The authors report on the metabolic alterations which occurred in 32 of 118 patients undergoing Total Parenteral Nutrition (TPN) in Intensive Care (total 1,636 days). The nutrient solutions consisted of 50 percent glucose or fructose (yielding about 2,800 Cal/day) and a crystalline amino acid mixture (prevalently at 8.5%); no fat emulsions were included. Comparison is made between glucose and fructose based solutions. The metabolic alterations were observed above all when TPN was prolonged over 20 days and in critical patients. Laboratory findings included: 1) increase of cytolytic indices (SGOT, SGPT, GLDH), 2) increase of cholestatic indices (bilirubin, alkaline phosphatase, LAP, gamma-GT), 3) increase in the indicators of carbohydrate metabolism (PHI, LDH), 4) protein metabolism alterations (decrease of proteinemia and PCH). These alterations are consistent with impairment of liver function. This conclusion is supported by: 1) frequent clinical findings of hepatomegaly and jaundice, 2) alterations of liver histological morphology in biopsy or autopsy examination (steatosis, hepatocellular damage, intrahepatic cholestasis). In favourable cases, these laboratory alterations were reversible. Hypotheses concerning the etiology of these alterations are presented. The data indicate that hypertonic fructose solutions caused less frequent alterations.
|Journal||Intensive Care Medicine|
|Publication status||Published - 1977|
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine