P.79 POSTOPERATIVE CARNITINE BALANCE; EFFECT OF SUPPLEMENTATION. M. Roulet(l), C. Pichard( R. Chiolero(2), Y. Schutz(3), E. Jequier(3), C. Rossle(4), P. Furst@r. (Oepts. of (1) Nutrition, (2) Anaesthesiology and (3) Physiology, Univ. of Lausanne, Switzerland; (4) Inst. for Biol. Chemistry and Nutrition, Univ. of Hohenheim, Stuttgart, FRG Trauma included break-down of muscle tissue might ba associated with cellular loss and successive output of carnitine (Car). During long-term TPN this waste of Car is not con- templated although parenteral supply of fat might further emphasize increased require- ment of this solute. In the present study, the time course of urinary total acid-soluble Car (free Car + short-chain acyl-Car; TASC) excretion was followed in 8 patients prior to and over 11 days after esophagectomy. The patients received the same TPN regimen (35 kcal/kg, equally provided as fat and glucose; 200 mg amino acid-N/kg), but 4 of them were supplemented with L-carnitine (14 mg/kg/day). In the table the preoperative (-1) and selected typical postoperative TASC-outputs are compared with 24-hr excretion acquired from a sex-matched control group (n=15). NOT SUPPLEMENTED CAR-SUPPLEMENTED DAY -1 +1 +3 +9 +11 -1 +l TASC-excretion MEAN 560 1217x* 497 493 407 416 1288** 3921*x* 5230x** 4740x' (pmol/24 h) SEM 98 262 152 193 102 x retention of the MEAN dally supplied dosis SEM l * P<O.Ol, *** P<O.OOl siqnificant with controls Without Car-supplementation, the marked immediate increase of TASC-output after operati- on is normalized on the third day. The cumulative excretion was 6.2tl.O mmol, corres- ponding to 5-8% of the estimated total body Car pool. In supplemented patients, TASC- excretion at the first postoperative day was about the same as in the former group, indicating that this loss is obligatory. Thus, following supplementation, the initial retention is marked (57.5%), successively decreasing to yield only 4.4% at the end of the study. Tt is conceivable to believe that Car-supplementation in the early postoperative phase is beneficial by preventing a depletion of the total body Car pool. 137

Postoperative carnitine balance; effect of supplementation

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Trauma included break-down of muscle tissue might ba associated with cellular loss and successive output of carnitine (Car). During long-term TPN this waste of Car is not con- templated although parenteral supply of fat might further emphasize increased require- ment of this solute. In the present study, the time course of urinary total acid-soluble Car (free Car + short-chain acyl-Car; TASC) excretion was followed in 8 patients prior to and over 11 days after esophagectomy. The patients received the same TPN regimen (35 kcal/kg, equally provided as fat and glucose; 200 mg amino acid-N/kg), but 4 of them were supplemented with L-carnitine (14 mg/kg/day). In the table the preoperative (-1) and selected typical postoperative TASC-outputs are compared with 24-hr excretion acquired from a sex-matched control group (n=15).

NOT SUPPLEMENTED CAR-SUPPLEMENTED

DAY -1 +1 +3 +9 +11 -1 +l

TASC-excretion MEAN 560 1217x* 497 493 407 416 1288** 3921*x* 5230x** 4740x'

(pmol/24 h) SEM 98 262 152 193 102

x retention of the MEAN dally supplied dosis SEM

l * P<O.Ol, *** P<O.OOl siqnificant with controls Without Car-supplementation, the marked immediate increase of TASC-output after operati- on is normalized on the third day. The cumulative excretion was 6.2tl.O mmol, corres- ponding to 5-8% of the estimated total body Car pool. In supplemented patients, TASC- excretion at the first postoperative day was about the same as in the former group, indicating that this loss is obligatory. Thus, following supplementation, the initial retention is marked (57.5%), successively decreasing to yield only 4.4% at the end of the study. Tt is conceivable to believe that Car-supplementation in the early postoperative phase is beneficial by preventing a depletion of the total body Car pool.

137