Multiple Systems Organ Failure

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Abstract
Amino acids and dextrose infusion were given for short periods of time to a young man whose basal state was characterized, and their effects were documented in terms of plasma concentrations and splanchnic extraction. The basal state measurements show in the acute trauma state and its subsequent starvation state a largely balanced splanchnic extraction of amino acids but at a decreasing rate. Amino acid (FreAmine) infusion at low rates on this background produced a large increase in extraction of a largely balanced mixture of amino acids but a minimal change in glucose release. The septic state was characterized in both the basal and amino acid infusion state by splanchnic extraction of an unbalanced mixture of amino acids deficient in branched-chain amino acids and in relative excess of glucogenic amino acids with increased glucose release and increased utilization of amino acids for gluconeogenesis. In early sepsis this state could largely be repaired by exogenous amino acid infusion but in late sepsis, was only partially repaired. Probably, the patient in late sepsis should have a branched-chain rich amino acid mixture and hepatic failure of sepsis is strongly associated with peripheral release of an unbalanced mixture of amino acids secondary to enhanced branched-chain catabolism. Infused glucose produces a large increase in plasma glucose, but also improves the balance of the splanchnic amino acids extracted. The statistical validity of these statements is examined.

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