Failure of hypertonic glucose supplementation to improve whole-body protein metabolism in fed trauma patients

Abstract

The beneficial effect of a high glucose intake for reducing the protein catabolism of trauma patients was investigated in 12 male (21-29 yrs old) patients with trauma, 6 with closed-head injury (HT) Glasgow score 4-6 and 6 with noncranial politrauma (PT), ISS 35-45. The study was undertaken 2-9 days after injury and extended for three consecutive periods (M1, M2 and M3) of 3-days each with the patients receiving enterally a complete liquid diet of 1.9 g protein and 47 kcal/kg/day. During the M2 period, the patients also received an i.v. hypertonic glucose supplement of 17.6 kcal/kg/day. Blood samples were collected thoughout the study for hormone (insulin, C-peptide, glucagon, cortisol and catecholamines) and glucose assays, and urine for whole-body protein metabolism analysis (N-balance and 15N-glycine kinetics). Following the M2 period, the patients, mainly PT, manifested an 11-20 mg/dl increase in plasma glucose without glucosuria, as well as increasing in insulin and Cpeptide levels. Also, the N-balance continued negative without any significant changes in 15N-kinetics. Thus, the present data does not support the assumption of a beneficial effect from glucose supplementation on whole-body protein metabolism in fed trauma patients.