0.36KETONE BODY PRODUCTION IN RELATION TO SPLANCHNIC FFA UPTAKE IN INFECTED PATIENTS.

---+-7- H. St ernstram J. SjUlin, L. Hagenfeldt, J. Wahren (Department of Anaesthesiology and Infect ous D seases, University Hospital Uppsala, Department of Clinical Chemistry, Karolinska Hospital and Department of.Physiology, Huddinge University Hospital, Stockholm, Sweden)

Data from experimental studies on animals show that infection is associated wit a low blood concentration of 3-hydroxybutyrate and acetoacetate due to a decreased capacity of the liver to synthesize ketone bodies. The resent study was undertaken to examine the relative importance of free fatty acid (FFA! delivery versus altered hepatic metabolism in influencing ketogenesis in patients with infections. Seven high-febrile patients with pneumonia (4), pyelonephritis (2) and serous meningitis (1) and six healthy control subjects were investigated. After an overnight fast cathe- ters were inserted into a radial artery, an antecubital vein, and a hepatic vein and a continuous infusion of albumin-bound 14C-oleic acid was given. In the infected patients arterial plasma FFA concentration was .50*.06 mnol/l (mean&SE). The plasma FFA concentration in the control subjects was .34*.06 aanol/l. Calculated splanchnic uptake of FFA was 208&31 umol/min which was significantly higher than in the controls where the FFA uptake was 105*18 pmol/min (p<.O2). Splanchnic release of 3- hydroxybutyrate and acetoacetate in the infected patients was 214*64 and 186*36 umol/min respectively which was higher than in the controls (39*10 and 48&12 umol/min, p<.O5). Ketone body output/FFA uptake was .48*.09 which was clearly higher than in the control subjects where this ratio was .20+.06 (p<.O2). Thus both splanchnic uptake of FFA and tne proportion of FFA converted to ketones were increased in these infected patients. It is concluded that in contrast to experimental studies there is no suppression of the hepatic ability to synthesize ketone bodies in human infection.

0.37 TOTCIL BODY POTASSIUM TO NITROBEN RATIOS DO NOT CORRELfiTE WITH HUSCLE POTASSIUtl TO NITROOEN RATIO6 IN SERIOUSLY ILL SURGICAL PATIENTS. FIT Boyd, RF6J King, L Burkinshaw, HJ McMahon. University Departments of Surgery and Hedical Physics, The General Infirmary, Leeds, UK.

Weight loss in surgical patients is associated uith a fall in the ratio of total body potassium to nitrogen iTBK/TBNl from a normal level of approximately 2 (mol K/kg Nl. This is usually explained by a disproportionate loss of potassium rich.tissue, largely muscle. However it has also been suggested that potassium is lost from remaining body tissues, leading to a fall in the ratio of potassium to nitrogen in muscle (KmlNm).

The aim of this study was to correlate TBK/TBN with Km/Nm in seriously ill surgical patients. Thirteen patients were studied. TBK was measured by nhole body counting of naturally occuring 40K and TEN by in vivo neutron activation analysis. Simultaneous muscle biopsies were taken and after drying and fat extraction K was estimated by flame photometry. N was measured by sulphuric acid oxidation to ammonium ions which were assayed by a calorimetric technique.

The mean value of TBK/TBN was 1.46. TBK/TBN was plotted against Km/Nm and there was no correlation (r = -0.0471. This evidence supports the hypothesis that the fall in TBKlTBN seen in these patients was due to chanqes in the relative sizes of body compartments alone.

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