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Does hyperketonemia affect protein or glucose kinetics in postabsorptive or traumatized man?
P J Crowe1, G T Royle, D Wagner
1Nuffield Department of Surgery, John Radcliffe Hospital, Oxford, United Kingdom.
The Journal of Surgical Research
|October 1, 1989
Summary
Exogenous ketone bodies, like sodium DL-hydroxybutyrate (Na DL-HB), increase leucine turnover and decrease glucose turnover, potentially boosting protein synthesis even after major surgery. This metabolic effect remained consistent despite the body's adaptation to trauma.
Area of Science:
- Metabolic research
- Nutritional science
- Surgical recovery
Background:
- Major surgery like total hip replacement triggers significant metabolic stress.
- Understanding nutrient metabolism, particularly protein and glucose, is crucial for optimizing patient recovery.
- Exogenous ketone bodies are being investigated for their potential metabolic benefits.
Purpose of the Study:
- To investigate the metabolic effects of exogenous ketone bodies (Na DL-HB) on leucine and glucose turnover in patients before and after hip replacement surgery.
- To determine if surgery impacts the body's response to ketone body infusion.
- To explore the potential role of ketone bodies in protein synthesis and nitrogen balance post-surgery.
Main Methods:
- Simultaneous infusions of stable isotopes [13C]leucine and [2H]glucose were used to measure turnover rates.
- Measurements were taken in overnight-fasted patients before surgery and 3 days after total hip replacement.
- Infusions of sodium DL-hydroxybutyrate (Na DL-HB) were administered before and during the isotope measurements.
Main Results:
- Before surgery, Na DL-HB infusion increased plasma leucine concentration and turnover while decreasing glucose concentration and turnover.
- Total hip replacement surgery increased leucine turnover.
- After surgery, Na DL-HB infusion further increased leucine turnover, but glucose turnover decreased as observed pre-surgery.
- The observed metabolic responses to ketone body infusion were not significantly altered by the surgical trauma or the body's adaptation to it.
Conclusions:
- Exogenous ketone bodies appear to suppress hepatic glucose production.
- Ketone bodies may stimulate protein synthesis over protein breakdown, leading to reduced nitrogen excretion post-surgery.
- The metabolic benefits of exogenous ketone bodies regarding protein and glucose metabolism persist despite the stress of major surgery.