[Efficacy of early amino acid substitution in gastrectomized patients]

Postaggression metabolism is characterized by decisive, hormone dependent metabolic changes. All reactions are directed with top priority toward ensuring the energy supply. To this end glycogenolysis, gluconeogenesis and lipolysis are increased. Since this reaction of the organism can barely be influenced and it appears to be teleologically purposeful, many authors have repeatedly attempted to achieve a utilization of nutrients as high and economic as possible using an infusion regimen adapted to these conditions. We studied the efficiency of one such adapted nutritional regimen during the first four postoperative days in 10 patients who had undergone gastrectomy. The patients were given 1 g/kg B.W. daily of an amino acid solution adapted to postaggression metabolism, plus 4 g/kg B.W. carbohydrates. We found that clinically relevant parameters such as glucose in serum, triglycerides in serum and pre-albumin could be kept in the reference range. Amino acid homeostasis remained stable under the infusion of the stress adapted amino acid solution. A rise in urea production was not observed. We conclude that good conditions for an economic utilization of the amino acids were created by the infusion regimen selected by us. These results probably can still be optimized by targetted preoperative nutrition with the goal of improving the protein status of such patients already during the preoperative phase.