CHANGES OF PLASMA AMINO ACID IN TPN SUPPORTED PATIENTS WITH INTRA-ABDOMINAL INFECTION
Li Jeishou, Li Aihua, Gu Shounian, Liu Fangnan, Department of Abdominal Surgery, Jinling Hospital, Nanjing, China
The changes of plasma aminogram were observed prospectively on 95 cases of enteric fistula associated with intra-abdominal infection under the supplement of TPN(total parenteral nutrition) with a conventional balanced nutritional amino acid solution Anfumine 14s (8.5% Tianjin, China). Plasma levels of amino acid and albumin were determined on the day of initiation of TPN and weekly through the Course of nutritional support and the day of termination of TPN or 2-5 days within death. Initial plasma aminograms obtained on the day before the TPN support were of characterics of aminogram of both sepsis and starvation. The initial total amount of plasma free amino acid was lower than normal and gradually elevated to normal range after two weeks TPN supplement in survivors. While in nonsurvivors, the total free amino acid was increased rapidly and reached the peak value at preterminal stage, significantly higher than the normal range. The level of phenylalanine was constantly high through the course of investigation, either in survivors or nonsurvivors. Proline also elevated proportional to the severity of infection, but to a lesser degree In contrast, the plasma ratio of BCAA/AAA (branched-chain amino acids /aromatic amino acids) was lower than normal and the level of arginine was decreased proportional to the severity of infection Authors considered that (1) the amino acid solution specific for starved septic patients should contain lower content of phenylalnine and higher amount of BCAA and arginine as compared with the conventional nutritional amino acid solution; (2) constant elevation of plasma phenylalanine and proline associated with progressive decrease of arginine is one of the meaningful predictive criteria for prognosis of septic patients; (3) inappropriate administration of exogeneous amino acids in metabolic decompensated septic patients might do more harm rather than benefit.