This program project in trauma is designed to quantitatively evaluate various biochemical and physiological parameters in the critically ill patient. The pathophysiology of trauma has been expressed by a number of overt clinical changes manifested by the patient which has served to emphasize the severity and seriousness of trauma, "the forgotten disease." This program has been conceived to explore in depth the clinical changes with the hope of providing a better rationale for the treatment and care of such patients. The progress since the inception of this grant in July of 1976 may be related to the successful setting up of a surgical metabolism facility, including physical construction, staffing with nurses, dietitians, and setting up a metabolic support laboratory for balance studies in these patients. In addition, a research program is under way to evaluate in major injury and sepsis the biochemical parameters of 1) indices of nutrition, 2) carbohydrate metabolism in major trauma, 3) an evaluation of the gluconeogenic response in major injury and sepsis, and 4) whole body protein synthesis in the injured and septic patient using 15N: 14C amino acids. These studies are in progress and the preliminary results suggest that creatinine-height ratios may reflect nutritional status in the patient who is not catabolic; 3-methyl-histidine does reflect increased muscle breakdown in injury and sepsis; alkaline plasma ribonuclease appears not bear an inverse relationship to nitrogen balance in hypercatabolic patients. The data from the metabolism studies thus far suggest that skeletal trauma without inflammatory processes results in very little change in the carbohydrate parameters. These findings are significant in the light of the intense effect of sepsis on increased carbohydrate metabolism as previously reported. Evaluation of hormonal levels in these patients, as well as their ability to convert alanine to glucose, which taken in relation to whole body metabolic responses will hopefully provide information on what substrates might be suitable for nutritional intervention in the care of these critically ill patients. BIBLIOGRAPHIC REFERENCE: Long, C.L. Clinical Application of Plasma Amino Acid Patterns Using Different and Ideal Solutions. Proceedings of Denver Symposium on Amino Acids, American Medical Association, Denver, March 3-4, 1977.