Intravenous nutrition with high-dose fat emulsion and amino acids without glucose provision after hepatic resection.
OBJECTIVE
Controversy remains regarding the optimal nutrition after hepatic resection. We studied the feasibility and efficacy of an intravenous nutrition with high-dose fat emulsion and amino acids without glucose provision by comparing a glucose-based intravenous nutrition.


METHODS
Twenty-eight patients received either glucose-intravenous nutrition (glucose-IVN group: glucose, 4.2 g; amino acids, 0.8 g/Kg/day) or high-dose fat emulsion and amino acids without glucose provision (HFHA-IVN group: lipids, 2.2 g; amino acids, 1.6 g/Kg/day) for 7 days after hepatic resection (14 patients in each group). Postoperative changes in biochemical tests and plasma levels and arterial-venous concentration differences of amino acids and total ketone bodies across the leg were compared between the two.


RESULTS
The 2 groups were comparable regarding perioperative patients' characteristics. None of the patients from either group developed any complications. Postoperative glucose levels showed normal in the HFHA-IVN group, but elevated in the glucose-IVN group. Seven of the glucose-IVN group patients required exogenous insulin administration. Lipid levels were decreased in the glucose-IVN group, but remained normal in the HFHA-IVN group. The HFHA-IVN group showed higher amino acid levels, higher amino acid release, and hyperketonemia and vigorous uptake of ketones by skeletal muscle.


CONCLUSIONS
These results indicate that dextrose provision is not essential and the HFHA-IVN provides an alternative to glucose-based intravenous nutrition in patients developing glucose intolerance after hepatic resection.
Department of Surgery II, Ehime University School of Medicine, Japan.
M
M
Sato
Y
Y
Watanabe
K
K
Tokui
T
T
Yamamoto
Y
Y
Hamada
T
T
Kohtani
K
K
Kawachi
D000368:Aged; D000596:Amino Acids / Q000008:administration & dosage*; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000379:methods*; D011184:Postoperative Period; D011446:Prospective Studies
D000596:Amino Acids; D005217:Fat Emulsions, Intravenous