Multiple systems organ failure: IV. Imbalances in plasma amino acids associated with exogenous albumin in the trauma-septic patient.
In a survey study of septic trauma patients, the response of plasma amino acid concentration to albumin infusion was contrasted in survivors (14 patients) and nonsurvivors (11 patients). Plasma albumin levels were maintained at 3 gm/dl by albumin infusion (0-128 gm/day) because of central venous pressure/adequate circulation considerations. Survivors showed no significant increase in plasma essential amino acid concentration as a function of albumin infusion. In nonsurvivors threonine, valine, leucine, phenylalanine, lysine, and histidine all rose significantly (p less than or equal to 0.025) with albumin infusion. Isoleucine (8 residues/molecule albumin), in contrast to leucine (60 residues/molecule) did not increase. As a result, the ratio of isoleucine to leucine (Ile/Leu) decreased with albumin infusion from 0.47 (no albumin infused) to 0.27 (60 gm albumin/day). Survivors did not exhibit a similar response. The low Ile/Leu increased in most nonsurvivors with amino acid infusion from 0.27 (no amino acids) to 0.59 (150 gm amino acids/day). The data strongly suggest that nonsurvivors had an increased rate of albumin catabolism with subsequent amino acid release. Moreover, hypoalbuminemia treated with albumin infusion without amino acid infusion appears to produce a relative isoleucine deficiency which may detrimentally affect protein synthesis.
D000063:Accidents, Traffic; D000418:Albumins / Q000008:administration & dosage*; D000596:Amino Acids / Q000008:administration & dosage / Q000097:blood* / Q000378:metabolism; D006801:Humans; D007275:Injections, Intravenous; D007532:Isoleucine / Q000097:blood / Q000172:deficiency; D007930:Leucine / Q000097:blood; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood* / Q000628:therapy; D014690:Venous Pressure / Q000187:drug effects; D014947:Wounds and Injuries / Q000097:blood* / Q000628:therapy; D014948:Wounds, Gunshot; D014951:Wounds, Stab
D000418:Albumins; D000596:Amino Acids; D007532:Isoleucine; D007930:Leucine