title: Effect of low-calorie parenteral nutrition on the incidence and severity of hyperglycemia in surgical patients: a randomized, controlled trial.
abstract: OBJECTIVE
  To determine the effect of a low-calorie parenteral nutrition (PN) regimen on the incidence and severity of hyperglycemia and insulin requirements.
  
  
  METHODS
  Prospective, randomized, clinical trial.
  
  
  METHODS
  Urban, university-affiliated, level-I trauma center.
  
  
  METHODS
  Consecutive surgical patients requiring PN.
  
  
  METHODS
  Patients were randomized to receive either a low-calorie PN formulation (20 nonprotein kilocalories per kg per day) or a standard PN formulation (30 nonprotein kilocalories per kg per day). Lipid-derived calories were standardized to 1000 kilocalories three times weekly for all patients; consequently, the number of calories varied only by the amount of carbohydrate administered. Protein requirements were individualized on the basis of estimated metabolic stress. Hyperglycemia was defined as a blood glucose level > or = 200 mg/dL.
  
  
  RESULTS
  Forty patients were evaluated (low-calorie PN, n = 20; standard PN, n = 20). Demographics of the two groups were similar. The incidence of hyperglycemic events was significantly lower in the low-calorie group (0% [0-0.5] vs. 33.1% [0-58.4]; p = .001]. Additionally, the severity of hyperglycemia was also lower in the low-calorie group (mean glucose area under the curve = 118 +/- 22 [mg x hr]/dL vs. 172 +/- 44 [mg x hr]/dL; p < .001). This resulted in lower average daily insulin requirements (0 [0-0] units vs. 10.9 [0-25.6] units; p < .001.). The only predictor of hyperglycemia was a dextrose administration rate >4 mg/kg/min.
  
  
  CONCLUSIONS
  : Administration of a low-calorie PN formulation resulted in fewer and less-severe hyperglycemic events and lower insulin requirements. PN regimens should not exceed a dextrose administration rate of 4 mg/kg/min to avoid hyperglycemic events.
authors.affiliation: Department of Pharmacy, The Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Ahrens
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Barletta
authors.forename: Salmaan
authors.initials: S
authors.lastname: Kanji
authors.forename: James G
authors.initials: JG
authors.lastname: Tyburski
authors.forename: Robert F
authors.initials: RF
authors.lastname: Wilson
authors.forename: James J
authors.initials: JJ
authors.lastname: Janisse
authors.forename: John W
authors.initials: JW
authors.lastname: Devlin
mesh_terms: D019540:Area Under Curve; D002149:Energy Intake; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000145:classification / Q000188:drug therapy / Q000209:etiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects*; D011184:Postoperative Period; D012720:Severity of Illness Index; D014193:Trauma Centers
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin