A Comparison of the Effects of Skeletal Trauma and Surgery on the Ketosis of Starvation in Man

Abstract

The increase of plasma ketone bodies (acetoacetic acid and .beta.-hydroxybutyric acid) is related to the efficient protein-sparing adaptation during a total fast by healthy man. To investigate the response to a total fast during the postinjury state, 20 patients with skeletal or soft-tissue trauma received 3 days of carbohydrate-free intake and then 3 more days of carbohydrate intake. Control subjects were 10 postoperative patients and 2 healthy volunteers who received similar nutritional treatment. The trauma patients lost nearly 20g N/day, which was twice control, and had a resting energy expenditure of 27.07 kcal/kg, 21.4% greater than controls. Trauma was found related to an elevation in plasma glucose and to inhibit the rise in plasma ketone bodies and free fatty acids. Indirect calorimetry showed that fat contributed 63% of the nonprotein energy on the 3rd day of fasting and injury. Apparently, fat is utilized by the trauma patient but fat metabolism is abnormal compared to starvation in healthy or mildly stressed patients.