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Is it possible to evaluate the efficacy of amino acid solutions after major surgical procedures or accidental injuries? Evaluation in a randomized and prospective study.

Two unbalanced amino acid solutions (essential amino acids, branched-chain amino acids) were compared to a complete and balanced amino acid solution with regard to efficacy of nitrogen balance. Patients were randomized to receive the amino acid solutions over 3 days for each regimen. The patients were examined postoperatively or directly after accidental trauma. Nonprotein calories were given as 40 kcal/kg/day consisting of 50% fat and 50% glucose. Nitrogen was given at the amount of 0.15 g N/kg/day. Unbalanced amino acid solutions gave a 2-fold more negative nitrogen balance than a balanced and complete amino acid solution. However, this difference disappeared and nitrogen balance approached equilibrium irrespective of the amino acid composition of the infused solutions when nitrogen in blood products was accounted for. All patients received a considerable amount of blood products in a comparable but unpredictable way. Blood products corresponded to around 40% of the daily nitrogen intake. Our study demonstrates that it is not possible to test the efficacy of amino acids for nitrogen retention in patients who are in the need of blood-product transfusions. It is likely that amino acids in blood proteins serve as a significant amino acid source that is utilized for resynthesis of body proteins especially in flow-phase patients with high protein breakdown. This fact has not been sufficiently accounted for in the previous literature.