Plasma amino and keto acids in chronic renal failure

During both early and late stages of chronic renal insufficiency the response of BCKA to the disease state, as indicated by plasma levels, differs from that of BCAA. Val is the only BCAA whose concentration changes under the conditions of our study, and this only during the more advanced stages of disease. In contrast, all three BCKA declined, KIVA and KICA even in mild renal failure, showing that already during the early stages of the disease these BCKA levels are decreased. BCKA are more sensitive parameters than the corresponding amino acids with regard to the metabolic dysfunctions characteristic of this disease. Modern analytical methods allow more exact and reliable knowledge of these indicators and thus a better understanding of biochemical mechanisms, possibly resulting in better therapy.

Metabolism of glutamine in lymphocytes

Pathways of glutamine metabolism in resting and proliferating rat thymocytes and established human T- and B-lymphoblastoid cell lines were evaluated by in vitro incubations of freshly prepared or cultured cells for one to two hours with [U14C]glutamine. Complete recovery of glutamine carbons utilized in products allowed quantification of the pathways of glutamine metabolism under the experimental conditions. Partial oxidation of glutamine via 2-oxoglutarate in a truncated citric acid cycle to CO2 and oxaloacetate, which then was converted to aspartate, accounted for 76% and 69%, respectively, of the glutamine metabolized beyond the stage of glutamate by resting and proliferating thymocytes. Similar results were obtained with the lymphoblastoid T- and B-cell lines. Complete oxidation to CO2 in the citric acid cycle via 2-oxoglutarate dehydrogenase and isocitrate dehydrogenase accounted for only 25% and 7%, respectively. In proliferating cells a substantial amount of glutamine carbons was also recovered in pyruvate, alanine, and especially lactate. The main route of glutamine and glutamate entrance into the citric acid cycle via 2-oxoglutarate in lymphocytes appears to be transamination by aspartate aminotransferase rather than oxidative deamination by glutamate dehydrogenase. In the presence of glucose as a second substrate, glutamine utilization and aspartate formation markedly decreased, but complete oxidation of glutamine carbons to CO2 increased to 37% and 23%, respectively, in resting and proliferating cells. The dipeptide, glycyl-L-glutamine, which is more stable than free glutamine, can substitute for glutamine in thymocyte cultures at higher concentrations.

Nitrogen absorption in pancreatectomized patients: protein versus protein hydrolysate as substrate

To investigate nitrogen absorption in the absence of the pancreas, six patients with total pancreatectomy, all in stable nutritional and metabolic condition, underwent two periods of enteral nutrition identical in all respects except for the nitrogen source. Nitrogen source was either lactalbumin or its hydrolysate. The quantity and quality of calories infused simulated the patient's usual diet, which was a high-protein diet (2.0 +/- 0.4 gm/kg body weight). Pancreatic enzyme replacement therapy was discontinued during each period of enteral nutrition. All patients had greater nitrogen absorption during the enteral nutrition with lactalbumin hydrolysate than that with lactalbumin (91% +/- 2% vs 61% +/- 6% of nitrogen intake, p less than 0.02). Despite this difference in absorption, nitrogen balances during the two periods of enteral nutrition were not significantly different. This appeared to be caused by a urea production rate that was greater during the enteral nutrition with lactalbumin hydrolysate than the rate during that with lactalbumin (26 +/- 1 gm/24 hr vs 16 +/- 3 gm/24 hr, p less than 0.05). Plasma concentrations of amino acids and proteins did not differ significantly during the two treatments. In conclusion, the data suggest that (1) the intestine plays a significant role in protein digestion and that (2) enteral feeding with a protein hydrolysate could eliminate the need for a high-protein diet in patients with pancreatic insufficiency.

Influence of two glutamine-containing dipeptides on growth of mammalian cells

The instability of the amino acid glutamine prompted us to investigate substitute compounds appropriate for culture conditions. The effect of two glutamine-containing dipeptides, alanylglutamine (Ala-Gln) and glycylglutamine (Gly-Gln), on the growth behavior of a hematopoietic cell line in culture (K562) was investigated. Growth rates and [3H]thymidine incorporation rates of cells cultivated in sterile-filtrated media, containing glutamine (Gln) or Ala-Gln or Gly-Gln, were not statistically different. Although heart-sterilization of media containing Gln caused approximately 95% decomposition of the Gln, both dipeptides remained unaltered. Consequently, cell growth was drastically decreased when autoclaved free Gln-containing media were used, but growth was unaffected in the presence of autoclaved dipeptides. Both Ala-Gln and Gly-Gln have an advantage over free Gln as growth factors for cell culture due to the stability of the dipeptides during both autoclaving and storage; the biological activity, however, is comparable.

Pathways of glutamine and glutamate metabolism in resting and proliferating rat thymocytes: comparison between free and peptide-bound glutamine

Pathways of glutamine metabolism in resting and proliferating rat thymocytes were evaluated by in vitro incubations of freshly prepared or 60-h cultured cells for 1-2 h with [U14C]glutamine. Complete recovery of glutamine carbons utilized in products allowed quantification of the pathways of glutamine metabolism under the experimental conditions. Partial oxidation of glutamine via 2-oxoglutarate in a truncated citric acid cycle to CO2 and oxaloacetate, which then was converted to aspartate, accounted for 76 and 69%, respectively, of the glutamine metabolized beyond the stage of glutamate by resting and proliferating thymocytes. Complete oxidation to CO2 in the citric acid cycle via 2-oxoglutarate dehydrogenase and isocitrate dehydrogenase accounted for 25 and 7%, respectively. In proliferating cells a substantial amount of glutamine carbons was also recovered in pyruvate, alanine, and especially lactate. The main route of glutamine and glutamate entrance into the citric acid cycle via 2-oxoglutarate in both cells is transamination by aspartate aminotransferase rather than oxidative deamination by glutamate dehydrogenase. In the presence of glucose as second substrate, glutamine utilization and aspartate formation markedly decreased, but complete oxidation of glutamine carbons to CO2 increased to 37 and 23%, respectively, in resting and proliferating cells. The dipeptide, glycyl-L-glutamine, which is more stable than free glutamine, can substitute for glutamine in thymocyte cultures at higher concentrations.

[Metabolism-oriented postoperative nutritional therapy--possibilities and limits in the use of glucose and xylitol]

Carbohydrates and polyols are essential constituents of intravenous nutrition. In order to better understand the problems associated with the supply of energy sources, the physiology of enteral nutrition will be covered and compared with intravenous nutrition. This review article will deal with the metabolic actions of glucose and xylitol and derive therapeutical consequences for their intravenous use during different illnesses.

[Imbalances of neutral plasma amino acids as a pathogenetic factor in anorexia]

Studies in anorectic tumor-bearing rats indicate that anorexia is correlated to imbalances of neutral amino acids in blood and CNS. Consequently plasma amino acids of patients with neoplastic and non-neoplastic internal diseases were studied during phases of anorexia; special regard was given to the precursors of dopamine and serotonin. Anorectic patients were compared to non-anorectic patients with neoplasia. During anorexia, plasma levels of valine and leucine and hence the ratio of the molar concentrations of Val + Leu + Ile/Phe + Tyr were significantly decreased in each anorectic patient as compared to non-anorectic patients whose ratios were always within the normal ranges. As aromatic and branched-chain amino acids compete for penetration of the blood brain barrier, the decrease of the amino acid ratio may induce a raised flux of phenylalanine and tyrosine into the CNS which results in an increased activation of dopaminergic neurons--known to cause anorexia.

The effect of L-carnitine-supplemented total parenteral nutrition on tissue amino acid concentrations in piglets

Miniature piglets underwent total parenteral nutrition (TPN) with and without L-carnitine supplementation during a 7-day period. Thereafter the tissue amino acid concentrations of liver, heart, skeletal muscle and brain were determined and compared to those of orally fed animals. The altered tissue amino acid concentrations during TPN without carnitine returned to normal when L-carnitine was supplemented. The most striking changes of tissue concentrations showed taurine in liver, muscle and brain and ethanolamine in heart and brain. In muscle the branched-chain amino acids were increased when L-carnitine was added to the TPN regime. Ethanolamine changes were discussed with respect to the position of this amino acid in the synthesis of phospholipids. The marked decrease of brain taurine concentrations after carnitine-free TPN was accompanied by reduced values for GABA. Both the substances function as inhibitory transmitters in the brain and should be considered when seizure activity in patients with systemic carnitine deficiency is discussed.

Improved N-retention during L-carnitine-supplemented total parenteral nutrition

The influence of intravenously administered L-carnitine on lipid- and nitrogen-metabolism was studied during total parenteral nutrition of piglets (mean weight 4077 g; n = 9). The infusion protocol was divided into three isocaloric and isonitrogenous 48-hr periods. Amino acids (3 g/kg day) were administered throughout all three periods: 140 cal/kg/day were given as nonprotein calories, consisting only of glucose during period 1; during periods 2 and 3, an amount of glucose calorically equivalent to 4 g fat/kg/day was substituted with a lipid emulsion, and L-carnitine (1.5 mg/kg/day) was added in period 3. Key parameters of fat- and nitrogen-metabolism were determined during the entire regime. Indirect calorimetry was performed and the respiratory quotient calculated during all three periods. The results demonstrate a more effective lipolysis and oxidation of fatty acids during L-carnitine supplementation. These changes produce an increased energy gain from exogenously administered fat and a distinct improvement in nitrogen balance.

Tissue carnitine concentrations after total parenteral nutrition with and without L-carnitine supplementation

The concentrations (mumoles/g dry weight) of total carnitine (TC), free carnitine (FC) and acylcarnitine (AC) were determined in skeletal muscle, heart, liver, kidney and brain cortex of male mini pigs (4000-5000 g) after seven days of total parenteral nutrition (TPN) with amino acids 5% (3.0g/kg/d), glucose (25g/kg/d) and lipids 20% (4g/kg/d). This regime was administered with L-carnitine supplementation (1.5 mg/kg/d; n = 7) (group 1) and without it (n = 5) (group 2). Orally alimented animals (n = 5) served as controls (group 3). (Average carnitine intake: 3 mg/d) Carnitine free TPN affected only the concentrations in muscle. TC was markedly reduced (3.6 +/- 0.8) when compared with oral controls (5.8 +/- 0.7) (p<0.01). This decrease was exclusively due to AC, whereas FC concentrations remained almost unchanged. In group 1 the concentrations of TC in skeletal muscle, heart and brain cortex were higher than in both the other groups. The increase was mainly due to AC and FC remained unchanged in heart and brain. The concentrations in liver and kidney were not affected by either carnitine free or carnitine supplemented TPN. AC, determined as described, consists almost entirely of acid soluble acetyl-carnitine, the major product of fatty acid oxidation. Since the AC concentrations were almost exclusively altered by the two TPN-regimes we conclude that the observed changes reflect regulatory changes of fatty acid oxidation. Thus the decrease of muscle TC in group 2 is considered a consequence of an insulin induced down regulation (plasma insulin: mean 20 muU/ml; maximum: 60 muU/ml) of fatty acid oxidation in consequence of high glucose intake (25 g/kg/d). The increased TC concentrations after carnitine supplemented TPN are discussed to reflect an enhancement of oxidative degradation of fatty acids as a pharmacological effect of L-carnitine.

[Animal experiment studies on the changes in lipid and protein metabolism in L-carnitine-supplemented total parenteral nutrition]

The influence of i.v. L-carnitine on parameters of lipid- and nitrogen metabolism was studied during total parenteral nutrition of mini pigs (x: 4077; n = 9). The infusion protocol was divided into isocaloric and isonitrogenous 48-hour-periods. Amino acids (3 g/kg/day) were administered throughout all three periods. 140 Cal/kg/day were given as non-protein calories, consisting only of glucose during period 1. During periods 2 and 3 an amount of glucose calorically equivalent to 4 g fat/kg/day was substituted with a lipid emulsion. In period 3, L-carnitine (1,5 mg/kg/day) was added. During the entire regime key parameters of fat and nitrogen metabolism were determined. During all three periods indirect calorimetry was performed and the respiratory quotient calculated. The results demonstrate a more effective lipolysis and oxydation of fatty acids during L-carnitine supplementation. This results in an increased energy gain from exogenously administered fat and a distinct improvement of nitrogen balance.

Tierexperimentelle Untersuchungen über Veränderungen des Lipid- und Proteinstoffwechsels bei L-Carnitin-supplementierter totaler parenteraler Ernährung

Bei totaler parenteraler Ernährung von Miniaturschweinen (X: 4077 g; n = 9) wurde der Einfluß einer intravenösen L-Carnitinzulage auf Parameter des Fett- und Proteinstoffwechsels untersucht. Das Infusionsprotokoll war in 3 isokalorische und isonitrogene 48-Stundenperioden unterteilt. Aminosäuren wurden in alien Abschnitten in einer Dosierung von 3 g/kg/Tag verabreicht. 140 Cal/kg/Tag wurden als Nichteiweißkalorien zugeführt. Diese bestanden in Phase 1 ausschließlich aus Glukose. In Phase 2 und 3 wurde Fett in einer Dosierung von 4 g/kg/Tag infundiert und die Glukosezufuhr um einen isokalorischen Anteil vermindert. In Phase 3 wurde L-Carnitin zugelegt (1,5 mg/kg/Tag). In alien Infusionsabschnitten wurden Schlüssel-parameter des Lipid- und Proteinstoffwechsels bestimmt, sowie der respiratorische Quotient durch indirekte Kalorimetrie ermittelt. Die Ergebnisse demonstrieren eine Verbesserung der Lipolyse und der Fettsäureoxydation nach L-Carnitinsubstitution, eine Anhebung der Energiebereitstellung aus exogen zugeführtem Fett und eine sich daraus ergebende deutliche Verbesserung der Stickstoffretention.

[Indication and practical aspects of perioperative parenteral nutrition]

By means of the present clinical findings it is demonstrated that an improvement of the preoperative nutritional status goes along with a reduction of the postoperative rates of mortality and complications. The effects of postoperative catabolism compared with chronic protein losses are shown. It is demonstrated that acute catabolism is essentially at the cost of viscerally synthesized and functionally important protein systems whereas chronic states of catabolism mainly affect the structural protein of the overall organism. This differentiation appears to be of importance in selecting the perioperative nutritional treatment. It must be distinguished between a specific protein replacement therapy in cases of acute protein losses and a calorically adequate parenteral nutrition in chronic deficiency states and calorie deficits. On the basis of our own findings these conceptions are illustrated, and practical hints for performing the infusion therapy are given.

Indikation und Praxis der perioperativen parenteralen Ernährung

Anhand vorliegender klinischer Ergebnisse wird aufgezeigt, daβ eine Verbesserung des präoperativen Ernährungsstatus mit einer Senkung von postoperativer Letalität und Komplikationen einhergeht. Die Folgen der postoperativen Katabolie werden im Vergleich zu chroni-schen Eiweiβverlusten aufgezeigt und dargelegt, daβ die akute Katabolie im wesentlichen zu Lasten viszeral synthetisierter und funktionell wichtiger Proteinsysteme geht. Hingegen betreffen chronisch katabole Zustände bevorzugt das Strukturprotein des Gesamtorganismus. Diese Unterscheidung erscheint bei der Wahl der perioperativen Ernährungstherapie wichtig, und es muβ zwischen einer spezifisch eiweissubstituierenden Therapie bei akuten Proteinverlusten und einer kalorisch adäquaten parenteralen Ernährung bei chronischen Mangelzuständen und Kaloriendefiziten differenziert werden. Anhand eigener Untersuchungsergebnisse werden diese Auffassungen belegt und praktische Hinweise für die Durchführung der Infusionstherapie aufgezeigt.

[Effect of human growth hormone on nitrogen retention]

A 13-year-old female, suffering from chronic juvenile arthritis, whose disease and medication had caused a severe catabolic state, was alimented orally and parenterally for a 32-day period. The influence of an intravenous supplement of arginine to stimulate endogenous human growth hormone (HGH) secretion, e.g. 4 U HGH/day, on nitrogen retention was studied. The administered amount of arginine (16 g/day) was not sufficient to cause an increase of either the serum HGH concentration or the nitrogen retention whereas nitrogen retention increased dramatically after the daily administration of 4 U HGH.

Beeinflussung der Stickstoffretention durch menschliches Wachstumshormon

Eine 13jährige Patientin mit chronisch juveniler Arthritis, die sich, durch Krankheit und Medikation bedingt, in einem katabolen Zustand befand, wurde über 32 Tage oral-parenteral ernährt. Der Einfluβ einer intravenösen Zulage von Arginin zur Stimulation endogenen Wachstumshormons (HGH) bzw. von 4 E HGH/Tag auf die Stickstoffretention wurde überprüft. Die zugeführte Argininmenge (16 g/Tag) war nicht ausreichend, um eine Erhöhung der HGH-Konzentration bzw. eine verbesserte Stickstoffretention zu bewirken. Unter täglicher Zufuhr von 4 E HGH trat eine deutliche Verbesserung der Stickstoffretention ein.

Effects of essential fatty acid deficiency on various functions of the rat erythrocyte membrane

Various membrane transport functions have been studied in erythrocytes from essential fatty acid (EFA) deficient rats in order to determine whether or not functional abnormalities induced by documented EFA-deficiency of the membrane could be demonstrated. No differences were found between EFA deficient and control cells with respect to mean values for osmotic resistance or intracellular sodium and potassium concentrations. However, uptake of leucine by EFA deficient erythrocytes was significantly greater than that of control erythrocytes. Kinetic studies suggest that EFA deficiency enhances the passive diffusion component of this transport.

Deficiencies of essential fatty acids and vitamin E in cystic fibrosis

In 25 children (13 male; 12 female) with cystic fibrosis aged 6 months to 16 years and 24 matched controls total serum vitamin E levels and fatty acid patterns of serum cholesterol esters, phospholipids and triglycerides are demonstrated. Compared to controls (1.02 +/- 0.24 mg/dl) the total serum vitamin E levels are significantly decreased in patients with cystic fibrosis (0.30 +/- 0.26 mg/dl) (p less than 0.01). There is no significant difference comparing the fatty acid patterns of the serum ester fractions of both groups. Differences can be seen best in the cholesterol ester fraction. In this fraction linoleic acid shows a trend to be decreased in the cystic fibrosis patients compared to the control group. A possible influence of height velocity on the levels of essential fatty acids is discussed.

[Diagnosis of malnutrition]

A diagnostic program for routine determination of the nutritional status during initial examination is presented. This program includes anthropometric methods (body weight, height, triceps skin fold, circumference of mid-arm muscle) and chemical parameters (creatinine index, albumin, prealbumin, cholesterinase). In addition, determination of the immune status through the absolute lymphocyte count in peripheral blood and intracutaneous testing with streptokinase-dornase, mumps skin test antigen and candida vaccine is recommended. This test plan allows assessment of fat stores, muscle mass, functional proteins and immune competence. The results of this study should be considered when planning adequate nutritional treatment. The results obtained for 168 patients in this test program are reported.

[Nutritional states in a medical clinic]

The nutritional state of 168 patients in a medical clinic was determined with the following parameters: Weight/height index, triceps skin fold, arm muscle circumference, creatinine/height index, albumin, prealbumin, transferrin and cholinesterase. Using these parameters we found that 51.2% of these patients were suffering from malnutrition (26.2% marasmus, 7.7% kwashiorkor-like syndrome, 17.3% marasmic kwashiorkor). Triceps skin fold, arm muscle circumference and creatinine/height index were the most precise parameters to confirm marasmus. Prealbumin and cholinesterase are especially recommended to determine acute protein deficiency, albumin to confirm chronic protein deficiency. It was also possible to demonstrate the deleterious effect of malnutrition on the immunological system of the patient through determination of the absolute lymphocyte count in peripheral blood and intracutaneous testing with streptokinase-dornase, mumps skin test antigen and candida vaccine.

Argininosuccinic aciduria: metabolic studies and effects of treatment with keto-analogues of essential amino acids

A 22 years old female with the late-onset of argininosuccinic aciduria was successfully treated for 5 months with a mixture of essential amino acids and their keto-analogues. There was a marked change in plasma ammonia, plasma amino acids and argininosuccinic acid excretion. A long term anabolic response was reflected by an increase of total serum proteins and serum albumin by about 1 g/dl during the first 5 months of treatment. There was a striking improvement in the patient's seizure disorder following institution of the keto-analogue therapy.

Protein load in argininosuccinic aciduria: thoughts on its biochemical implications

A patient with argininosuccinc aciduria was charged with 50 grams of protein, which was followed by considerable hyperammonemia. There was no response in further urea formation; but there was a considerable production of orotic acid, a precursor of pyrimidines. This makes orotic acid to an important diagnostic tool for the diagnosis of impaired urea formation. The patient's plasma amino acid pattern led to the suggestion that orotic acid synthesis is initiated by increased de novo formation of carbamyl phosphate in the cytosol and not by deviation of already existing intramitochondrial carbamyl phosphate.

[Dosage of calcium and phosphate in parenteral feeding]

In a carbohydrate combination solution containing 12.5 mEq/1 calcium and 12 mmol/1 phosphate the concentrations of calcium and phosphate were kept constant during parenteral infusion therapy with carbohydrate, at a rate of 0.5 g/kg/h and amino acids at a rate of 0.1 g/kg/h. Balance for calcium and phosphate was positive. Calcium excretion was slightly above the levels determined in oral nutrition. A slight modification of calcium supplement by changing the concentration of the solution to 10 mEq/1 is suggested.

Untersuchungen zur Dosierung von Kalzium und Phosphat bei parenteraler Ernährung

Unter Verwendung einer Kohlenhydratkombinationslösung, welche 12,5 mval/Liter Kalzium und 12 mmol/Liter Phosphat enthielt, gelang es, die Konzentrationen für Kalzium und Phosphat während der parenteralen Infusionstherapie mit Kohlenhydraten mit einer Zufuhrrate von 0,5 g/kg/h und Aminosäuren mit einer Zufuhrrate von 0,1 g/kg/h konstant zu halten. Die Bilanzen für Kalzium und Phosphat waren positiv. Die Kalziumausscheidung lag geringfügig über der Norm, wie sie bei oraler Ernährung ermittelt wurde. Eine geringfügige Verminderung der Kalziumzufuhr durch eine Konzentrationsänderung der Lösung auf 10 mval/Liter wird vorgeschlagen.

[Clinical and metabolic studies in the acute stage of Crohn's disease with total parenteral feeding and elementary diet]

The acute phase of Crohn's disease in a 14 year old female was effectively treated with total parenteral nutrition (TPN) and an elemental diet (ED). Acute abdominal symptoms subsided at once. With TPN there was a daily nitrogen retention of 3,2-5.6 grams. With ED nitrogen retention decreased presumably because of the reduced nitrogen content of the oral diet. During the 7 weeks of treatment body weight increased 7 kgrams. Observed skin lesions were caused by zinc deficiency.

[Metabolically adapted nutrition following the concept of clinical nutrition therapy--success and prospects]

Modern dietetics abandon the traditional, mainly hypothetically based special types of nutrition. A better knowledge of the physiological and pathological metabolic reactions and the technical possibilities to produce defined, tailor-made dietetics products require a new way of thinking. It is attempted to establish a simple scheme according to the composition and use of balanced and defined diets and to outline future tendencies. In summary, it is concluded that the consequent use of modern nutritional physiology and the application of the actual technologies allow to supply patients with a metabolicly adapted nutrition even under difficult conditions.

Free amino acids in plasma in the post-traumatic period

The pattern of the amino acids in plasma of 22 polytraumatized patients who obtained a standardized total parenteral nutrition over a period of 3-10 days was studied. Following to the trauma - before the infusion period - a rapid decrease of concentration of a part of the amino acids appeared. During the period of parenteral nutrition nearly all of the amino acids showed a different increase in plasma, partly manifold over their normal range which resulted in a disturbance of the pattern of the amino acids. Particularly the influence of the infusion therapy on the sulfur-containing amino acids, the branched-chain amino acids and the glycine level in plasma is discussed.

[Metabolic effect of a carbohydrate combination during simultaneous amino acid infusion]

During a period of 12 hours, eight normal subjects were infused with an electrolyte containing combined 24% carbohydrate solution of fructose, glucose, and xylitol at a ratio of 2:1:1 (Triofusin E 1000 Pfrimmer) with a rate of supply of 0.6 gm/kg/h. Lamino acids (Aminofusin L 10% carbohydrate-free Pfrimmer) were simultaneously administered at a rate of 0.1 gm/kg/h. The serum substrate concentrations of fructose, glucose and xylitol and their excretion were measured. The utilization of fructose was 99%, of glucose practically 100% and of xylitol 88%. In accordance with the slight glucose increase, the concentration of insulin also showed an only slight increase. An increased serum concentration of oxalate was not observed. Despite the infusion of a glycine containing amino acid mixture, the excretion of oxalic acid even decreased during the infusion. The dilution effect measured by means of hematocrit, hemoglobin, erythrocyte count, total protein, and albumin was between 2 and 5%. The lactate concentration did not change significantly whereas hydroxy butyrate decreased significantly by the end of the infusion indicating the antiketogenic effect. A disturbance of fat metabolism was not observed as was indicated by the concentrations of neutral fat and cholesterol. The decrease of free glycerol cannot be clearly explained. A highly significant reduction of the serum uric acid concentration resulted from an increased renal elimination. The electrolyte concentrations of potassium, sodium, calcium and phosphate showed only slight modifications. The concentration of potassium initially rose significantly within normal ranges. Sodium and chloride remained constant whereas calcium decreased slightly but not significantly and phosphate decreased significantly until the 12th hour. The serum transaminase and bilirubin concentrations did not show any change. During the permanent infusion, a respiratory alkalosis developed. The average urinary excretion was 134 ml per hour, the excretion of potassium was 6 mEq/h, of sodium 15 mEq/h, and of phosphate 27 mg/h. The utilazation of a combined carbohydrate solution was in the same range with or without the simultaneous application of amino acids. The reduction of the uric acid concentration and the absent increase of lactate, bilirubin and oxalate may be considered as an additional desirable effect of the simultaneous application of amino acids.