OBJECTIVES:To study the metabolic effects of a high-dose fat infusion application in the early phase of total parenteral nutrition (TPN) after major trauma.DESIGN:Prospective study in male patients after major trauma.SETTING:Intensive care unit of the University Clinic.PATIENTS:21 male, mechanically ventilated patients after major trauma.INTERVENTIONS:Infusion of Elolipid 20% (Fa. Leopold, Graz, Austria), starting on the 3rd day after ICU admission (0.075 g/kg body weight/h) in 8 h. The dose was increased on the 5th day (0.125 g/kg BW/h) and on the 7th day (0.15 g/kg BW/h).RESULTS:There was a pathologic rise in serum triglycerides on days 3, 5 and 7 during the infusion period. A serious diabetic metabolic state was shown on the 3rd day. No significant changes in urea production rate could be demonstrated after the high-dose fat infusion.CONCLUSIONS:The reason for the decreased fat elimination in patients after major trauma after high-dose fat infusion (8 h) remains unclear (fat clearance or fat oxidation failure). Therefore the fat infusion should be started after normalization of the blood glucose level. Thus the fat infusion should be given continuously over 24 h to avoid serious metabolic complications.

Objectives: To study the metabolic effects of a high-dose fat infusion application in the early phase of total parenteral nutrition (TPN) after major trauma.Design: Prospective study in male patients after major trauma.Setting: Intensive care unit of the University Clinic.Patients: 21 male, mechanically ventilated patients after major trauma.Interventions: Infusion of Elolipid(R) 20% (Fa. Leopold, Graz, Austria), starting on the 3rd day after ICU admission (0.075 g/kg body weight/h) in 8 h. The dose was increased on the 5th day (0.125 g/kg BW/h) and on the 7th day (0.15 g/kg BW/h).Results: There was a pathologic rise in serum triglycerides on days 3, 5 and 7 during the infusion period. A serious diabetic metabolic state was shown on the 3rd day. No significant changes in urea production rate could be demonstrated after the high-dose fat infusion.Conclusions: The reason for the decreased fat elimination in patients after major trauma after high-dose fat infusion (8 h) remains unclear (fat clearance or fat oxidation failure). Therefore the fat infusion should be started after normalization of the blood glucose level. Thus the fat infusion should be given continuously over 24 h to avoid serious metabolic complications.

Ziel: Untersuchung der metabolischen Auswirkung einer Fettinfusion in steigender Dosierung in der frühen Phase der totalen parenteralen Ernährung (TPN). Design: Offene, prospektive Untersuchung an männlichen Patienten nach multiplem Trauma. Rahmen: Intensivstation einer Universitätsklinik. Patienten: 21 männliche, maschinell beatmete Patienten nach einem schweren Trauma. Interventionen: Fettinfusion (Elolipid 20%, Fa. Leopold, Graz, Osterreich) vom 3. Aufnahmetag an in steigender Dosierung: 0,075 g/kg Körpergewicht/h am 3. Tag; 0,125 g/kg KG am 5. Tag und 0,15 g/kg KG am 7. Tag i. v. über jeweils 8 h. Ergebnisse: Die Triglyzeridwerte stiegen am 3. Behandlungstag während und nach der Infusion signifikant an, während der prozentuale Anstieg (gewichtet auf 1 g/kg KG) am 5. Behandlungstag nur unter laufender Fettzufuhr signifikant war. Die Werte nach Beendigung der Fettzufuhr lagen in alien Fallen niedriger als unter laufender Fettzufuhr. Eine Hyperglykämie konnte besonders am 3. Tag beobachtet werden. Es konnte keine Senkung der Harnstoff-Produktionsrate nach hochdosierter Fettgabe beobachtet werden. Schlußfolgerungen: Unter der vorgegebenen Fettzufuhr dürfte es zu einer Überschreitung der Fettelimination gekommen sein, wobei nicht geklärt ist, ob die Clearance oder die Oxidation vermindert war. Das gestörte Verhalten im Glukose-stoffwechsel scheint diese Annahme zu unterstützen. Daraus ergibt sich unseres Erachtens die Notwendigkeit einer entsprechenden Dosisanpassung und einer kontinuierlichen Applikation von Fett über 24 h, wenn die Kohlenhydratzufuhr bedarfsdeckend erfolgt und die Glukosewerte sich im Normbereich befinden, um bei schwer traumatisierten Patienten metabolische Störungen zu vermeiden.

Objective: To determine the effect of short-term recombinant human growth hormone (rhGH) administration on urea production rate (UPR), N balance and aminograms.Design: Prospective, double-blind placebo-controlled study.Setting: Intensive care unit of a University Hospital.Patients: 20 adult patients after major abdominal surgery. Interventions: Postoperative substitution of rhGH (Saizen(R), Serono, Aubonne, CH) in a dose of 0.15 IE/kg BW for 3 days. The serum levels of hGH, insulin-like growth factor-1 (IGF-1), ACTH and cortisol were measured as well as the amino acids in plasma. The degree of catabolism was calculated according to Woolfson's formula, which is based on the UPR, and by calculation of the cumulative N balance.Results: With exception of proline, the plasma amino acids between the groups receiving active substance and total parenteral nutrition (TPN) and those receiving placebo and TPN did not differ significantly. Neither was there a significant difference between the groups for any other parameter measured. The UPR and IGF-1 levels showed only a tendency towards higher values as compared with the placebo group (UPR verum group, values in g/day: 1st measurement, 29.8 +/- 16.7; 2nd measurement, 28.3 +/- 17.7; 3rd measurement, 32.1 +/- 19.1; 4th measurement, 33.1 +/- 21.2. UPR placebo, values in g/day: 1 st measurement, 32.6 +/- 23.9; 2nd measurement, 30.8 +/- 17.9: 3rd measurement 41.6 +/-28.7: 4th measurement, 47.3 +/- 29.5. IGF-1 verum group, values in nmol/l: 1st measurement, 25.7 +/- 19.2; 2nd measurement, 44.8 +/- 23; 3rd measurement, 52.4 +/- 30; 4th measurement, 54.3+/- 20. IGF-1 placebo, values in nmol/l: 1st measurement: 22.9 +/- 11.7; 2nd measurement, 37.0 +/- 19.4, 3rd measurement, 38.4 +/- 21.4: 4th measurement, 40.0 +/- 23.0). The ACTH-cortisol axis was only slightly depressed in the group receiving active substance.Conclusions: We conclude that short-term rhGH administration over 3 days is not capable of significantly reducing the UPR in postoperative patients, but we cannot exclude a significant difference between rhGH group and placebo after a longer administration period.

OBJECTIVE:To determine the effect of short-term recombinant human growth hormone (rhGH) administration on urea production rate (UPR), N balance and aminograms.DESIGN:Prospective, double-blind placebo-controlled study.SETTING:Intensive care unit of a University Hospital.PATIENTS:20 adult patients after major abdominal surgery.INTERVENTIONS:Postoperative substitution of rhGH (Saizen, Serono, Aubonne, CH) in a dose of 0.15 IE/kg BW for 3 days. The serum levels of hGH, insulin-like growth factor-1 (IGF-1), ACTH and cortisol were measured as well as the amino acids in plasma. The degree of catabolism was calculated according to Woolfson's formula, which is based on the UPR, and by calculation of the cumulative N balance.RESULTS:With exception of proline, the plasma amino acids between the groups receiving active substance and total parenteral nutrition (TPN) and those receiving placebo and TPN did not differ significantly. Neither was there a significant difference between the groups for any other parameter measured. The UPR and IGF-1 levels showed only a tendency towards higher values as compared with the placebo group (UPR verum group, values in g/day: 1st measurement, 29.8 +/- 16.7; 2nd measurement, 28.3 +/- 17.7; 3rd measurement, 32.1 +/- 19.1; 4th measurement, 33.1 +/- 21.2. UPR placebo, values in g/day; 1st measurement, 32.6 +/- 23.9; 2nd measurement, 30.8 +/- 17.9; 3rd measurement 41.6 +/- 28.7; 4th measurement, 47.3 +/- 29.5. IGF-1 verum group, values in nmol/l; 1st measurement, 25.7 +/- 19.2; 2nd measurement, 44.8 +/- 23; 3rd measurement, 52.4 +/- 30; 4th measurement, 54.3 +/- 20. IGF-1 placebo, values in nmol/l; 1st measurement: 22.9 +/- 11.7; 2nd measurement, 37.0 +/- 19.4; 3rd measurement, 38.4 +/- 21.4; 4th measurement, 40.0 +/- 23.0). The ACTH-cortisol axis was only slightly depressed in the group receiving active substance.CONCLUSIONS:We conclude that short-term rhGH administration over 3 days is not capable of significantly reducing the UPR in postoperative patients, but we cannot exclude a significant difference between rhGH group and placebo after a longer administration period.