Effect of 3-hydroxybutyrate on posttraumatic metabolism in man

Of 20 patients suffering trauma, with Injury Severity Scores greater than 20, 11 patients received DL-3-hydroxybutyrate (3-OHB) at a rate of 25 mumol/kg/min for 3 hours. The remaining nine patients received sodium DL-lactate at the same rate as the control subjects. With increased arterial concentrations of ketone bodies, the femoral arteriovenous difference (arterial concentration minus venous concentration) of ketone bodies increased proportionally in the 3-OHB group (R = 0.853, p less than 0.001). Venous concentrations of nonesterified free fatty acids, alanine, glycine, and valine were decreased significantly in the 3-OHB group as compared to the control group. The concentration difference between femoral vein and artery (venous concentration minus arterial concentration) for these substrates also decreased, indicating decreased release from the extremity. A decrease in venous concentration of alanine and difference between femoral vein and artery reached 102.3 +/- 69.3 mumol/L and 32.6 +/- 22.8 mumol/L (mean +/- SD), respectively, after 3-OHB infusion. Decreased alanine release from muscle during 3-OHB infusion in traumatized patients suggests a suppressive effect of ketone body on posttraumatic protein catabolism.