Brief communication: clinical experience with high branched-chain parenteral nutrition

Patients who appear to respond best to high branched-chain amino acid (BCAA) solutions have been previously described by objective measurements such as total urinary nitrogen (TUN) excretion, oxygen consumption index (O2Cl), plasma lactate, plasma pyruvate, plasma glucose (PG) and urinary 3-methylhistidine. Use of these measurements in assessing possible candidates for high BCAA solutions may not be convenient for some institutions. The purpose of this study is to describe our clinical practice experience with patients receiving high BCAA parenteral nutrition (PN) and how we apply the criteria previously developed. Forty critically ill adult patients (19 males, 21 females; 50 +/- 19 years) who received BCAA-enriched PN were prospectively monitored for demographic information as well as objective biochemical measurements and current clinical status within a time window of 72 hours before or after beginning the high BCAA solution. Patients demonstrated marked elevations in O2Cl (168 +/- 44 ml/min/m2), TUN (18 +/- 6 g/day), and PG (157 +/- 63 mg/dl), and decreased serum albumin (2.4 +/- 0.6 g/dl) and transferrin (123 +/- 50 mg/dl). Patients were categorized according to primary diagnosis: malignant tumor (n = 10), organ transplant (n = 12), trauma (n = 1), chronic or acute disease (n = 1, n = 3), and chronic or acute disease requiring surgery (n = 7, n = 6). Clinical statuses within the 72-hour time window were as follows: infection (n = 26), renal dysfunction (n = 15), pulmonary dysfunction (n = 22), liver dysfunction (n = 14), and multiple organ failures (n = 14).(ABSTRACT TRUNCATED AT 250 WORDS)