Carbohydrates - Guidelines on Parenteral Nutrition, Chapter 5

Overview

Journal Ger Med Sci

Specialty General Medicine

Date 2010 Jan 6

PMID 20049080

Citations 5

Authors

U Bolder

C Ebener

H Hauner

K W Jauch

G Kreymann

J Ockenga

K Traeger

Affiliations

Soon will be listed here.

Abstract

The main role of carbohydrates in the human body is to provide energy. Carbohydrates should always be infused with PN (parenteral nutrition) in combination with amino acids and lipid emulsions to improve nitrogen balance. Glucose should be provided as a standard carbohydrate for PN, whereas the use of xylite is not generally recommended. Fructose solutions should not be used for PN. Approximately 60% of non-protein energy should be supplied as glucose with an intake of 3.0-3.5 g/kg body weight/day (2.1-2.4 mg/kg body weight/min). In patients with a high risk of hyperglycaemia (critically ill, diabetes, sepsis, or steroid therapy) an lower initial carbohydrate infusion rate of 1-2 g/kg body weight/day is recommended to achieve normoglycaemia. One should aim at reaching a blood glucose level of 80-110 mg/dL, and at least a glucose level <145 mg/dL should be achieved to reduce morbidity and mortality. Hyperglycaemia may require addition of an insulin infusion or a reduction (2.0-3.0 g/kg body weight/day) or even a temporary interruption of glucose infusion. Close monitoring of blood glucose levels is highly important.

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References

Valero M, Leon-Sanz M, Escobar I, Gomis P, de la Camara A, Moreno J . Evaluation of nonglucose carbohydrates in parenteral nutrition for diabetic patients. Eur J Clin Nutr. 2002; 55(12):1111-6. DOI: 10.1038/sj.ejcn.1601274. View

Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M . Intensive insulin therapy in critically ill patients. N Engl J Med. 2002; 345(19):1359-67. DOI: 10.1056/NEJMoa011300. View

Baird T, Parsons M, Phan T, Phanh T, Butcher K, Desmond P . Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome. Stroke. 2003; 34(9):2208-14. DOI: 10.1161/01.STR.0000085087.41330.FF. View

Demchuk A, Morgenstern L, Krieger D, Chi T, Hu W, Wein T . Serum glucose level and diabetes predict tissue plasminogen activator-related intracerebral hemorrhage in acute ischemic stroke. Stroke. 1999; 30(1):34-9. DOI: 10.1161/01.str.30.1.34. View

Van den Berghe G, Wouters P, Bouillon R, Weekers F, Verwaest C, Schetz M . Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control. Crit Care Med. 2003; 31(2):359-66. DOI: 10.1097/01.CCM.0000045568.12881.10. View

Baker J, Detsky A, Stewart S, Whitwell J, Marliss E, Jeejeebhoy K . Randomized trial of total parenteral nutrition in critically ill patients: metabolic effects of varying glucose-lipid ratios as the energy source. Gastroenterology. 1984; 87(1):53-9. View

Leutenegger A, GOSCHKE H, Stutz K, Mannhart H, Werdenberg J, Werdenberg D . Comparison between glucose and a combination of glucose, fructose, and xylitol as carbohydrates for total parenteral nutrition of surgical intensive care patients. Am J Surg. 1977; 133(2):199-205. DOI: 10.1016/0002-9610(77)90080-0. View

Ladefoged K, Berthelsen P, Jarnum S, Larsen V . Fructose, xylitol and glucose in total parenteral nutrition. Intensive Care Med. 1982; 8(1):19-23. DOI: 10.1007/BF01686849. View

Mesotten D, Van den Berghe G . Clinical potential of insulin therapy in critically ill patients. Drugs. 2003; 63(7):625-36. DOI: 10.2165/00003495-200363070-00001. View

10.

Finney S, Zekveld C, Elia A, Evans T . Glucose control and mortality in critically ill patients. JAMA. 2003; 290(15):2041-7. DOI: 10.1001/jama.290.15.2041. View

11.

Krinsley J . Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc. 2003; 78(12):1471-8. DOI: 10.4065/78.12.1471. View

12.

Shaw J, Holdaway C . Protein-sparing effect of substrate infusion in surgical patients is governed by the clinical state, and not by the individual substrate infused. JPEN J Parenter Enteral Nutr. 1988; 12(5):433-40. DOI: 10.1177/0148607188012005433. View

13.

Paluzzi M, Meguid M . A prospective randomized study of the optimal source of nonprotein calories in total parenteral nutrition. Surgery. 1987; 102(4):711-7. View

14.

Mizock B . Blood glucose management during critical illness. Rev Endocr Metab Disord. 2003; 4(2):187-94. DOI: 10.1023/a:1022998204978. View

15.

de Chalain T, Michell W, OKeefe S, Ogden J . The effect of fuel source on amino acid metabolism in critically ill patients. J Surg Res. 1992; 52(2):167-76. DOI: 10.1016/0022-4804(92)90300-o. View

16.

Napolitano L . Parenteral nutrition in trauma patients: glucose-based, lipid-based, or none?. Crit Care Med. 1998; 26(5):813-4. DOI: 10.1097/00003246-199805000-00004. View

17.

Keller U . [The sugar substitutes fructose and sorbite: an unnecessary risk in parenteral nutrition]. Schweiz Med Wochenschr. 1989; 119(4):101-6. View

18.

Tappy L, Schwarz J, Schneiter P, Cayeux C, Revelly J, Fagerquist C . Effects of isoenergetic glucose-based or lipid-based parenteral nutrition on glucose metabolism, de novo lipogenesis, and respiratory gas exchanges in critically ill patients. Crit Care Med. 1998; 26(5):860-7. DOI: 10.1097/00003246-199805000-00018. View

19.

Bruno A, Biller J, Adams Jr H, Clarke W, Woolson R, Williams L . Acute blood glucose level and outcome from ischemic stroke. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Neurology. 1999; 52(2):280-4. DOI: 10.1212/wnl.52.2.280. View

20.

Young G, Hill G . A controlled study of protein-sparing therapy after excision of the rectum: effects of intravenous amino acids and hyperalimentation on body composition and plasma amino acids. Ann Surg. 1980; 192(2):183-91. PMC: 1344850. DOI: 10.1097/00000658-198008000-00009. View