Skip to main content
SpringerLink
Log in
Book cover

Update 1990 pp 60–68Cite as

The Role of Amino Acid Changes in Septic Encephalopathy

  • Conference paper

  • 103 Accesses

Part of the book series: Update in Intensive Care and Emergency Medicine ((UICM,volume 10))

Abstract

There are several factors which may be important in the altered mental state observed in patients with sepsis. These include a direct central nervous system infection [1–3], endotoxin effects on the brain [4, 5], inadequate perfusion [6, 7], altered metabolism including disturbed plasma and brain amino acid levels [8–17], deranged amino acid transport across the blood brain barrier [15], abnormal levels of neurotransmitters in the brain [8, 16, 17], metabolic disturbances [6], liver insufficiency [8], multiple organ failure [14, 18] or complications of medical therapies.

Part of this work was performed during Dr. Sprung’s tenure as a Lady Davis Visiting Professor at Hebrew University, Hadassah University Hospital, Department of Anesthesiology, Kiryat Hadassah, P.O. Box 12000, 91120 Jerusalem, Israel.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Diamond IB (1928) Changes in the brain in pyemia and in septicemia. Arch Neurol Psychiatry 20:524–536

    Google Scholar 

  2. Anker P, Stroun M (1972) Bacterial ribonucleic acid in the frog brain after a bacterial peritoneal infection. Science 178:621–623

    Article  PubMed  CAS  Google Scholar 

  3. Jackson AC, Gilbert JJ, Young GB, Bolton CF (1985) The encephalopathy of sepsis. Can J Neurol Sci 12:303–307

    PubMed  CAS  Google Scholar 

  4. Gilles FH, Averill DR, Kerr CS (1977) Neonatal endotoxin encephalopathy. Ann Neurol 2:49–56

    Article  PubMed  CAS  Google Scholar 

  5. Mela L (1981) Direct and indirect effects of endotoxin on mitochondrial function. Prog Clin Biol Res 62:15–21

    PubMed  CAS  Google Scholar 

  6. Plum F, Posner JB (1980) The diagnosis of stupor and coma, 3rd edn. Davies, Philadelphia, pp 170–303

    Google Scholar 

  7. Bolton CF, Young GB (1986) Sepsis and septic shock: Central and peripheral nervous systems. In: Sibbald WJ, Sprung CL (eds) New horizons: perspectives on sepsis and septic shock. Fullerton, CA, Soc Crit Care Med, pp 157–171

    Google Scholar 

  8. Freund HR, Ryan J A, Fischer JE (1978) Amino acid derangements in patients with sepsis: Treatment with branched chain amino acid rich infusions. Ann Surg 188:423–430

    Article  PubMed  CAS  Google Scholar 

  9. Cerra FB, Siegel JH, Border JR, Wiles J, McMenamy RR (1979) The hepatic failure of sepsis: Cellular versus substrate. Surgery 86:409–422

    PubMed  CAS  Google Scholar 

  10. Cerra FB, Siegel JH, Border JR, Peters DM, McMenamy RR (1979) Correlations between metabolic and cardiopulmonary measurements in patients after trauma, general surgery, and sepsis. J Trauma 19:621–629

    Article  PubMed  CAS  Google Scholar 

  11. Cerra FB, Caprioli J, Siegel JH, McMenamy RR, Border JR (1979) Proline metabolism in sepsis, cirrhosis and general surgery. The peripheral energy deficit. Ann Surg 190:577–586

    Article  PubMed  CAS  Google Scholar 

  12. Freund HR, Atamian S, Holroyde J, Fischer JE (1979) Plasma amino acids as predictors of the severity and outcome of sepsis. Ann Surg 190:571–576

    Article  PubMed  CAS  Google Scholar 

  13. Cerra FB, Siegel JH, Coleman B, Border JR, McMenamy RR (1980) Septic autocannibalism. A failure of exogenous nutritional support. Ann Surg 192:570–580

    Article  PubMed  CAS  Google Scholar 

  14. Moyer ED, McMenamy RR, Cerra FB, et al (1981) Multiple systems organ failure. III. Contrasts in plasma amino acid profiles in septic trauma patients who subsequently survive and do not survive — Effects of intravenous amino acids. J Trauma 21:263–274

    Article  PubMed  CAS  Google Scholar 

  15. Jeppsson B, Freund HR, Gimmon Z, James JH, von Meyenfeldt MF, Fischer JE (1981) Blood-brain barrier derangement in sepsis: Cause of septic encephalopathy? Am J Surg 141:136–142

    Article  PubMed  CAS  Google Scholar 

  16. Freund HR, Muggia-Sullam M, Peiser J, Melamed E (1985) Brain neurotransmitter profile is deranged during sepsis and septic encephalopathy in the rat. J Surg Res 38:267–271

    Article  PubMed  CAS  Google Scholar 

  17. Freund HR, Muggia-Sullam M, LaFrance R, Holroyde J, Fischer JE (1986) Regional brain amino acid and neurotransmitter derangements during abdominal sepsis and septic encephalopathy in the rat. The effect of amino acid infusions. Arch Surg 121:209–216

    Article  PubMed  CAS  Google Scholar 

  18. Coalson J J (1986) Pathology of sepsis, septic shock and multiple organ failure. In: Sibbald WJ, Sprung CL (eds) New horizons: perspectives on sepsis and septic shock. Fullerton, CA, Soc Crit Care Med, pp 27–59

    Google Scholar 

  19. Adams RD, Victor M (1981) Principles of neurology, 2nd edn. McGraw-Hill, New York, pp 231–247

    Google Scholar 

  20. Posner JB (1982) General causes of delirium stupor and coma. In: Wyngaarden JB, Smith LH (eds) Cecil textbook of medicine. Saunders, Philadelphia, pp 1914–1920

    Google Scholar 

  21. Ropper AH, Martin JB (1983) Derangements in intellect, mood and behavior. In: Petersdorf RG, Adams RD, Braunwald E, et al (eds) Harrison’s principles of internal medicine, 10th edn. McGraw-Hill, New York, pp 131–136

    Google Scholar 

  22. Forse RA, Kinney JM (1985) The metabolic response to infection. In: Meakins JL (ed) Surgical infection in critical care medicine. Churchill-Livingstone, New York, pp 69–94

    Google Scholar 

  23. Cerra FB (1986) Metabolic support of the systemic septic response. In: Sibbald WJ, Sprung CL (eds) New horizons: perspectives on sepsis and septic shock. Fullerton, CA, Soc Crit Care Med, pp 235–256

    Google Scholar 

  24. Munro HN, Fernstrom JD, Wurtman RJ (1975) Insulin, plasma amino acid imbalance, and hepatic coma. Lancet 1:772–774

    Google Scholar 

  25. Sax HC, Talamini MA, Fischer JE (1986) Clinical use of branched-chain amino acids in liver disease, sepsis, trauma, and burns. Arch Surg 121:358–366

    Article  PubMed  CAS  Google Scholar 

  26. Fischer JE, Yoshimura N, Aguirre A, et al (1974) Plasma amino acids in patients with hepatic encephalopathy. Effects of amino acid infusions. Am J Surg 127:40–47

    Article  PubMed  CAS  Google Scholar 

  27. Fischer JE, Funovics JM, Aguirre A, et al (1975) The role of plasma amino acids in hepatic encephalopathy. Surgery 78:276–290

    PubMed  CAS  Google Scholar 

  28. Fischer JE, Rosen HM, Ebeid AM, James JH, Keane JM, Soeters PB (1976) The effect of normalization of plasma amino acids on hepatic encephalopathy in man. Surgery 80:77–91

    PubMed  CAS  Google Scholar 

  29. Smith A, Rossi-Fanelli F, Ziparo V, James JH, Perelle B, Fischer JE (1978) Alterations in plasma and CSF amino acids, amines, and metabolites in hepatic coma. Ann Surg 187:343–350

    Article  PubMed  CAS  Google Scholar 

  30. Cerra FB, Cheung NK, Fischer JE, et al (1985) Disease specific amino acid infusion (F080) in hepatic encephalopathy: A prospective, randomized, double-blind, controlled trial. J Parent Enter Nutr 9:288–295

    Article  CAS  Google Scholar 

  31. Cangiano C, Cascino A, Fiaccadori F, Riggio O, Rossi-Fanelli F, Capocaccia L (1981) Is the blood-brain barrier really intact in portal-systemic encephalopathy? Lancet 1:1367

    Article  PubMed  CAS  Google Scholar 

  32. James JH, Jeppsson B, Ziparo V, Fischer JE (1979) Hyperammonemia, plasma amino acid imbalance, and blood-brain amino acid transport: A unified theory of portal-systemic encephalopathy. Lancet 2:772–775

    Article  PubMed  CAS  Google Scholar 

  33. James JH, Escourrou J, Fischer JE (1978) Blood-brain neutral amino acid transport activity is increased after portocaval anastomosis. Science 200:1395–1397

    Article  PubMed  CAS  Google Scholar 

  34. Fernstrom JD, Wurtman RJ (1972) Brain serotonin content: Physiological regulation by plasma neutral amino acids. Science 178:414–416

    Article  PubMed  CAS  Google Scholar 

  35. Hourani BT, Hamlin EM, Reynolds TB (1971) Cerebrospinal fluid glutamine as a measure of hepatic encephalopathy. Arch Intern Med 127:1033–1036

    Article  PubMed  CAS  Google Scholar 

  36. Rossi-Fanelli F, Freund H, Krause R, et al (1982) Induction of coma in normal dogs by the infusion of aromatic amino acids and its prevention by the addition of branched chain amino acids. Gastroenterology 83:664–671

    PubMed  CAS  Google Scholar 

  37. Dodsworth JM, James JH, Cummings MC, Fischer JE (1974) Depletion of brain norepinephrine in acute hepatic coma. Surgery 75:811–820

    PubMed  CAS  Google Scholar 

  38. Fischer JE (1984) Efficacy of branched chain amino acids in the treatment of hepatic encephalopathy. In: Capocaccia L, Fischer JE, Rossi-Finelli F (eds) Hepatic encephalopathy in chronic liver failure. Plenum Press, New York, pp 311–321

    Google Scholar 

  39. O’Donnell TF, Clowes GHA, Blackburn GL, Ryan NT, Benotti PN, Miller JD (1976) Proteolysis associated with a deficit of peripheral energy full substrates in septic man. Surgery 80:192–200

    Google Scholar 

  40. Sprung CL, Cerra FB, Schein RMH, et al (1989) Amino acid alterations and encephalopathy in the sepsis syndrome. Crit Care Med 17:S54

    Article  Google Scholar 

  41. Wannemacher RW Jr (1977) Key role of various individual amino acids in host response to infection. Am J Clin Nutr 30:1269–1280

    PubMed  CAS  Google Scholar 

  42. Chaudry JH, Schleck S, Clemens MG (1982) Altered hepatocellular transport. An early change in peritonitis. Arch Surg 117:151–157

    Article  PubMed  CAS  Google Scholar 

  43. Bower RH, Muggia-Sullam M, Vallgren S, et al (1986) Branched chain amino acid-enriched solutions in the septic patient. Ann Surg 203:13–20

    Article  PubMed  CAS  Google Scholar 

  44. Cerra FB, Mazuski JE, Chute E, et al (1984) Branched chain metabolic support: A prospective, randomized, double-blind trial in surgical stress. Ann Surg 199:286–291

    Article  PubMed  CAS  Google Scholar 

  45. Cerra FB, Mazuski JE, Teasley K, et al (1983) Nitrogen retention in critically ill patients is proportional to the branched chain amino acid load. Crit Care Med 11:775–778

    Article  PubMed  CAS  Google Scholar 

  46. Van Berlo CLH, von Meyenfeldt MF, Rouflart M, Soeters PB (1985) Does branched chain amino acid enrichment reduce mortality in septic and traumatized patients. Clin Nutr 5:132 (abstract)

    Google Scholar 

  47. de Jong KP, von Meyenfeldt MF, Rouflart M, et al (1984) The effect of branched chain amino acids on organ functioning in septic and stressed patients. Clin Nutr 4:71 (abstract)

    Google Scholar 

  48. Fernstrom JD, Faller DJ (1978) Neutral amino acids in brain: changes in response to food ingestion. J Neurochem 30:1531–1538

    Article  PubMed  CAS  Google Scholar 

  49. Rosen MH, Soeters PB, James JH, et al (1978) Influences of exogenous intake and nitrogen balance on plasma and brain aromatic amino acid concentrations. Metabolism 27:393–404

    Article  PubMed  CAS  Google Scholar 

  50. Freund HR, Hoover HC, Atamian S, et al (1979) Infusion of the branched chain amino acids in postoperative patients: anti-catabolic properties. Ann Surg 190:18–23

    Article  PubMed  CAS  Google Scholar 

  51. Lindberg BO, Clowes GHA (1981) The effects of hyperalimentation and infused leucine on the amino acid metabolism in sepsis: An experimental study in vivo. Surgery 90:278–290

    PubMed  CAS  Google Scholar 

  52. Freund HR, James JH, Fischer JE (1981) Nitrogen-sparing mechanisms of singly administered branched chain amino acids in the injured rat. Surgery 90:237–243

    PubMed  CAS  Google Scholar 

  53. Blackburn BR, Moldawer LL, Usui S, Bothe A, O’Keefe SJD, Bistrian BR (1979) Branched chain amino acid administration and metabolism during starvation, injury, and infection. Surgery 86:307–315

    PubMed  CAS  Google Scholar 

  54. Gelfand RA, Hendler RS, Sherwin RS (1979) Dietary carbohydrate and metabolism of ingested protein. Lancet 1:65–68

    Article  PubMed  CAS  Google Scholar 

  55. Nuwer N, Cerra FB, Shronts EP, et al (1983) Does modified amino acid total parenteral nutrition alter immune-response in high level surgical stress? J Parent Enter Nutr 7:521–524

    Article  CAS  Google Scholar 

  56. Kern KA, Bower RH, Atamian S, Matarese LE, Ghory MJ, Fischer JE (1982) The effect of a new branched chain-enriched amino acid solution on postoperative catabolism. Surgery 92:780–785

    PubMed  CAS  Google Scholar 

  57. Bower RH, Kern KA, Fischer JE (1985) Use of a branched chain amino acid enriched solution in patients unter metabolic stress. Am J Surg 149:266–270

    Article  PubMed  CAS  Google Scholar 

  58. Cerra FB, Upson D, Angelico R, et al (1982) Branched chains support postoperative protein synthesis. Surgery 92:192–199

    PubMed  CAS  Google Scholar 

  59. Daly JM, Mihranian MH, Kehoe JE, Brennan MF (1983) Effects of post-operative infusions of branched chain amino acids on nitrogen balance and forearm muscle substrate flux. Surgery 94:151–158

    PubMed  CAS  Google Scholar 

  60. Jaikin A, Agrest A (1969) Cerebrospinal fluid glutamine concentrations in patients with chronic hypercapnia. Clin Sci 36:11–14

    PubMed  CAS  Google Scholar 

  61. Sjaastad O, Gjessing L, Ritland S, Blichfeldt P, Sandres K (1979) Chronic relapsing pancreatitis, encephalopathy with disturbance of consciousness and CSF amino acid aberration. J Neurol 220:83–94

    Article  PubMed  CAS  Google Scholar 

  62. Abel RM, Beck CH Jr, Abbott WM, et al (1973) Improved survival from acute renal failure after treatment with intravenous essential L-amino acids and glucose. N Engl J Med 288:695–699

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. C. L. Sprung
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Intensive Care, Erasme Hospital, Free University of Brussels, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean Louis Vincent (Clinical Director) (Clinical Director)

Rights and permissions

Reprints and permissions

Copyright information

© 1990 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Sprung, C.L. (1990). The Role of Amino Acid Changes in Septic Encephalopathy. In: Vincent, J.L. (eds) Update 1990. Update in Intensive Care and Emergency Medicine, vol 10. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-84125-5_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-84125-5_6

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-52269-0

  • Online ISBN: 978-3-642-84125-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation