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Comparison of Maltose with Glucose

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Comparison of Maltose with Glucose MALTOSE AS AN ENERGY SUBSTRATE DURING SURGERY: COMPARISON OF MALTOSE WITH GLUCOSE KAZUYA AONO, NOBUKO KAWACHINO AND KUNIHIKO SATOH ABSTRACT To evaluate the usefulness of maltose as an energy substrate to be administered during surgery, five per cent maltose in lactated Ringer's solution and five per cent glucose in lactated Ringer's solution were administered to 10 cases each, at a rate of 5 ml.kg-~ hour (0.25 g'kg-t hour as sugar) for two hours from the start of oral surgery, and their metabolic effects were compared. The maltose group showed a smaller increase in blood sugar level than the glucose group immediately after the completion of infusion. The mean plasma concentration of maltose reached a maximum of 121.6 mg/dl, and it remained at 12.3 mg/dl at four hours, indicating that the retention time of maltose in blood was longer than that of glucose. The mean recovery of sugar from four-hour urine samples was 3.26 per cent in the maltose group and 0.06 per cent in the glucose group respectively, showing greater urinary excretion by the maltose group. Plasma insulin was elevated less after maltose than after glucose infusion. The elevation following maltose infusion was considered not to be due to the administration of maltose per se, but to glucose produced from the maltose in the body. The anti-ketogenie effect of maltose was comparable to and tended to last longer than that of glucose. From overall assessment it was concluded that maltose exerts essentially the same metabolic effects as glucose when used under these conditions. KEY WORDS: METABOLISM, energy substrate, maltose, glucose. THE PATIENT is often in a starved state when utilized in humans. Since then, maltose has been exposed to the stress caused by surgical opera- widely used in Japan. Subsequent studies have tions or other therapy. The stress usually accel- shown that maltose does not markedly increase erates catabolic responses in the body. However, blood sugar level and is less insulin-dependent in such a state there is little sugar in the body than glucose. A 10 per cent solution of maltose usable as an energy source (mainly glycogen) has about the same osmotic pressure as that of and hence, once it is consumed, muscle protein plasma, half of that of glucose in the same begins to be converted to glucose by gluconeo- concentration, which implies that at the same genesis and fat tissues are converted to free fatty osmotic pressure maltose supplies twice as many acids. As a consequence, these are used as a calories as glucose. A considerable amount of main energy source. The use of protein and fat sugar is excreted in the urine when maltose is wastes muscle tissue and induces increases in infused at speeds of 0.5-1.0g-kg-~/hour. In ketone body and free fatty acid concentrations. general, tolerance to glucose decreases during To prevent these phenomena, it is necessary to surgery, which is called surgical diabetes. How- supply sugar as an energy source. Moffitt, etal. 1 ever, tolerance to maltose is reported to remain reported that glucose given during abdominal unch~ged during surgery. 4 surgery increased the metabolism of glucose and In order to evaluate the usefulness of maltose decreased the utilization of fat. as a sugar source to be given during surgery, we 23 On the other hand, Young and Weser, et al. infused maltose at a slower speed (0.25 g-kg-l/ demonstrated that intravenous maltose is well hour) than in previous tests, examined blood and urinary glucose and maltose concentrations, Kazuya Aono, M.D., Professor; Nobuko Kawa- chino, B.S., Kunihiko Satoh, D.D.S., Assistants; plasma insulin level, ketone bodies, free fatty Department of Anesthesiology, Fukuoka Dental Col- acids, plasma osmotic pressure and urinary lege, Fukuoka, 814-01 Japan. nitrogen, and compared the results obtained with 236 Can. Anaesth. Soc. J., vol. 29, no. 3, May 1982 AONO, et al.: MALTOSEAS ENERGY SUBSTRATE 237 those for glucose infused under the same condi- Group G; 5~ glucose tn L.R. ~ . 0.25 ~/kg/hr tions. Group H; 51 maltose In L.R. J for 2 hours / SUBJECTS AND METHODS 1 Twenty patients, aged from 16 to 50 years, who were diagnosed free of metabolic disorders and scheduled to undergo oral surgery were J~ 0 2 4 6 divided into two groups of 10 each for adminis- "' ( hours ) tration of glucose (Group G) and maltose (Group op. 8~:en't. M) (Table I). All patients gave their consent after l .4neBt:h. 8ta2~t being informed of the test procedures and blood S~npl t ng samplings by the physician in charge. r162 t t Anaesthesia was condL:~tcd by the combina- tion of nitrous oxide oxygen-methoxyflurane vrlne O) @ and modified neuroleptanaesthesia. At the be- ginning of operation infusion of either five per F-)GURE 1 Experimental procedures. cent glucose in lactated Ringer's solution or five per cent maltose in lactated Ringer's solution ringer Mannheim), maltose by the maltase- was begun at the speed of 5 ml.kg-1/hour (or glucose oxidase method, 5 plasma insulin by 0.25 g-kg-I/hour as sugar) and continued for two radioimmunoassay, blood ketone bodies (beta- hours. Before and after the glucose or maltose hydroxybutyrate and acetoacetate) by the en- infusion, lactated Ringer's solution was given zymatic method, 6 plasma free fatty acids by the slowly. The blood was sampled before the modified Ui and Itaya method, 7 urine nitrogen anaesthetic induction, just before the start of by Kjeldahl-Nessler method, plasma osmotic operation and two, four and six hours after the pressure by the freezing-point method, and start of operation for a total of five times. The plasma sodium and potassium by flame- urine was collected two and six hours after the photometry. Plasma inorganic phosphorus was beginning of operation. (Figure 1). Immediately measured by the Fiske-Subbarow method in after obtaining blood samples with heparinized three cases from each group, s syringes, 5 ml of the blood was thoroughly mixed with the same volume of 10 per cent (w/v) RESULTS perchloric acid solution previously cooled with ice, and then centrifuged to obtain the supernate, At the end of infusion, the mean value of which was then examined for ketone bodies. The plasma glucose rose from 80.0mg/dl to 156.1 remaining blood was cooled with ice and cen- mg/dl in Group G, showing a significant increase trifuged to separate the plasma. The plasma was of 95 percent, and from 78.9 mg/dl to 103.9 mg/ examined for substances other than ketone bod- dl in Group M, also showing a significant ies. increase of 32 per cent. The highest glucose level The plasma and urine glucose levels were at the end of infusion was significantly lower in determined with hexokinase by the enzymatic Group M than in Group G (Figure 2). The method (Glucose HK test-Glucoquant | Brh- plasma glucose concentrations in Groups G and M declined almost to the previous levels two TABLE I hours after the completion of infusion, though the latter still showed a higher level than the SUBJECTS former. Group G Group M The mean value of plasma maltose in Group M was 121.6 - 7.0 mg/dl at the end of infusion, Age (years) 37.1 --- 4.2* 28.5 -+ 3.2* declined to 37.2 - 2.6 mg/dl at two hours, and Sex male 4 5 female 6 5 decreased further to 12.3 -+ 1.7 mg/dl at four Weight (kg) 53.6 --- 2.4* 51.3 • 3.2* hours. So even after four hours, maltose persis- Height (cm) 157.0 • 1.9* 163.2 -+ 2.6" ted in the blood (Figure 3). Sugar administered glucose maltose The recovery of glucose in the urine collected Number I 0 10 during the four hours after infusion was 15.7 mg *Mean _+ standard error. on the average in Group G (0.06 per cent of the 238 CANADIAN ANAESTHETISTS' SOCIETY JOURNAL TABLE II URINE VOLUME, SPECIFIC GRAVITY AND SUGAR EXCRETION IN EACH GROUP Urine Dose Of Rate Of Volume Specific Sugar Sugar Excretion Excretion (ml) Gravity (g) (rag) (per cent) Group G 536.3 1.016 27.0 Glucose 15.7 -+ 6.6 0.06 -+67.6 -+.002 -+1.I Group M 782.7 1.016 25.3* Glucose 205.7" | +134.3 --..002 -+1.7 -+44.8 { 825.0* 3.26 -+168.7 Maltose 619.3" -+ 167.2 Mean -+ standard error. *Average of nine cases GZuooaR MaZtos~ :mg/d] ) (mg/d]) Group G 100 .E. 150 ---- Group M I Mean 5.E. I00 50 50 0 * P<O.O1 0 2 4 6 Time ( hours ) Infusion FIGURE 3 Changes in plasma maltose during and o " o 2 ~ ; after infusion. Time ( hours } rises in both groups after infusion. It declined FIGURE 2 Changes in plasma glucose during and almost to the prior level in both groups two hours afterinfusion. after the completion of infusion (Figure 5). The I/G ratio (the ratio of the insulin level to the dose given) and 205.7mg on the average in glucose level and indicates the degree of insulin Group M (0.81 per cent of the dose given). release due to glucose) at the maximum level Maltose was also excreted in the urine in Group was 0.242 in Group G and 0.238 in Group M, M, at an average of 619.3 mg (2.45 per cent of showing no difference between the two groups the dose given).
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