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Muscle Catabolism, Total Parenteral Nutrition, and Hepatic Clearance of Amino Acids

Mauro Pittiruti, MD; John H. Siegel, MD; Gabriele Sganga, MD; Bill Coleman; Charles E. Wiles, III, MD; Robert Placko

Arch Surg. 1989;124(3):362-372.

Abstract
• The major determinants of urea production were investigated in 26 patients with multiple trauma (300 studies). The body clearances (CLRs) of ten amino acids (AAs) were estimated as a ratio of muscle-released AAs plus total parenteral nutrition–infused AAs to their extracellular pool. While clinically septic trauma (ST) patients without multiple-organ failure syndrome (MOFS) had a higher level of urea nitrogen production (25.6± 13.4 g of N per day) compared with nonseptic trauma (NST) patients (14±7.5 g of N per day) and with ST patients with MOFS (4.28± 1.5 g of N per day), in all groups urea N production was found to be a function of muscle protein degradation (catabolism), total parenteral nutrition–administered AAs, and the ratio between leucine CLR and tyrosine CLR (L/T) (r² =.82, P<.0001). Since tyrosine is cleared almost exclusively by the liver, the L/T ratio may be regarded as an index of hepatic function. The significant differences between urea N production in ST and NST patients lay in an increased positive dependence on muscle catabolism and increased negative correlation with L/T in the ST group. At any L/T ratio, urea N production was increased in ST patients over NST patients, but in ST patients with MOFS, it fell to or below levels of NST patients. These data show that the ST process is associated with enhancement of ureagenesis, due to increased hepatic CLR of both exogenous and endogenous AAs. In sepsis with MOFS, a marked inhibition of urea synthesis occurs, partially explained by a decreased hepatic CLR of non-branched-chain AAs.

(Arch Surg 1989;124:362-372)

Author Affiliations
From the Maryland Institute for Emergency Medical Services Systems (MIEMSS) and the Department of Surgery, University of Maryland, Baltimore. Drs Pittiruti and Sganga were MIEMSS Consiglio Nationale de Researche fellows of the Centro di Studio per la Fisiopatologia dello Shock, Università Cattolica, Rome.

Footnotes
Accepted for publication April 12, 1988.

Reprint requests to Maryland Institute for Emergency Medical Services Systems, University of Maryland, 22 S Greene St, Baltimore, MD 21201 (Dr Siegel).

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