Gastric emptying in trauma patients.
OBJECTIVE
The aim of this study was to obtain quantitative data on gastric emptying following trauma.


METHODS
In order to assess gastric emptying for early enteral feeding, we evaluated the absorption of an amino acid, L-[1-(13)C]phenylalanine, within 24 h of admission and 7 days later in 14 trauma patients (injury severity score 36 +/- 2). Following nasogastric administration of 100 mg L-[1-(13)C]phenylalanine, the plasma L-[1-(13)C]phenylalanine enrichment at 30 and 60 min and the expired (13)CO(2) for 1 h in the breath were used to measure the degree of gastric emptying.


RESULTS
The plasma L-[1-(13)C]phenylalanine enrichment concentration at 30 min was 0.53 +/- 0.23 mmol/l during the first study and 2.46 +/- 0. 62 mmol/l during the second study (p = 0.006, a fivefold increase). The L-[1-(13)C]phenylalanine plasma level in historic controls was 4. 57 +/- 1.48 mmol/l. The percent of the dose oxidized and expired as (13)CO(2) in 1 h was 0.51 +/- 0.17 during the first 24-hour study compared to the second study of 3.37 +/- 0.68 (p = 0.0008) 7 days later (an over sixfold increase). The percent of the dose oxidized in 1 h in 37 normal historic controls was 7.08 +/- 0.33.


CONCLUSIONS
These data indicate delayed gastric emptying with limited recovery in 1 week. We conclude that gastric feeding should not be employed, and the route for early nutritional intervention should be transpyloric for the trauma patient.
Carlin
C B
CB
Department of Medical Education, Carraway Methodist Medical Center, Birmingham, AL, USA.
Scanlon
P H
PH
Wagner
D A
DA
Borghesi
L
L
Geiger
J W
JW
Long
C L
CL
D000328:Adult; D002247:Carbon Isotopes; D016022:Case-Control Studies; D004750:Enteral Nutrition; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D006801:Humans; D007408:Intestinal Absorption; D008297:Male; D010649:Phenylalanine; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000503:physiopathology* / Q000628:therapy
D002247:Carbon Isotopes; D010649:Phenylalanine