title: Albumin synthesis rates are not responsive to hyperglycemic hyperinsulinemia in postoperative patients.
abstract: BACKGROUND
  Insulin regulates albumin synthesis in vitro and in various experimental models. The current study was undertaken to determine the effects of a physiologic hyperinsulinemia on albumin synthesis in postoperative patients in whom plasma albumin concentrations are decreased.
  
  
  METHODS
  Studies were performed in postabsorptive patients after major abdominal operations. Mass spectrometry techniques were used to directly determine the incorporation rate of 1-[(13)C]-leucine into albumin. Consecutive blood samples were taken during a continuous isotope (D-Glc) infusion (0.16 µmol/kg/min). Isotopic enrichments were determined at baseline (period I) and after a 4-hour D-glucose (D-Glc) infusion at currently recommended rates (170 mg/kg/h, n = 10) or after infusion of saline (control group, n = 8) (period II).
  
  
  RESULTS
  After D-Glc infusion, plasma insulin concentrations increased significantly (period I, 6.6 ± 1.8 µU/mL; period II, 21.4 ± 2.1 µU/mL; P < .01). In contrast, plasma insulin concentration remained constant in control patients (period I, 3.8 ± 0.9 µU/mL(-1); period II, 5.9 ± 1.1 µU/mL; not significant vs period I, but P < .005 vs the corresponding value at the end of period II in the control group). Hyperinsulinemia was without effect on fractional albumin synthesis (period I, 12.8% ± 1.9%/d; period II, 11.9% ± 1.9%/d; not significant), and synthesis rates corresponded to those measured in controls (period I, 13.0% ± 1.2%/d; period II, 12.1% ± 0.1%/d; not significant vs period I and vs D-Glc infusion).
  
  
  CONCLUSIONS
  A standard D-Glc infusion is insufficient to increase albumin synthesis in postoperative patients.
authors.affiliation: Department of Surgery, University Hospital Campus Grosshadern, Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Rittler
authors.forename: Susanne
authors.initials: S
authors.lastname: Braun
authors.forename: David
authors.initials: D
authors.lastname: Kuppinger
authors.forename: Hans
authors.initials: H
authors.lastname: Demmelmair
authors.forename: Berthold
authors.initials: B
authors.lastname: Koletzko
authors.forename: Michael
authors.initials: M
authors.lastname: Vogeser
authors.forename: Karl-Walter
authors.initials: KW
authors.lastname: Jauch
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Hartl
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D002247:Carbon Isotopes / Q000097:blood; D016022:Case-Control Studies; D005947:Glucose / Q000494:pharmacology*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000139:chemically induced; D006946:Hyperinsulinism / Q000097:blood* / Q000139:chemically induced; D007328:Insulin / Q000097:blood*; D007930:Leucine / Q000097:blood; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood*; D012709:Serum Albumin / Q000096:biosynthesis* / Q000172:deficiency
chemical_list: D002247:Carbon Isotopes; D007328:Insulin; D012709:Serum Albumin; D007930:Leucine; D005947:Glucose