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After a 5-day preoperative preparing period, 24 metabolically healthy patients, who had to undergo gastric resection, were fed postoperatively by hypocaloric total parenteral nutrition for a 5-day period. Group I, n = 13; received 0.11 g Xylitol/kg BW . h; Group II, n = 11, received 0.11 g Glucose/kg BW . h. Both groups received 1.71 g L-crystalline amino acids/kg BW . day. During the whole postoperative period, group II had significantly higher serum glucose and insulin levels. Due to the high postoperative insulin concentration in group II, free fatty acids, acetoacetate, beta-hydroxybutyrate and branched chained amino acids were significantly lower. The augmented release of muscle amino acids and the covering of a part of the energy expenditure by increased fatty acid oxidation in group I led to a higher postoperative synthesis rate of visceral proteins. From postoperative day 3 on transferrin and from postoperative day 6 on albumin and total protein were significantly higher in group I. This study could demonstrate that due to its special role in the intermediary metabolism during the postoperative period xylitol leads to a significantly higher regeneration rate of visceral proteins compared to glucose during total parenteral nutrition.

The metabolic status of 15 intensive care patients receiving a standardized total parenteral nutrition regimen was followed up to 15 days immediately after admission by measuring 3-methylhistidine, total nitrogen, and creatinine excretion. The average 3-methylhistidine excretion was within the normal range during the first 3 days, rising on day 4 and reached a maximum of 70% above normal values on day 5. It declined to within normal range thereafter in most of the patients. Mean values for creatinine excretion remained relatively constant within the normal range throughout the study. During all days 3-methylhistidine was negatively correlated with N-balance. It is concluded that these patients had increasing catabolism with a maximum on day 5 and that the catabolic condition was associated with an increased muscle protein breakdown.

An enzymatic endpoint determination of xylitol and sorbitol by the use of L-iditol dehydrogenase is described. Despite the use of pH 9 and the addition of semicarbazide, the reaction goes only 80% to completion. Therefore a standard value has to be used. The lower limit for measurement of concentrations in serum is around 0.1 mmol/l. The most favorable range is between 0.4 and 1.2 mmol/l with a coefficient of variation of below 4%. Sensitivity and precision is higher than with the kinetic method described earlier. Further simplification for the routine control of infusion therapy with polyols is suggested.

As demonstrated in the literature on vitamin A metabolism and homeostasis of retinol in serum, the concentration of retinol in serum is regulated very exactly if the liver stores are within the physiological range (20-300 micrograms/g liver). Therefore, the serum level indicates the status of vitamin A storage only if there is an extreme depletion or overconsumption of vitamin A. At marginal depletion, however, there is damage to peripheral tissue before changes in the vitamin A level in serum occur. At the beginning of hypervitaminosis A, changes in the level of vitamin A in serum also occur later. Therefore, the determination of vitamin A in serum gives no information on the adequacy of liver reserves for judging the necessity of a substitution.

Glutamine may be important especially in the catabolic patient, due to its universal role in transamination reactions. Because of its instability, until presently, glutamine is not included in amino acid solutions for parenteral nutrition. The availability of glutamine from the stable derivate N-acetyl-L-glutamine is investigated under the condition of a long-term parenteral nutrition by means of growth, N-balance, and amino acid concentrations in plasma, muscle and urine. For this purpose 2 groups of young healthy male rats (n = 6) are maintained entirely by parenteral nutrition for 12 days. Both groups are given 0.8 g N/kg/24 h as an amino acid solution without containing glutamine. Only one of the groups was supplied additionally with 0.4 g N as N-acetyl-L-glutamine. This resulted in a weight gain of 33 +/- 1.5 g and a cumulative N-balance of 1.5 +/- 0.045 g. In the group in which no acetyl-L-glutamine is given, weight gain is 27 +/- 1.8 g (p less than 0.05) and cumulative N-balance amounts only 1.16 +/- 0.034 g (p less than 0.001). In plasma and urine the amino acid concentrations are significantly elevated for the essential one in this group. The results indicate a good availability of glutamine from N-acetyl-L-glutamine when given intravenously to the rat.

Hormonal changes, occurring during electrocoagulation of the Gasserian ganglion under neuroleptanalgesia, and the effects of intravenous administration of pindolol 0.4 mg on these changes were investigated in two groups of 10 and 12 patients of advanced age. At the end of the operation there were marked increases of the concentrations of catecholamines, a rise of the plasma cortisol and a fall of the serum insulin. The administration of the beta-adrenergic blocking agent did not induce any statistically significant changes of the determined hormones compared to the control group.

There is no formula to calculate practicable application rates for carbohydrates and polyols. Maximum turnover rates, elimination constants, half-life, and total clearances are rough criteria only to marke out a possible range. Suitable and safe infusion rates have to be established empirically for each substance, considering carefully desired and undesired effects. Recommendations for safe infusion rates are the safer, the most parameters have been considered. Present knowledge is compiled in Table 2.

Presently 3-methylhistidine excretion is widely used for monitoring the metabolic status of patients during different kinds of clinical conditions. Aim of the study was to reconsider its predicative value on the basis of a larger collective of healthy persons and to find a standardization independent from sex. Therefore endogenous 3-methylhistidine release of 40 healthy adults (24 women and 16 men) was measured and related to body weight, body surface area, arm muscle circumference, and nitrogen and creatinine excretion. A positive correlation could be observed only for 3-methylhistidine and creatinine excretion and that to the same extent both for females and males. Assuming that the excreted 3-methylhistidine is mainly originating from muscle protein the calculated daily protein breakdown amounted for women 39.9 g and 68.1 g for men. No difference between females and males could be observed in the percentual turnover of myofibrillar protein which has been estimated with 0.90 and 0.98 respectively. We interpret our results saying that endogenous 3-methylhistidine excretion is a valuable indicator for muscle protein breakdown in humans with intact kidney function. For the assessment of muscle proteolysis by 3-methylhistidine excretion in heterogenous groups of patients it is recommended to use the 3-methylhistidine/creatinine ratio or the percental turnover of myofibrillar protein.