Nitrogen Conservation in Starvation: Graded Responses to Intravenous Glucose

Criminally Prosecuted Cases of Child Starvation

“…29 With refeeding, carbohydrate repletion and insulin release cause intracellular shifts of glucose, phosphorus, potassium, and other components, resulting in lower serum levels. 30 All the surviving patients in this study had hypophosphatemia with refeeding, most had hypokalemia, and half had hypomagnesia. Half had hyperglycemia, reflecting limited ability to diminish nitrogen loss and to metabolize glucose.…”

“…Half had hyperglycemia, reflecting limited ability to diminish nitrogen loss and to metabolize glucose. 30,31 In addition, 1 patient developed hepatomegaly in the month subsequent to his rescue; the suspected etiology was fatty liver resulting from conversion of excess glucose to fat. 32 Other complications of refeeding, including fluid overload problems, arrhythmias, and gastrointestinal dysmotility were documented in several of the patients in this study.…”

Effect of glucose, independent of changes in insulin and glucagon secretion, on alanine metabolism in the conscious dog.

“…Whether the usual changes in these two hormones that normally accompany hyperglycemia would potentiate or inhibit the observed changes in alanine and lactate flux is not known. The data reported by O'Connell et al (34) and Fitzpatrick et al (35) that showed that glucose administration at high rates (intravenously or orally) increases the plasma alanine con-centration would suggest that the effects of hyperglycemia are not offset by concurrent changes in insulin or glucagon. Although Waterhouse and Kleison (36) were unable to detect an effect of glucose infusion on alanine metabolism in malnourished female subjects the rate of infusion was small and resulted in a glucose level of only about 125 mg/dl.…”

Effect of intraoperative acetated Ringer’s solution with 1% glucose on glucose and protein metabolism

“…An increase in protein catabolism can be suspected in the glucose-free group (Group R) due to a lack of the nitrogensparing effect of glucose after surgery [20][21][22]. The administration of exogenous glucose is thought to suppress protein catabolism during surgery and preserve muscle protein.…”