G. Pelosi

Total parenteral nutrition infusate. An approach to its optimal composition in post-trauma acute renal failure

Abstract A study on 46 patients suffering from acute post-traumatic oliguric renal failure was carried out in order to provide adequate nutritional support. It was found that a high nitrogen intake was achieved by combined infusion of essential (EAA) and non-essential (NEAA) free amino acids; the essential amino acid/total ( E T ) nitrogen ratio had to be higher than four for the improvement of nitrogen balance and protein metabolism.

ANTICATABOLIC PROPERTIES OF BRANCHED CHAIN AMINO ACIDS IN TRAUMA

The anticatabolic properties of branched chain amino acids enriched protein solutions in 22 patients with multiple trauma have been evaluated. Nitrogen balance, nitrogen output, the daily change of blood urea nitrogen, plasma albumin and total protein levels were recorded daily. Each 2 days free amino acids and 3-methyl histidine urinary concentrations were measured. The results obtained in the study suggest that in trauma patients high ratios of essential amino acids/total nitrogen are needed and that amino acid solutions enriched in branched chain amino acids are most effective in preventing muscle catabolism and promoting protein synthesis.

Nutrition in acute renal failure.

The nutritional value of regimes enriched with branched chain amino acids has been evaluated in 22 adult patients suffering from acute post-traumatic renal failure. The study was carried out for 12 days. The following data were recorded and compared daily: nitrogen balance, daily blood urea nitrogen (BUN), BUN/creatinine ratio, and plasma albumin levels. Also after 6 days of dialysis and nutritional support, the plasma medium molecular weight compounds (uremic toxins) were studied. It was concluded that: (a) the combined use of parenteral and oral nutrition appears most adequate in this type of patient; (b) the nitrogen intake should provide an essential amino acid/total nitrogen ratio of greater than or equal to 4 and a branched chain essential amino acid ratio of greater than or equal to 0.5; and (c) caution is still necessary in interpreting analyses of middle molecular weight compounds in this type of patient.

Plasma free amino acids in trauma: clinical and therapeutic implications.

Abstract The aim of this study was to evaluate the plasma free amino acid patterns in patients suffering from traumatic shock. Changes found in the behaviour of single free amino acids appear to indicate that the nutritional infusate solutions should not contain glutamic acid, high concentrations of arginine or a ratio of essential free amino acids to total nitrogen of more than 3.2.

Plasma an intraerythrocyte amino-acid levels during and after haemodialysis in acute renal failure

A study is carried out on the variations of plasma and blood red cells free amino acid concentrations secondary to haemodialysis in patients suffering from acute renal failure.A reduction in plasma free amino acid pool has been observed in patients undergoing to many periodic haemosialysis, but no significant differences occur in plasma aminogram between before and after a single dyalitic procedure.Significant alterations were also observed in blood red cells aminogram, and this may be interpreted as reflex of intracellular omeostatic mechanisms for the maintenance of normal plasma free amioacid pattern.

Acute renal failure: biochemical evaluation of total parenteral nutrition with essential l-amino acids

Plasma amino acid patterns were studied in three groups: one of 10 healthy subjects used as control, one of five patients in acute renal failure treated by haemodialysis plus a standard high-calorie non-protein diet, and one of five patients with the same clinical condition and treated in the same way except that the total parenteral nutrition consisted of a mixture of carbohydrate and essential L-amino acids. Our results indicate that haemodialysis seems to be responsible for some part of the depletion of amino acids and that their administration reduces this effect both for the essential and for the non-essential amino acids.

Amino acid loss in acute renal failure: comparative effects of peritoneal dialysis and haemodialysis

Abstract The concentration of free amino acids has been determined in plasma and erythrocytes of 10 patients with acute renal failure treated by peritoneal dialysis and haemodialysis, and of 10 healthy subjects as controls. The variations observed have been compared in an attempt to evaluate the effects of two different methods of dialysis on the amino acid pools. The effects of peritoneal dialysis on changes in the plasma valine, glycine, glutamic acid and taurine have been interpreted.

Free amino acids in plasma and erythrocytes during and after cardiopulmonary by-pass in open-heart surgery.

The concentrations in plasma and erythrocytes of free amino acids before, during and after cardiopulmonary by-pass have been determined. During by-pass and the early postoperative period the total alpha-amino nitrogen decreased, mainly because of changes in glucogenic amino acids; ketogenic amino acids, on the other hand, increased. The phenylalanine/tyrosine ratio was markedly increased in all cases.

Plasma and cerebrospinal fluid acid-base balance and gas content in shock

Abstract Seven patients in shock secondary to heart failure, eight patients with sepsis and eight with massive haemorrhage have been studied. The acid-base balance and gas content of arterial blood and cerebrospinal fluid indicated severe acidosis in these fluids. This condition appears related to the high lactate/pyruvate ratios in the arterial and jugular venous blood and in the cerebrospinal fluid. The prognostic value of the lactate/pyruvate ratio and changes in acid-base ratios is also reported.

Decompression sickness: A Medical emergency

Abstract Our clinical experience on the use of decompression chamber and intensive care in the treatment of decompression sickness in 64 patients is reported. The results obtained in this study allow the formulation of some considerations regarding the evaluation of type of patients; the effect of delay upon prognosis; the use of particular schedules of treatment; the management of residual damage.