keton bodies, would reduce the consumption of glucose and hence the need for gluconeogenesis from protein. The purpose of this report is to review the experience in a large group of patientswho have undertook a hyperalimentation with crystalline amino-acid-instead of protein hydrolysate and a peripheral intravenous feeding with isotonic amino-acid-solution to achieve positive, nitrogen´ balance.
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