ISSN:
1432-1238
Keywords:
Total parenteral nutrition
;
Critical care
;
Energy metabolism
;
Indirect calorimetry
;
Nutritional requirements
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Objective Metabolic effects of different caloric regimens were investigated in nonsurgical, medical patients with multipleorgan failure (MOF). Design Seven total parenteral nutrition (TPN) regimens were administered, differing in amount (14, 28, and 56 kcal/kg per day, i.e., hypo-, iso-, and hypercaloric nutrition, respectively) and distribution [carbohydrates (COH), amino acids (AA), long-chain and mediumchain triglycerides (LCT/MCT)] of calories. Each regimen was administered over 12 h. Metabolism was monitored by energy expenditure (EE), body temperature (BT), protein breakdown (PB), and blood glucose and serum lactate levels. Measurements were started within 2 days of MOF onset. Setting The study was conducted in a medical intensive care unit.Patients: Twenty patients with MOF on mechanical ventilation (mean Apache II score $$\bar x$$ =26) were investigated. Measurements and results The mean values of the EE ( $$\bar x$$ =31 kcal/kg per day), BT ( $$\bar x$$ -38°C), PB ( $$\bar x$$ =1.5 g/kg per day), and lactate ( $$\bar x$$ =2.0 mmol/l) and glucose level ( $$\bar x$$ =222 mg/dl) parameters were elevated. EE, BT, and lactate and glucose levels were significantly lower under hypocaloric nutrition than during iso- and hypercaloric nutrition (p〈0.01). Differences in the metabilic effects of LCT and MCT were not significant. PB was significantly elevated under hypercaloric nutrition (p〈0.01). Protein balance was positive under hypercaloric nutrition, and negative under iso- and hypocaloric nutrition. Conclusions In nonsurgical, medical patients neither hypercaloric nor isocaloric nutritional support prevented protein catabolism; in contrast, they enhanced the metabolic burden measured by EE, thermogenesis, urea production rate, and glucose and lactate levels. A hypocaloric regimen is therefore recommended for these patients during the early phase of MOF.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF01700160
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