A comparison of the effects of skeletal trauma and surgery on the ketosis of starvation in man.

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. This study investigated the response to a total fast during the postinjury state. Twenty 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 ten postoperative patients and two healthy volunteers who received similar nutritional treatment. The trauma patients lost nearly 20 gm of nitrogen/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. In contrast, indirect calorimetry showed that fat contributed 63% of the nonprotein energy on the third day of fasting and injury. These data indicate that fat is utilized by the trauma patient but that fatty metabolism is abnormal compared to starvation in healthy or mildly stressed patients.