Multiple Systems Organ Failure

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Abstract
In a survey study of septic trauma patients, the response of plasma amino acid concentration to albumin infusion was contrasted in survivors (14 patients) and nonsurvivors (11 patients). Plasma albumin levels were maintained at 3 g/dl by albumin infusion (0-128 g/day) because of central venous pressure/adequate circulation considerations. Survivors showed no significant increase in plasma essential amino acid concentration as a function of albumin infusion. In nonsurvivors, threonine, valine, leucine, phenylalanine, lysine and histidine all rose significantly (P .ltoreq. 0.025) with albumin infusion. Isoleucine (8 residues/molecule albumin), in contrast to leucine (60 residues/molecule), did not increase. The ratio of isoleucine to leucine (Ile/Leu) decreased with albumin infusion from 0.47 (no albumin infused) to 0.27 (60 g albumin/day). Survivors did not exhibit a similar response. The low Ile/Leu increased in most nonsurvivors with amino acid infusion from 0.27 (no amino acids) to 0.59 (150 g amino acids/day). Nonsurvivors evidently had an increased rate of albumin catabolism with subsequent amino acid release. Hypoalbuminemia treated with albumin infusion without amino acid infusion appears to produce a relative isoleucine deficiency which may detrimentally affect protein synthesis.