Despite the fact that previous authors have already reported a good tolerance of infants and children to high glucose load in total parenteral nutrition (TPN), very little is known on the relative importance of endocrine factors maintaining homeostasis in patients fed with this very unphysiological type of nutrition. 21 infants were carefully followed monitoring blood sugar values before, during and after TPN; insulin, HGH and cortisol levels were measured by immunoassay methods in most of these cases. During the first 24 hr of TPN blood glucose levels rose significantly, but remained between clinically acceptable levels. Subsequently no variations from normal values were observed, except after sudden cessation of the infusion, when asymptomatic hypoglycemia was noticed. Plasma insulin levels were found well above basal values only during the first 24 hr of TPN. HGH plasma concentrations on the contrary fell from normal basal levels to very low values through all the TPN period. Also, cortisol concentration values were found to be low during TPN. After cessation of parenteral nutrition a further decrease of insulin concentrations was noticed, HGH remained very low and, in the only one case which was examined, cortisol rose sharply. The importance of controlling very carefully the constant rate of infusion and the possible interference of intercurrent infections is reported. From an overall evaluation of these data it is suggested that variations in insulin, HGH and cortisol plasma concentrations do play a very important role maintaining glucose homeostasis only during the first 24 hr after starting TPN. Subsequently the mechanism which controls blood glucose concentrations during chronic intravenous high carbohydrate load must still be clarified.
|Translated title of the contribution||Total parenteral nutrition with fat free solutions. I. Glucose tolerance and plasma concentrations of insulin, HGH and cortisol|
|Title of host publication||RIV.ITAL.PEDIAT.|
|Number of pages||10|
|Publication status||Published - 1975|
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