Immediate metabolic effects of different nutritional regimens in critically ill medical patients.
OBJECTIVE
Metabolic effects of different caloric regimens were investigated in nonsurgical, medical patients with multiple-organ failure (MOF).


METHODS
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 medium-chain 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.


METHODS
The study was conducted in a medical intensive care unit.


METHODS
Twenty patients with MOF on mechanical ventilation (mean Apache II score x = 26) were investigated.


RESULTS
The mean values of the EE (x = 31 kcal/kg per day), BT (x = 38 degrees C), PB (x = 1.5 g/kg per day), and lactate (x = 2.0 mmol/l) and glucose level (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 metabolic 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.
Müller
T F
TF
Department of Nephrology, Philipps-University, Lahn, Germany.
Müller
A
A
Bachem
M G
MG
Lange
H
H
D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001806:Blood Urea Nitrogen; D001831:Body Temperature; D016638:Critical Illness; D002149:Energy Intake; D004734:Energy Metabolism; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D006801:Humans; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000378:metabolism* / Q000628:therapy*; D015596:Nutrition Assessment; D010289:Parenteral Nutrition, Total / Q000379:methods*; D012121:Respiration, Artificial
D001786:Blood Glucose; D005217:Fat Emulsions, Intravenous; D007773:Lactates; D019344:Lactic Acid