An experimental study on parenteral nutrition in sepsis: effect of combined hypertonic carbohydrates or amino acids infusion on postinjury metabolisms
Yan, K.; Ohyanagi, H.; Saitoh, Y.
Kobe Journal of Medical Sciences 29(6): 171-196
1983
ISSN/ISBN: 0023-2513 PMID: 6425555 Document Number: 210125
The appropriate formula for total parenteral nutrition (TPN) under septic conditions was studied. Rabbits with perforated diffuse peritonitis and consequent sepsis were nourished with 4 types of nutrients, i.e., low calorie infusion; conventional TPN (C-TPN); TPN with glucose, fructose and xylitol solution (GFX-TPN); and TPN with high concentrations of amino acids (AA-TPN). The general conditions of the animals and immune defense mechanisms suggested that TPN plays an important role in improving malabsorptive status and depressed immunity in sepsis. No definite evidence was obtained for an optimum TPN composition to combat sepsis. Routine nutritional assessment revealed that GFX-TPN and AA-TPN were of metabolic advantage. In addition to favorable blood glucose and insulin levels, fructose-2,6-bisphosphate and phosphofructokinase activity in the liver suggested that glycolysis was better maintained in GFX-TPN than C-TPN and AA-TPN in situations of severe stress such as sepsis. Changes of serum TG , free fatty acid and ketone body and of liver TG content suggested that lipogenesis was enhanced by TPN; lipid utilization was depressed due to high blood glucose and insulin in C-TPN and not depressed due to the relatively low blood glucose and insulin in GFX-TPN and AA-TPN. In view of glucose and lipid metabolism, therefore, GFX-TPN and AA-TPN were superior to C-TPN; no differences between GFX-TPN and AA-TPN were found.