Protein-sparing effect of substrate infusion in surgical patients is governed by the clinical state, and not by the individual substrate infused

Abstract

We have determined iostopically the effect of either glucose or lipid infusion on rates of glucose turnover, glucose oxidation, and net protein catabolism (NPC) in three groups of surgical patients. Kinetic measurements were performed using the primed constant infusion of 3H-glucose, and either 14C-glucose or 14C-urea. The three groups included patients with: (1) sepsis and/or trauma (ST); (2) upper gastrointestinal cancer (UGI); (3) lower gastrointestinal cancer (LGI). In each patient group the effect of either glucose infusion (approximately 4 mg/kg.min) or lipid infusion (20% Intralipid lipid emulsion infused to provide calories approximately isocaloric to the glucose infusion) was assessed. The infusion of calories as either glucose or lipid was equally effective as a means of suppressing NPC in each individual patient group, and the degree of response was governed by the clinical disease state. In the LGI and ST patients the infusion of either glucose or fat resulted in a significant suppression of NPC (p less than 0.005) of approximately 15%. However, the ongoing rate of NPC that occurred despite substrate infusion was more than twice as great in the ST patients as in the LGI patients.(ABSTRACT TRUNCATED AT 250 WORDS)