Amino acids and
dextrose infusion were given for short periods of time to a young man whose basal state is characterized in the previous paper in this series, and their effects were documented in terms of plasma concentrations and splanchnic extraction. The basal state measurements show in the acute
trauma state and its subsequent
starvation state a largely balanced splanchnic extraction of
amino acids but at a decreasing rate.
Amino acid (
FreAmine) infusion at low rates on this background produced a large increase in extraction of a largely balanced mixture of
amino acids but a minimal change in
glucose release. The septic state is characterized in both the basal and
amino acid infusion state by splanchnic extraction of an unbalanced mixture of
amino acids which is deficient in
branched-chain amino acids and in relative excess of glucogenic
amino acids with increased
glucose release and increased utilization of
amino acids for gluconeogenesis. In early
sepsis this state can largely be repaired by exogenous
amino acid infusion but in late
sepsis can only be partially repaired. The data suggest that the patient in late
sepsis should have a branched-chain rich
amino acid mixture and that the
hepatic failure of
sepsis is strongly associated with peripheral release of an unbalanced mixture of
amino acids secondary to enhanced branched-chain catabolism. Infused
glucose produces a large increase in the plasma
glucose but also improves the balance of the splanchnic
amino acids extracted. The statistical validity of the preceding statements are examined in detail in the manuscript.