[Protein-sparing mechanisms of parenteral feeding. II. Clinical aspects]

Based on primarily clinical findings this review tries to give a survey on the influence of parenteral application of single substrates, different nutritional regimens or special amino acids mixtures on acute protein losses. It can be emphasized that adequate amino acids substitution as such represents the dominating protein sparing mechanism during acute diseased states. The additional influence of calorie supply, however, is relatively limited, demonstrated by the fact, that already low-dosed carbohydrate supply shows a comparably favourable protein-sparing effect. At increased energy expenditure after major trauma or operation the relatively early use of fat emulsions--after decline of acute hormonal trauma reaction--for partial replacement of calories clearly seems to be of metabolic advantage compared to an exclusive and high-dosed carbohydrate supply. Further positive influence on acute protein losses can be expected by the adaption of the rates of amino acids supplementation to the trauma dependent alterations in behaviour of free amino acids, however, comprehensive clinical experiences are still lacking.