COMPARISON OF LONG-CHAIN AND MIXED MEDIUM LONG-CHAIN FAT EMULSIONS IN POSTOPERATIVE STRESS

Objective: To determine the effect of a pure glucose and of different glucose/fat regimens as nonprotein energy source on substrate metabolism, nitrogen balance, lipoprotein pattern and liver enzymes. Long-chain and mixed long-/medium-chain triglycerid emulsions as 10 and 20% solutions were infused. Design: Prospective randomized study. Setting: General ward of a university hospital. Patients: 29 patients in five groups after colorectal surgery. Interventions: According to Harris-Benedict an amount of 150% of the calculated daily calorie intake was infused. Besides nitrogen balance and routine laboratory tests the lipoprotein pattern was examined. Results: No difference was observed in protein balance, while a pathological rise of liver enzymes was mainly seen with glucose 20% and long-chain fat emulsions in a concentration of 10%. Physiological lipoprotein balance could only be achieved with a 20% solution of long-chain and medium-chain emulsions. Conclusions: The results demonstrate a fast metabolism of the MCT/LCT 20% solution with physiological lipoprotein pattern and no change in liver enzymes. High-dose glucose infusions and long-chain fat emulsions may cause a fatty degeneration of the liver, and 10% MCT/LCT emulsions may cause a rise of phospholipids and a generation of lipoprotein X.