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Einfluß von L-Carnitin-supplementierter total parenteraler Ernährung (TPE) auf die postoperative Fett- und Stickstoff-Utilisation

Effects of l-carnitine-supplemented TPN on postoperative fat and nitrogen utilization

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Summary

During episodes of trauma carnitine-free total parenteral nutrition (TPN) may result in a reduction of the total body carnitine pool, leading to a diminished rate of fat oxidation. Sixteen patients undergoing esophagectomy were equally and randomly divided and received isonitrogenous (0.2 gN/kg·day) and isocaloric (35 kcal/kg·day TPN over 11 days without and with L-carnitine supplementation (12 mg/kg·day). Compared with healthy controls, the total body carnitine pool was significantly reduced in both groups prior to the operation. Without supplementation carnitine concentrations were maintained, while daily provision of carnitine resulted in an elevation of total carnitine mainly due to an increase of the free fraction. Without supplementation the cumulative urinary carnitine losses were 11.5±6.3 mmol corresponding to 15.5%±8.5% of the estimated total body carnitine pool. Patients receiving carnitine revealed a positive carnitine balance in the immediate postoperative phase, 11.1%±19.0% of the infused carnitine being retained. After 11 days of treatment comparable values for respiratory quotient, plasma triglycerides, free fatty acids, ketone bodies, and cumulative nitrogen balance were observed. It is concluded that in the patient population studied here carnitine supplementation during postoperative TPN did not improve fat oxidation or nitrogen balance.

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Abbreviations

TPE:

total parenterale Ernährung=total parenteral nutrition

FC:

freies Carnitin=free carnitine

TASC:

gesamtes säurelösliches Carnitin=total acid soluble carnitine

LCC:

langkettiges Acylcarnitin=longchain carnitine

SCC:

kurzkettiges Acylcarnitin=shortchain carnitine

TC:

Gesamtcarnitin=total carnitine

AC:

Acylcarnitin=acyl carnitine

NCP:

nicht-kollagenes Protein=non-collagenous protein

RQ:

respiratorischer Quotient=respiratory quotient

np-RQ:

Nicht-Eiweiß-RQ=non-protein RQ

Literatur

  1. Balogh D, Hackl JM, Legenstein E, Musil HE (1986) Erfahrungen mit L-Carnitin in der Postaggressionsphase. Infusionstherapie 13:204–208

    Google Scholar 

  2. Bergström J (1962) Muscle electrolytes in man. Scand J Clin Lab Invest 14: Suppl 68

  3. Böhles H, Akcetin Z (1987) Ketogenic effects of low and high levels of carnitine during parenteral nutrition in the rat. Am J Clin Nutr 46:47–51

    Google Scholar 

  4. Böhles H, Noppeney T, Akcetin Z, Rein J, van der Emde J (1986) The effect of preoperative L-carnitine on myocardial metabolism during aorto-coronary bypass-surgery. Curr Ther Res 39:429–435

    Google Scholar 

  5. Böhles H, Segerer H, Fekl W (1983) Improved N-retention during L-carnitine-supplemented total parenteral nutrition. J Parent Ent Nutr 8:9–13

    Google Scholar 

  6. Border JR, Burns GP, Rumph C, Schenk WG (1970) Carnitine levels in severe infection and starvation. Surgery 68:175–179

    Google Scholar 

  7. Borum PR (1983) Carnitine. Ann Rev Nutr 3:233–259

    Google Scholar 

  8. Bowyer BA, Fleming CR, Ilstrup D, Nelson J, Reek S, Burnes J (1986) Plasma carnitine levels in patients receiving home parenteral nutrition. Am J Clin Nutr 43:85–91

    Google Scholar 

  9. Bremer J (1983) Carnitine — Metabolism and functions. Physiol Reviews 63:1420–1480

    Google Scholar 

  10. Carlsson M, Forsberg E, Thörne A (1984) Observations during L-carnitine infusion in two long-term critically ill patients (letter). Clin Physiol 4:363–365

    Google Scholar 

  11. Cederblad G, Larsson J, Schildt B (1984) Muscle and plasma carnitine levels and urinary carnitine excretion in multiply injured patients on total parenteral nutrition. Clin Nutr 2:143–148

    Google Scholar 

  12. Cederblad G, Lindstedt S, Lundholm K (1974) Concentration of carnitine in human muscle tissue. Clin Chim Acta 53:311–321

    Google Scholar 

  13. Cederblad G, Schildt B, Larsson J, Liljedahl SO (1983) Urinary excretion of carnitine in multiply injured patients on different regimens of total parenteral nutrition. Metabolism 32:383–389

    Google Scholar 

  14. D'Attellis NP, Kulapongse S, Richelle M, Dahlan W, Elwyn D, Rössle C, Fürst P, Carpentier YA (1988) Metabolic utilization of energy substrates during intravenous L-carnitine supplementation in normal man. Metabolism (in press)

  15. Engel AG, Rebouche CJ, Wilson DM, Glasgow AM, Romshe CA, Cruse RP (1985) Primary systemic carnitine deficiency. II. Renal handling of carnitine. Neurology 31:819–825

    Google Scholar 

  16. Hahn P, Allerdyce DB, Frohlich J (1982) Plasma carnitine levels during total parenteral nutrition of adult surgical patients. Am J Clin Nutr 36:569–572

    Google Scholar 

  17. Harris RC, Foster CI, Hultman E (1987) Acetylcarnitine formation during intense muscular contraction in humans. J Appl Physiol 63:440–442

    Google Scholar 

  18. Heindel JJ, Cushman SW (1974) Intracellular free fatty acids and energy metabolism in fat cells. Am J Physiol 226:16–24

    Google Scholar 

  19. Hoppel CL, Genuth SM (1980) Carnitine metabolism in normal-weight and obese human subjects during fasting. Am J Physiol 238:E409-E415

    Google Scholar 

  20. Hoppel CL, Genuth SM (1982) Urinary excretion of acetylcarnitine during human diabetes and fasting ketosis. Am J Physiol 243:E168-E172

    Google Scholar 

  21. Jeejeebhoy KN (1984) Total parenteral nutrition in the hospital and at home. CRC Press, Boca Raton

    Google Scholar 

  22. Jéquier E, Acheson K, Schutz Y (1987) Assessment of energy expenditure and fuel utilization in man. Ann Rev Nutr 7:187–208

    Google Scholar 

  23. Lennon DL, Stratman F, Shrago E, Nagle FJ, Madden M, Hanson P, Carter AL (1983) Effects of acute moderate-intensity exercise on carnitine metabolism in men and women. J Appl Physiol 55:489–495

    Google Scholar 

  24. Lowry OL, Rosebrough NJ, Farr AL, Randall RJ (1951) Protein measurement with the folin phenol reagent. J Biol Chem 193:265–275

    Google Scholar 

  25. McGarry JD, Foster DW (1980) Regulation of hepatic fatty acid oxidation and ketone body production. Ann Rev Biochem 49:395–420

    Google Scholar 

  26. Mellanby J, Williamson DH (1974) Aceto-acetate and β-hydroxybutyrate. In: Bergmeyer HU (ed) Methods of enzymatic analysis. Verlag Chemie, Weinheim and Academic Press, New York, pp 1836–1843

    Google Scholar 

  27. Nanni G, Pittiruti M, Giovannini I, Boldrini G, Ronconi P, Castagneto M (1985) Plasma carnitine levels and urinary carnitine excretion during sepsis. J Parent Ent Nutr 9:483–490

    Google Scholar 

  28. Rebouche CJ, Engel AG (1984) Kinetic compartemental analysis of carnitine metabolism in the human carnitine deficiency syndromes. Evidence for alterations in tissue carnitine transport. J Clin Invest 73:857–867

    Google Scholar 

  29. Rebouche CJ, Paulson DJ (1986) Carnitine metabolism and function in humans. Ann Rev Nutr 6:41–66

    Google Scholar 

  30. Rössle C (1988) Untersuchungen zur Physiologie und Pathophysiologie des Carnitin-Stoffwechsels. Einsatz einer optimierten radiochemisch-enzymatischen Methode zur Carnitin-Bestimmung. Dissertation an der Universität Hohenheim, Stuttgart

    Google Scholar 

  31. Rössle C, Kohse KP, Franz HE, Fürst P (1985) An improved method for the determination of free and esterified carnitine. Clin Chim Acta 149:263–268

    Google Scholar 

  32. Ryan RJ, Williams JD, Ansell BM, Bernstein LM (1957) The relationship of body composition to oxygen consumption and creatinine excretion in healthy and wasted men. Metabolism 6:365–377

    Google Scholar 

  33. Sachan DS, Dodson WL (1987) The serum carnitine status of cancer patients. J Am Coll Nutr 6:145–150

    Google Scholar 

  34. Sandstedt S, Larsson J, Cederblad G (1986) Carnitine levels in skeletal muscle of malnourished patients before and after total parenteral nutrition. Clin Nutr 5:227–230

    Google Scholar 

  35. Stavropoulos WS, Crouch RD (1974) A new colorimeter procedure for the determination of serum triglycerides. Clin Chem 20:857

    Google Scholar 

  36. Tanphaichitr Y, Lerdvuthisopon N (1984) Urinary carnitine excretion in surgical patients on total parenteral nutrition. Clin Nutr 2:143–148

    Google Scholar 

  37. Ward ME, Owens CW, Rennie MJ (1980) Nitrogen estimation in biological samples by use of chemiluminescence. Clin Chem 26:1336–1339

    Google Scholar 

  38. Weidler B, v Bormann B, Peil J, Elmadfa I, Schwanen N, Sommermeyer K, Hempelmann G (1987) Does carnitine addition change pharmacokinetic data of a fat emulsion? Clin Nutr 6 (Suppl):105

    Google Scholar 

  39. Winterer JC, Stefee WP, Davy W, Perera A, Uamy R, Scrimishaw NS, Young VR (1976) Whole body turnover in aging man. Exp Geront 11:79–87

    Google Scholar 

  40. Worthley LI, Fishlock RC, Snoswell AM (1984) Carnitine balance and effects of intravenous L-carnitine in two patients receiving long-term total parenteral nutrition. J Parent Ent Nutr 8:717–719

    Google Scholar 

  41. Zurlo F, Schutz Y, Frascarolo P, Enzi G, Deriaz O, Jéquier E (1986) Variability of resting energy expenditure in healthy volunteers during fasting and continuous enteral feeding. Critical Care Medicine 14:535–538

    Google Scholar 

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Rössle, C., Pichard, C., Roulet, M. et al. Einfluß von L-Carnitin-supplementierter total parenteraler Ernährung (TPE) auf die postoperative Fett- und Stickstoff-Utilisation. Klin Wochenschr 66, 1202–1211 (1988). https://doi.org/10.1007/BF01727424

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  • DOI: https://doi.org/10.1007/BF01727424

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