Abstract
The metabolic effects of an intravenous lipid emulsion containing medium chain triglycerides (MCTs) were studied in eleven critically ill, ventilated patients receiving parenteral nutrition. The effects were compared in a cross-over study with those of a conventional emulsion containing only long chain triglycerides (LCTs). The lipid was well tolerated, but there were differences in the metabolic effects with a significantly greater increase in the plasma concentrations of glycerol and ketones during MCT/LCT infusion compared to LCT. The plasma concentration of non esterified fatty acids was also higher. This fell rapidly post infusion. Since non esterified fatty acids and ketones are readily available energy sources for tissues lipid emulsions containing MCT may prove valuable for catabolic, critically ill patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ashcroft S, Crossley JR (1975) The effects of glucose, n-acetyl glucosamine, glyceraldehyde and other sugars on insulin release in vivo. Diabetologia 11:279–284
Bach AC, Babayon VK (1982) Medium chain triglycerides. Am J Clin Nutr 36:950–962
Ball M, Sear J (1986) Intravenous feeding; effect on blood gases and complement in critically ill patients. Anaesthesia 41: 423–426
Birkhahn R, Long C, Fitkin D (1981) A comparison of the effects of skeletal muscle trauma and surgery on the ketosis of starvation in man. J Trauma 21:513–519
Border J, Burns G, Rumph C (1970) Carnitine levels in severe infection and starvation. Surgery 68:175–179
Brennan MF, Fitzpatrick GF, Cohen KH, Moore FD (1975) Glyceriol: major contribution to the short term protein sparing effects. Ann Surg 182:386–394
Cederblad G, Schildt B, Larsson J, Liljedahl S (1983) Urinary excretion of carnitine in multiply injured patients on different regimes of total parenteral nutrition. Metabolism 32:383–389
Clarke J, Ball M, Hands L, Dennison A, Kettlewell M (1987) Use of a lipid containing medium chain triglycerides in patients receiving TPN. Br J Surg 74:701–704
Covelli H, Black J, Olsen M, Beckman J (1981) Respiratory failure precipitated by high carbohydrate loads. Ann Int Med 95:579–581
Crowe P, Dennison A, Royle GT (1985) A new intravenous emulsion containing medium chain triglyceride. JPEN 9:720–724
Deckelbaum R, Carpentier Y, Olivecrona T, Moser A (1986) Hydrolysis of medium vs. long chain triglycerides in pure and mixed intravenous lipid emulsions by purified lipoprotein lipases in vitro. Abstract presented at ESPEN, Paris
Dehn MS, Kirkpatrick JR, Blasier R (1984) Alterations in the metabolism of exogenous lipid associated with sepsis. JPEN 8:169–173
Dennison A, Ball M, Crowe P, White K, Hands L, Kettlewell M (1986) The metabolic effects of infusing emulsions containing medium chain triglycerides for parenteral nutrition. J R Coll Surg 68:119–122
Dennison A, Ball M, Crowe P, Hands L, Kettlewell M (1988) Total parenteral nutrition using conventional and medium chain triglycerides. JPEN 12:15–19
Eckart J, Adolph M, van der Muhlen U, Naab V (1980) Fat emulsions containing medium chain triglycerides in parenteral nutrition of intensive care patients. JPEN 4:360–366
Giovanni I, Boldrini G, Castagneto M, Sgange G, Nanni G, Pittiruti M, Castiglioni G (1983) RQ and pattern of substrate utilisation in human sepsis and trauma. JPEN 8:357–360
Johnson RC, Young SK, Cotter R, Rowe WB (1985) Metabolism and distribution of medium chain lipid emulsion. Am J Clin Nutr 41:486 (abstract)
Knaus W, Draper E, Wagner D, Zimmerman J (1985) Apache II; a severity of disease classification system. Crit Care Med 13:818–829
Kolb S, Sailer D (1984) Effect of fat emulsions containing medium chain triglycerides and glucose on ketone body production and excretion. JPEN 8:285–289
Nordenstrom J, Carpentier YA, Askanazi J, Robin A, Elwyn D, Hensle T, Kinney J (1982) Metabolic utilization of intravenous fat emulsion during total parenteral nutrition. Ann Surg 196:221–231
Sailer D, Muller M (1981) Medium chain triglycerides in parenteral nutrition. JPEN 5:115–119
Schuberth O, Wretlind A (1959) Intravenous infusion of fat emulsions, phosphatides and emulsifying agents. Acta Chir Scand 278 (Suppl):1–21
Sherwin RS, Hendler RG, Felig P (1975) Effect of ketone infusions on amino acid and nitrogen metabolism in man. J Clin Invest 55:1382–1390
Shimuzu S, Inoue K, Tani Y, Yamada H (1979) Enzymatic microdetermination of serum free fatty acids. Anal Biochem 98:341–345
Siegel S (1956) Non parametric statistics. International student edition. McGraw-Hill, pp 75–81
Stein TP, Presti M, Leskiw M, Torasian M, Settle R, Buzby GP, Schluter MD (1984) Comparison of glucose, LCT, and LCT plus MCT as calorie sources of parenterally fed rats. Am J Physiol 246:277–286
Tao R, Yoshimura N (1980) Carnitine metabolism and its application in parenteral nutrition. JPEN 4:469–485
Williamson JR, Krebs HA (1961) Acetoacetate as fuel of respiration in the perfused rat heart. Biochem J 80:541–547
Williamson DH, Mellanby J (1974) D-3-hydroxybutyrate and acetoacetate. In: Bergmeyer H (ed) Methods of enzymic analysis, pp 1836–1843
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ball, M.J., White, K. Comparison of medium and long chain triglyceride metabolism in intensive care patients on parenteral nutrition. Intensive Care Med 15, 250–254 (1989). https://doi.org/10.1007/BF00271061
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00271061