Elevated levels of urinary
polyamines (PA) in severely injured
trauma patients are further enhanced by
total parenteral nutrition (TPN) that contains both
glucose and
amino acids (AAs). Since TPN solutions contain
arginine, the AA precursor of PA, it is not certain whether the increased urinary PA are due to this substrate. Nutritional factors can evidently modify PA metabolism. We measured the daily excretion of the PA,
putrescine (PU) and
spermidine (SD) in 18 multiply injured (injury severity score [ISS], 32 +/- 2), hypermetabolic (resting energy expenditure [REE]/basal energy expenditure [BEE], 1.41 +/- 0.06), and highly catabolic (daily N loss, 17.2 +/- 1.8 g N/d) acute
trauma patients for 5 days in the early flow phase of injury. The patients were fed only maintenance fluids without calories or
nitrogen for the first day 60 to 72 hours after injury, and then were randomized to receive
glucose alone ([GLUC] 4.1 mg/kg/min, 80% measured REE, n = 8) or the same amount of
glucose with AAs (TPN, 275 mg N/kg/d, n = 10) for the following 4 days. There was no significant difference in the enhanced daily PA excretion either in the free or acetylated form between the two dietary regimens. The addition of AAs in the TPN mixture did not seem to further stimulate PA metabolism in the
trauma patients. The source of the nutrient content of the diet appears to be important for enhancing total PA excretion in
critically ill patients.