PEDIATRICS Vol. 80 No. 3 September 1987, pp. 401-408
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Amino Acid Mixture Designed to Maintain Normal Plasma Amino Acid Patterns in Infants and Children Requiring Parenteral Nutrition

William C. Heird MD1, Ralph B. Dell MD1, Richard A. Helms PharmD1, Harry L. Greene MD1, Marvin E. Ament MD1, Padmani Karna MD1, and Michael C. Storm PhD1

1 From the Departments of Pediatrics, Columbia University College of Physicians and Surgeons, New York, Vanderbilt University, Nashville, Tennessee, and University of California at Los Angeles; the Department of Clinical Pharmacy, University of Tennessee, Memphis, Sparrow Children's Hospital, Lansing, Michigan; and the Research Department of Kendall-McGaw Laboratories, Inc, Irvine, California

A mixture of amino acids designed to maintain normal plasma amino acid concentrations of infants and children requiring parenteral nutrition was evaluated in 40 infants and children receiving only parenteral nutrients (2.39 ± 0.26 g/kg/d of amino acids and 110.3 ± 10.4 kcal/kg/d) for five to 21 days. The children ranged in weight from 2.0 to 12.6 kg (median weight, 3.83 kg; fifth to 95th percentile, 2.06 to 11.1 kg) and in age from 1 week to 43.6 months (median age, 2.7 months; fifth to 95th percentile, 0.2 to 25.3 months). Mean weight gain was 11.0. ± 5.0 g/kg/d; mean nitrogen balance was 242 ± 70 mg/kg/d. Plasma concentrations of all amino acids except tyrosine were within the normal range (ie, within the 95% confidence limits of the two-hour postprandial plasma concentrations observed in 30-day-old, healthy, normally growing, breast-fed, term infants) throughout the period of study. Mean prestudy and poststudy serum total protein, albumin, and transthyretin (prealbumin) concentrations were not significantly different. However, plasma transthyretin concentration increased in all children with low prestudy concentrations. Mean poststudy serum total bilirubin concentration of the total population was not different from the mean prestudy concentration. This was true also for the 31 children who received the parenteral amino acid mixture for more than ten days. In contrast to the expected 30% to 50% incidence of cholestasis, only one of these 31 experienced an unexplained increase in serum total bilirubin concentration during study, suggesting that normalizing plasma amino acid concentrations and/or providing taurine during parenteral nutrition may decrease the incidence of cholestasis associated with this therapy.

Key Words: plasma amino acid • cyst(e)ine • N-acetyl-L-tyrosine • taurine • cholestasis • nutrition

Submitted on August 4, 1986
Accepted on December 10, 1986




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