[Effect of intravenous glucose versus glucose-xylose (1:1) administration on carbohydrate and lipid metabolism after trauma and during infection].
OBJECTIVE
To detect the effects of glucose-xylitol infusion versus glucose infusion alone on carbohydrate and lipid metabolism in postoperative stress and during sepsis.


METHODS
Prospective randomized study (study I after cardiac surgery) and intraindividual cross-over control study (study II in septic patients), respectively.


METHODS
Intensive care unit of a university hospital.


METHODS
18 patients after aortocoronary bypass (ACVB) and 5 patients with sepsis.


METHODS
In study I during the first 24 postoperative hours one group (K I, n = 6) received glucose only (2 mg/kg BW/min), a second group (K II, n = 6) a mixture of glucose and xylitol (1:1; 2 mg/kg BW/min) and a third group (K III, n = 6) a glucose-containing electrolyte solution (0.8 mg/kg BW/min). Glucose, lactate, insulin and free fatty acid concentrations were measured pre- and postoperatively in 6-hour intervals over 36 h. In study II patients were firstly given 4 mg glucose/kg BW/min over 6 h, then infusion was changed to a 1:1 glucose-xylitol mixture (4 mg/kg BW/min) for another 6 h. Hepatic glucose production, palmitate oxidation rates and lactate concentrations were determined at the end of both infusion regimens.


RESULTS
Glucose and insulin concentrations were significantly lower in K II and K III than in K I. The highest lactate values were observed 6 h postoperatively in K I. Concentrations of all fatty acids were lower in K I than in K II and K III during the infusion periods. In study II the glucose production and lactate values were significantly reduced during xylitol infusion, whereas palmitate oxidation rates were significantly increased when the infusion regimen changed from glucose to glucose-xylitol mixture.


CONCLUSIONS
These data indicate that energetically ineffective high glucose concentrations were avoided and lactate production was diminished by infusion of glucose-xylitol in study I. In addition, xylitol achieved a higher endogenous release and oxidative utilisation of free fatty acids representing important fuel substrates after trauma and during sepsis.
Schricker
T
T
Universitätsklinik für Anästhesiologie, Klinikum der Universität Ulm, BRD.
Gross
G
G
von der Emde
J
J
Georgieff
M
M
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D001026:Coronary Artery Bypass; D003422:Critical Care; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005950:Glucose Solution, Hypertonic / Q000008:administration & dosage*; D006801:Humans; D007328:Insulin / Q000097:blood; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D008055:Lipids / Q000097:blood*; D008099:Liver / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000097:blood / Q000628:therapy*; D012772:Shock, Septic / Q000097:blood / Q000628:therapy*; D013530:Surgical Wound Infection / Q000097:blood / Q000628:therapy; D014994:Xylose / Q000008:administration & dosage*
D001786:Blood Glucose; D005230:Fatty Acids, Nonesterified; D005950:Glucose Solution, Hypertonic; D007328:Insulin; D007773:Lactates; D008055:Lipids; D019344:Lactic Acid; D014994:Xylose
Einfluss intravenöser Zufuhr von Glucose versus Glucose-Xylit (1:1) auf den Kohlenhydrat- und Fettstoffwechsel nach Trauma und während Sepsis.