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Free fatty acid mobilization and oxidation during total parenteral nutrition in trauma and infection

Free fatty acid (FFA) metabolism was studied in 18 traumatized and/or septic patients. Each patient was studied while receiving 5% dextrose (D5W) and after 4 to 7 days of total parenteral nutrition (TPN). Nonprotein energy during TPN was given either entirely as glucose (Glucose System) or as equal...

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Published in:Annals of surgery 1983-12, Vol.198 (6), p.725-735
Main Authors: NORDENSTROM, J, CARPENTIER, Y. A, ASKANAZI, J, ROBIN, A. P, ELWYN, D. H, HENSLE, T. W, KINNEY, J. M
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container_issue 6
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container_title Annals of surgery
container_volume 198
creator NORDENSTROM, J
CARPENTIER, Y. A
ASKANAZI, J
ROBIN, A. P
ELWYN, D. H
HENSLE, T. W
KINNEY, J. M
description Free fatty acid (FFA) metabolism was studied in 18 traumatized and/or septic patients. Each patient was studied while receiving 5% dextrose (D5W) and after 4 to 7 days of total parenteral nutrition (TPN). Nonprotein energy during TPN was given either entirely as glucose (Glucose System) or as equal portions of intravenous fat and glucose (Lipid System). Plasma FFA concentrations were in the normal range on D5W and decreased markedly with TPN. FFA turnover was higher than normal on D5W and did not decrease significantly with TPN. The poor correlation between these two variables emphasizes the need to perform kinetic studies to characterize FFA metabolism in trauma and sepsis. Plasma FFA oxidation and net whole body fat oxidation measured by indirect calorimetry were in the normal range on D5W, 35 and 82%, respectively, of resting energy expenditure (REE). With a glucose intake averaging 108% of REE, plasma FFA oxidation and net fat oxidation decreased to 17 and 13%, respectively, of REE. Nonprotein RQ increased only to 0.94 despite administration of glucose in excess of REE, indicating an abnormal persistence of fat oxidation. During D5W administration, plasma FFA accounted for less than one half of total fat oxidation, indicating that unlabeled fat, such as tissue or plasma triglycerides not in rapid equilibrium with plasma FFA, accounted for the bulk of fat oxidation. Glucagon concentrations which were high on D5W did not decrease significantly with TPN. Insulin concentrations were normal on D5W and increased in response to TPN. The abnormal hormonal milieu may account for much of the abnormal fat metabolism. Administration of large amounts of glucose decreased FFA oxidation much more than FFA mobilization. Thus, the infused glucose acts to increase the rate of "futile cycling" of FFA in these acutely ill patients.
doi_str_mv 10.1097/00000658-198312000-00011
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A ; ASKANAZI, J ; ROBIN, A. P ; ELWYN, D. H ; HENSLE, T. W ; KINNEY, J. M</creator><creatorcontrib>NORDENSTROM, J ; CARPENTIER, Y. A ; ASKANAZI, J ; ROBIN, A. P ; ELWYN, D. H ; HENSLE, T. W ; KINNEY, J. M</creatorcontrib><description>Free fatty acid (FFA) metabolism was studied in 18 traumatized and/or septic patients. Each patient was studied while receiving 5% dextrose (D5W) and after 4 to 7 days of total parenteral nutrition (TPN). Nonprotein energy during TPN was given either entirely as glucose (Glucose System) or as equal portions of intravenous fat and glucose (Lipid System). Plasma FFA concentrations were in the normal range on D5W and decreased markedly with TPN. FFA turnover was higher than normal on D5W and did not decrease significantly with TPN. The poor correlation between these two variables emphasizes the need to perform kinetic studies to characterize FFA metabolism in trauma and sepsis. 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Glucagon concentrations which were high on D5W did not decrease significantly with TPN. Insulin concentrations were normal on D5W and increased in response to TPN. The abnormal hormonal milieu may account for much of the abnormal fat metabolism. Administration of large amounts of glucose decreased FFA oxidation much more than FFA mobilization. Thus, the infused glucose acts to increase the rate of "futile cycling" of FFA in these acutely ill patients.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>6416194</pmid><doi>10.1097/00000658-198312000-00011</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record>
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subjects Adolescent
Adult
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Blood Glucose - metabolism
Calorimetry
Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine
Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition
Energy Intake
Energy Metabolism
Fat Emulsions, Intravenous - administration & dosage
Fatty Acids, Nonesterified - blood
Female
Glucagon - blood
Glucose - administration & dosage
Humans
Insulin - blood
Intensive care medicine
Male
Medical sciences
Middle Aged
Oxidation-Reduction
Parenteral Nutrition
Parenteral Nutrition, Total
Sepsis - blood
Sepsis - therapy
Triglycerides - blood
Wounds and Injuries - blood
Wounds and Injuries - therapy
title Free fatty acid mobilization and oxidation during total parenteral nutrition in trauma and infection
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