title: Histidine and other amino acids in blood and urine after administration of Bretschneider solution (HTK) for cardioplegic arrest in patients: effects on N-metabolism.
abstract: Bretschneider (histidine-tryptophan-ketoglutarate, HTK) solution employed for induction of cardioplegic arrest possesses a high histidine concentration (198 mM). Due to the large volume administered, massive amounts of histidine are incorporated. The aim of the study was to evaluate alterations in amino acid and nitrogen metabolism originating from histidine degradation. Between 07/2014 and 10/2014, a total of 29 consecutive patients scheduled for elective isolated coronary artery bypass grafting with cardiopulmonary bypass (CPB) were enrolled in this prospective observational study. The patients received 1.6 L cardioplegic Bretschneider solution on average. Blood gas and urine samples obtained were analyzed for amino acid as well as urea and ammonium concentrations. After CPB initiation, plasma histidine concentration greatly increased to 21,000 µM to reach 8000 µM at the end. Within the operative period, plasma concentrations of aspartate, glutamate, asparagine, alanine, and glutamine increased variable in magnitude. During the same time, urinary analysis revealed histidine excretion of 19,500 µmol in total and marked elevations in glutamate and glutamine excretion. The absolute amounts of urea and ammonium excreted additionally were 3 mmol and 8 mmol, respectively. Already during CPB, distinct amounts of the histidine administered are metabolized, mainly to other amino acids, but only small amounts to urea and ammonia. Thus, the impact of the histidine incorporated on acid-base status in the intraoperative phase is minor. On the other hand, intraoperative provision of several amino acids arising from histidine metabolism might mitigate postaggression syndrome.
authors.affiliation: Institute of Physiological Chemistry, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany.
authors.forename: Johanna K
authors.initials: JK
authors.lastname: Teloh
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
authors.forename: Daniel-Sebastian
authors.initials: DS
authors.lastname: Dohle
authors.affiliation: Ambulatory Healthcare Center MVZ Dr. Eberhard und Partner, Brauhausstraße 4, 44137, Dortmund, Germany.
authors.forename: Miriam
authors.initials: M
authors.lastname: Petersen
authors.affiliation: Institute of Physiological Chemistry, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany.
authors.forename: Rabea
authors.initials: R
authors.lastname: Verhaegh
authors.affiliation: Institute of Physiological Chemistry, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany.
authors.forename: Indra N
authors.initials: IN
authors.lastname: Waack
authors.affiliation: Institute of Physiological Chemistry, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Roehrborn
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.affiliation: Institute of Physiological Chemistry, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany. herbert.de-groot@uni-duisburg-essen.de.
authors.forename: Herbert
authors.initials: H
authors.lastname: de Groot
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D006324:Heart Arrest, Induced; D006639:Histidine / Q000097:blood* / Q000652:urine*; D006801:Humans; D008297:Male; D008353:Mannitol / Q000008:administration & dosage; D011189:Potassium Chloride / Q000008:administration & dosage; D011343:Procaine / Q000008:administration & dosage
chemical_list: C039984:Bretschneider cardioplegic solution; D008353:Mannitol; D006639:Histidine; D011343:Procaine; D011189:Potassium Chloride; D005947:Glucose
keywords: Cardioplegia; Cardiopulmonary bypass; Heart–lung machine; Inzolen