Clinical and metabolic effects and wound healing metabolism in controlled total parenteral nutrition with high vs. low nitrogen content for seven days after abdominoperineal rectum resection for carcinoma.

The clinical, metabolic and anthropometric effects and wound healing metabolism of two regimens of total parenteral nutrition with different amount of nitrogen low, 0.1 g, and high, 0.3 g/body weight kg/day were examined in this prospective double-blind study in two groups of ten patients subjected to abdominoperineal rectum resection for carcinoma for seven postoperative days. The results showed that the high nitrogen infusion associated with metabolic stress indicated by high excretion of urea, high level of serum urea and by a higher frequency of complications. Five patients of the high and one of the low nitrogen group showed complications (p less than 0.05). Further, the metabolic load, complications and high nitrogen infusion associated with higher body temperature, degree of fatigue, levels of C-reactive proteins, leukocytosis and lower of hand pressure force than found in those with low nitrogen infusion. The patient with low or high nitrogen infusion had similar parameters in wound healing metabolism of incision and stoma. The patients with complications showed a reduced stomal hydroxyproline concentration on the third postoperative day (p less than 0.05) and an increase of stomal and wound hydroxyproline and DNA on the seventh postoperative day (p less than 0.05). It is concluded that nitrogen amount of 0.1 g body weight kg/day is a better and a good alternative as compared to 0.3 g in total parenteral nutrition after major abdominal surgery for carcinoma.