Multiple Systems Organ Failure

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Abstract
The response of the plasma substrate and hormone profile of survivor and nonsurvivor septic trauma patients to varying rates of amino acid infusion (IVAA) were contrasted. When IVAA = 0 levels of most plasma amino acids (except aspartate, tryptophan, cysteine and proline) were lower in nonsurvivors. At IVAA = 1-100, 11 of 20 plasma amino acids were significantly (P .ltoreq. 0.05) higher in nonsurvivors: only glutamate was significantly lower (P .ltoreq. 0.001) and valine, isoleucine and arginine on average lower. At IVAA .ltoreq. 101-200, only alanine, methionine, tyrosine and phenylalanine were significantly (P .ltoreq. 0.005) higher in nonsurvivors; isoleucine was significantly (P .ltoreq. 0.02) lower. The sharp increase in methionine and decrease in tryptophan in nonsurvivors with IVAA was particularly marked. Polynomial regression analysis showed that urea increased significantly with IVAA in both patient groups; free fatty acids and cortisol decreased only in nonsurvivors. Insulin increased with IVAA only in survivors, glucagon only in nonsurvivors. Triglycerides, glycerol, acetoacetate, .beta. OH butyrate and glucose appeared to show no significant response to IVAA in either patient group. Increased peripheral protein catabolism and branched-chain amino acid oxidation with decreased tissue uptake of conventional energetic fuels was suggested. An impairment of mitochondrial translocase systems is possible.

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