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

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Abstract

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, 0.52g kg-1 day-1 was more sparing than 0.37 g kg-1 day-1 of BCAA.

N balance of the three groups suggests that injured patients need more than 0.24 g N kg-1 day-1 probably for non-essential AA synthesis. The study of plasma AA values support the increased non-essential N need in group C and allows us to suggest the proper AA composition of the overall optimal daily N intake (0.28–0.30 g N kg-1 day-1) in catabolic patients: BCAA about 0.5 g kg-1 day-1, phenylalanine, methionine, tryptophane, threonine and lysine from 2–3 to 5–10 times the normal allowance, the remainding N supply (about 0.14 g kg-1 day-1) should be made up from histidine, arginine, tyrosine, serine, proline, glycine, glutamic and aspartic acid.

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Authors and Affiliations

  1. Reparto di Rianimazione e Istituto di Anestesiologia e Rianimazione dell' Universita, Italia

    G. Iapichino, D. Radrizzani, G. Ronzoni, A. Colombo & G. Damia

  2. Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore di Milano, Italia

    L. Leoni

  3. Reparto di Rianimazione Ospedale di Sondrio, Italia

    A. Scherini & P. Della Torre

  4. Unita' di Cure Intense, Ospedale S. Giovanni, Bellinzona, Svizzera

    R. Malacrida

  5. Servizio di Ricerche Cliniche, Ospedale R. Margherita, Torino, Italia

    G. Bonetti & M. Marengo

  6. ICU “E. Vecla” Ospedale Maggiore, Via F. Sforza 33, I-20122, Milano, Italy

    G. Iapichino

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  1. G. Iapichino
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  2. D. Radrizzani
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  3. A. Scherini
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  4. R. Malacrida
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  5. G. Bonetti
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  6. L. Leoni
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  7. P. Della Torre
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  8. G. Ronzoni
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  9. A. Colombo
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  10. M. Marengo
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  11. G. Damia
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Iapichino, G., Radrizzani, D., Scherini, A. et al. Essential and non-essential amino acid requirement in injured patients receiving total parenteral nutrition. Intensive Care Med 14, 399–405 (1988). https://doi.org/10.1007/BF00262896

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  • DOI: https://doi.org/10.1007/BF00262896

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