Metabolic effects of a D-beta-hydroxybutyrate infusion in septic patients: inhibition of lipolysis and glucose production but not leucine oxidation.
OBJECTIVE
To study the effect of a D-beta-hydroxybutyrate infusion on protein metabolism, lipolysis, and endogenous glucose production in septic patients.


METHODS
Prospective, randomized trial.


METHODS
Intensive care unit (ICU) and metabolic unit at a university hospital.


METHODS
Twelve ICU patients with sepsis and six healthy normal subjects.


METHODS
Septic patients were administered 4-hr infusions of either D-beta-hydroxybutyrate or a control solution, 12 hrs after parenteral nutrition was replaced with an isotonic saline infusion.


RESULTS
The appearance and oxidation rates of leucine (L[1-13C]leucine) and endogenous glucose production (D[6,6-2H2]glucose), plasma fatty acids, and glycerol values were measured before and at the end of infusion of D-beta-hydroxybutyrate or control solution. Unlike the control test, the D-beta-hydroxybutyrate infusion decreased glucose production, fatty acids, and glycerol concentrations, but failed to decrease the leucine oxidation rate.


CONCLUSIONS
Exogenous ketone-bodies infusion decreased lipolysis and glucose production in septic patients but had no beneficial effect on protein metabolism, as evaluated with L[1-13C]leucine.
Beylot
M
M
INSERM U 197, Faculté de Médecine Alexis Carrel, Lyon, France.
Chassard
D
D
Chambrier
C
C
Guiraud
M
M
Odeon
M
M
Beaufrère
B
B
Bouletreau
P
P
D020155:3-Hydroxybutyric Acid; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002247:Carbon Isotopes; D003864:Depression, Chemical; D005260:Female; D005947:Glucose / Q000096:biosynthesis*; D006801:Humans; D006885:Hydroxybutyrates / Q000008:administration & dosage* / Q000494:pharmacology; D007262:Infusions, Intravenous; D007930:Leucine / Q000187:drug effects* / Q000378:metabolism; D008066:Lipolysis / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D010084:Oxidation-Reduction / Q000187:drug effects; D011446:Prospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D013997:Time Factors
D002247:Carbon Isotopes; D006885:Hydroxybutyrates; D007930:Leucine; D005947:Glucose; D020155:3-Hydroxybutyric Acid