Protein‐Sparing Therapy During Pneumococcal infection in Rhesus Monkeys

Abstract

A model was developed in the rhesus monkey to determine if the marked wasting of body proteins associated with sepsis could be prevented by an intravenous supply of various nutritional substrates. All monkeys were given a basic infusion of 0.5 gm of amino acid nitrogen/kg body weight via an indwelling catheter in the jugular vein. Three groups were given diets with no added calories, 85 calories/kg from dextrose or 85 calories from lipid. In each group, six monkeys were inoculated with 3 x 10(8) Streptococcus pneumoniae and four with heatkilled organisms. In the monkeys infused with the amino acids alone, pneumococcal sepsis resulted in a fourfold increase in loss of body proteins compared with calorie-restricted controls. Addition of 85 calories/kg/day of either dextrose or lipid reduced body wasting associated with infectious disease. The calories from lipid were utilized bythe septic host as a source of energy, with a slightly reduced efficiency when compared with the isocaloric infusion of dextrose. The nitrogen sparing of the fat emulsion could not be accounted for by its glycerol content. Therefore, the septic monkey seemed to utilize fatty acids as an energy substrate. It appears that the carbohydrate calories tend to favor the synthesis of peripheral proteins (associated mainly with skeletal muscle), while lipid calories favor synthesis of visceral proteins such as plasma albumin and acute-phase proteins.

Role of the Liver in Regulation of Ketone Body Production during Sepsis

“…This ketonemic adaptation to starvation reduces the need for energy derived from glucose calories, which in turn spares body protein by decreasing the rate of amino acid usage for glucose synthesis. However, there is a general failure of ketonemic adaptation to occur dunrng caloric deprivation associated with severe sepsis in man, monkey, or rodent (2)(3)(4)(5)(6). Because of the lack of alternative fuels during severe sepsis, skeletal muscle breaks down protein and increases the usage of amino acids, especially the branched-chain ones, as a source of energy (7).…”

Die geschichtliche Entwicklung der Intensivmedizin in Deutschland

“…In dieser Hinsicht hat sich besonders J. Eckart große Verdienste erworben. Jahrelange, unermüdliche Forschungsarbeiten in diesem Bereich, verbunden mit geduldiger Aufklärungsarbeit und Auswertung ausländischer wissenschaftlicher Untersuchungen wie von Carpentier, Nordenström und Wannemacher führten dazu, daß schon bald Fett als Bestandteil einer vollständigen parenteralen Ernährung nicht mehr wegzudenken war [11,22,34,35,37,38,89,90,107]. In der Folgezeit konnten noch weitere Fettemulsionen, die anstelle des Sojabohnenöls Safloröl enthielten, klinische Anwendung erfahren.…”