Design and evaluation by nitrogen balance and blood aminograms of an amino acid mixture for total parenteral nutrition of adults with gastrointestinal disease.
This study was undertaken to assess the efficacy of an amino acid mixture formulated for intravenous use from estimates of requirements for essential amino acids of human adults, and from data previously derived from a study using casein hydrolysate as the amino acid source. This mixture contained 39.4% essential amino acids, with glycine, alanine, arginine, histidine, and proline selected to supply the nonessential nitrogen. Nitrogen balance and blood aminograms were measured in six adult patients with gastrointestinal disease, fed intravenously for 1 wk at each of three levels of amino acid intake, while all other nutrients were constant and adequate in relation to body weight. Four of the patients were then fed 1.0 g/kg of egg or meat protein orally for 1 wk at the end of the 3 wk study, while all nutrients other than the amino acids were fed intravenously. Average nitrogen balances of -0.8, 0.5, and 2.2 g/day were observed when the amounts of amino acids infused were 0.25, 0.5, and 1.0 g/kg, respectively. Fasting levels of threonine, glycine, cystine, methionine, isoleucine, tryptophan, and arginine, but not of the other amino acids, increased with the increment in input, although the levels were generally lower than normal. The increase in blood concentration observed during infusion was similar for each of the essential amino acids, indicating that the supply of each of the amino acids was much better balanced for utilization than casein hydrolysate. However the blood aminograms did suggest that some changes in composition of the mixture for the malnourished adult were desirable, such that the amino acid mixture resembled that needed by the normal growing child. Nitrogen balance in the four patients fed orally with high-quality protein averaged 2.0 g/day, showing that an amino acid mixture given intravenously, provided it is well-balanced, can be utilized as efficiently as protein given orally. It is concluded that the prediction of oral requirements for amino acids should be combined with observations on changes in blood aminograms during infusion over a range of amino acid input in the development of amino acid mixtures for intravenous feeding.