A descriptive study of skeletal muscle metabolism in critically ill patients: Free amino acids, energy-rich phosphates, protein, nucleic acids, fat, water, and electrolytes

Objective: To characterize biochemical changes in skeletal muscle in critically ill patients. Design: Survey of critically ill patients. Setting: Intensive care unit (ICU) at a university hospital. Patients: Critically ill patients (n = 20) subjected to trauma, surgical complications, and/or bacteremia who were treated in the ICU and showed no risk of bleeding complications were included, Reference groups of metabolically healthy volunteers and patients served as the control/reference groups. Interventions: Percutaneous muscle biopsy was obtained from both patients and healthy volunteers. Measurements and Main Results: Total free amino acids in skeletal muscle decreased 59% (p <.001) and skeletal muscle glutamine concentration decreased 72% (p <.001) in the critically ill patients, Basic amino acids decreased 49% (p<.001). Branch-chain amino acids increased 39% (p <.01), and aromatic amino acids increased 88% (p <.001) in the patients. Adenosine triphosphate (ATP) was reduced by 12% (p <.01). Total creatine concentration increased by 26% (p <.001) due to an 80% increase in free creatine (p <.001). The phosphorylated creatine fraction of total creatine decreased 22% (p<.001) in the patients. Alkali-soluble protein/DNA decreased 24% (p <.01) and fat free solid/DNA decreased 21% (p <.01) in patients sampled on or after ICU day 5 compared with the reference group. Muscle water increased 10% due to a doubling of the extracellular water fraction. Conclusions: Although critically ill patients are a very heterogeneous group from a clinical point of view, there is a remarkable homogeneity in many of the biochemical parameters regardless of the severity of illness and the length of the ICU admission. The three most consistent differences were the skeletal muscle low glutamine concentration, the decrease in protein content, and the increase in extracellular water in the patients.