[Behavior of plasma amino acids, blood sugar, insulin and glucagon in the early post-traumatic phase with sole substitution of fluid and electrolytes].

The findings on the changes in amino acid metabolism and hormonal regulation after severe trauma and the conclusions draw from these are rather controversial. It is well documented that even small amounts of carbohydrates may significantly influence amino acid and carbohydrate metabolism especially in stress situations. Very few studies have been carried out on polytraumatized patients given an absolutely carbohydrate-free diet however. The following study was carried out on 20 polytraumatized, ventilated patients, substituted with water and electrolytes only over a period of 4 days after trauma. Besides amino acids in plasma and urine, blood glucose, insulin and glucagon levels were determined every day as was energy expenditure, nitrogen excretion and parameters reflecting homeostasis. The total plasma amino acid concentration showed a slight increase, but remained nearly unchanged and within the reference range over the entire period of investigation. The plasma branched chain amino acids showed the most marked change. Their total concentration increased continuously from the first (median: 301 mumol X l-1), to the 4. day (median: 743 mumol X l-1) after trauma. Less affected, but also submitted to marked changes in plasma concentration in the early period after trauma were alanine, proline and phenylalanine. Although blood glucose concentrations were high, and clearly above reference range, insulin concentrations remained relatively low at all times (median: 24 microU X ml-1) while plasma glucagon concentrations were increased at all points of measurement (median: 327 pg X ml-1).(ABSTRACT TRUNCATED AT 250 WORDS)