0.3 CHROMIUM INTAKE IN TOTAL PARENTERAL NUTRITION 0. Van Schoor", M. Ieven O", H. Deelstra O, E. Grysonoo, I. De Leeuwoo (" Department of Pharmaceutical Sciences, University of Antwerp, Belgium O" University Hospital Antwerp, Belgium)

Chromium is required for the periferal action of insulin. It is known that patients receiving long-term T.P.N. can develop a severe glucose intolerance. Addition of inorganic chromium to parenteral nutrition is recommended in these cases.

The estimated oral requirement is about !jOyg/day. Up to now no definitive requirement for TPN can be made.

In this study the daily chromium intake in TPN was determined using graphite furnace atomic absorption spectrometry. Samples of commercially available fluids and additives and samples of TPN formulations with these components were measured.

The chromium concentrations of commercially available infusion solutions varied widely. The highest concentration was found in albumin solutions: 12O>g/l. In amino acid solu- tions

& oncentrations were: 24fig/l in Protein Steril Hepa@, 36pg/l in Protein Steril

Neprho and 6.39g/l in Travasol 10%. In the lipid emulsions Intralipid 10% and Intra- lipid 20% 6.Opg/l and 4.2pg/l respectively were found. In carbohydrate solutions only O.srg/l was detected. However due to their respective volumes in TPN mixtures the largest concentration in total chromium content in TPN can be attributed to the amino acid solutions and to the lipid emulsions.

Daily intakes were calculated using these concentrations for a number of formulations. There was a good correlation between calculated values and values measured in TPN. The average intake was 8.6yg/day (range 7.8 - lj.T)cg/day).

These results suggest that especially during long-term parenteral nutrition chromium deficiency might arise. Therefore, in these cases of long-term TPN we suggest to include chromium in any regimen of TPN.

0.4 REDUCTION OF POSTOPERATIVE INSULIN RESISTANCE BY BRADYKININ INFUSION:

Jauch, K.-W., B.GDnther, W.Hartl, F.Utz, K.Kett, M.Wicklmayr, G.Dietze

(Chirurgische Klinik, LMU Munchen, Klinikum GroRhadern und Forschergruppe Diabetes, Med.Klinik, Krankenhaus MUnchen-Schwabing, FRG )

The kallikrein-kinin-prostaglandin system have been shown to play a major role in muscular glucose uptake during work and after hypoxia. Bradykinin (BK) exerts an insulin-like-activity on muscular glucose uptake and protein metabolism. Our investigations should show whether a systemic BK infusion can reduce postoperative insulin resistance of whole body tissues and skeletal muscle.

In five male patients, 24 to 57 years old, we combined the euglycemic glucose clamp technique and the forearm catheter technique. On the first day after major abdominal surgery catheters were placed into the femoral artery and a deep forearm vein. After a basal period insulin was infused at a constant rate of 1,0 mU/kgBW/min. over 90 min. This period was followed by an additional BK infusion (lOOug/h) over 30 minutes. Glucose levels were kept constant. The steady state glucose infusion rate at an insulin level of 80uU/ml was 2,8 mg/kgBW/ min without BK and rose to 3,7 mg/kgBW/min with BK. While forearm blood flow remained stable glucose utilisation of forearm muscle tissue rose from 0,87 umol/lOOg/min without BK to 1,35umol/lODg/min with BK in the steady state period. Our results demonstrate clearly that postoperative insulin resistance of whole body and skeletal muscle can be deminished by bradykinin. As kinins are reduced in postoperative state, they may contribute to the postaggressive stress metabolism. Further studies are necessary to show if BK may become a therapeutic agent in postoperative catabolism.

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