Parenteral nutrition in the critically ill: use of a medium chain triglyceride emulsion.
OBJECTIVE
The study investigated the use of an intravenous lipid emulsion containing medium chain triglycerides (MCTs) in critically ill patients, and compared the effects with those of a conventional long chain triglyceride (LCT) preparation.


METHODS
Patients received a parenteral nutrition regime including either 500 ml 20% Lipofundin MCT/LCT (1/1) per day, or 500 ml 20% Lipofundin S (LCT) infused over 8 h each evening.


METHODS
The patients were receiving treatment, including assisted ventilation, in the Intensive Care Unit of a large teaching hospital. All patients on this unit for at least 3 days and who were likely to receive parenteral nutrition for at least a week were considered, unless they had severe renal or liver disease, or trauma/major surgery in the previous 3 days. Because ICU patients are a heterogenous group, subjects were randomised within clinical groups to receive either lipid. There were 24 patients entered into the study and the data on 20 matched patients is reported.


RESULTS
Blood specimens were collected pre-TPN, daily at 0800 and after 5 h lipid infusion on days 1 and 6. Urine collections (24 h) were also performed. There were no apparent adverse effects due to the new MCT/LCT emulsion. Plasma ketone and glycerol concentrations were higher during MCT/LCT infusion, but 8 h post infusion plasma levels of ketones, triglycerides, non-esterified fatty acids and glucose were similar. Urinary carnitine excretion was high in all patients and was not significantly different between the groups. Nitrogen balance was less negative in patients receiving MCT/LCT on days 6 and 9.


CONCLUSIONS
MCTs are rapidly hydrolysed and oxidised to fatty acids and ketones which can be readily utilised. This study indicates that intravenous lipid emulsion containing MCT are safe in critically ill patients and may have advantages over LCT. The number and range of patients studied was, however, small and larger studies are needed.
Ball
M J
MJ
Department of Human Nutrition, University of Otago, Dunedin, New Zealand.
D020155:3-Hydroxybutyric Acid; D000090:Acetoacetates / Q000097:blood; D000328:Adult; D000368:Aged; D001772:Blood Cell Count; D002331:Carnitine / Q000652:urine; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004734:Energy Metabolism; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D005990:Glycerol / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D006885:Hydroxybutyrates / Q000097:blood; D007659:Ketones / Q000097:blood; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D010743:Phospholipids / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D013012:Sorbitol / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D013024:Soybean Oil / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D015996:Survival Rate; D014280:Triglycerides / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*
D000090:Acetoacetates; D004338:Drug Combinations; D005217:Fat Emulsions, Intravenous; D005230:Fatty Acids, Nonesterified; D006885:Hydroxybutyrates; D007659:Ketones; D010743:Phospholipids; D014280:Triglycerides; C008288:Lipofundin; C016635:acetoacetic acid; D013012:Sorbitol; C046535:Lipofundin S; D013024:Soybean Oil; D005990:Glycerol; D002331:Carnitine; D020155:3-Hydroxybutyric Acid