Amelioration of Metabolic Complications of Conventional Total Parenteral Nutrition: A Prospective Randomized Study

doi:10.1001/archsurg.1984.01390230060014

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Vol. 119 No. 11, November 1984

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PAPERS READ BEFORE THE ANNUAL MEETING OF THE SOUTHERN CALIFORNIA CHAPTER OF THE AMERICAN COLLEGE OF SURGEONS, SANTA BARBARA, CALIF, JAN 27-29, 1984

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Amelioration of Metabolic Complications of Conventional Total Parenteral Nutrition

A Prospective Randomized Study

Michael M. Meguid, MD, PhD; Michael P. Akahoshi, PharmD; Susan Jeffers, RN, MS; Robert J. Hayashi, PharmD; William G. Hammond, MD

Arch Surg. 1984;119(11):1294-1298.

Abstract

• The most common metabolic complications of total parenteralnutrition (TPN), glucose intolerance and abnormal liver function,can be significantly reduced when 30% of the glucose caloriesare replaced by fat. We gave 88 patients either conventionalTPN (CON-TPN, 25% dextrose and 4.25% amino acids) or modifiedTPN (MOD-TPN, 15% dextrose, fat, and 5% amino acids). The treatmentgroups were as follows: group A, no surgery with TPN only; groupB, postoperative TPN; and group C, preoperative and postoperativeTPN. Serial blood samples were analyzed for glucose, albumin,triglycerides, and insulin, and for liver function values. Ninepatients manifested hyperglycemia and were removed from thestudy; seven patients had received CON-TPN and two had receivedMOD-TPN. In group A, the insulin level rose 50% less with MOD-TPN.There was a 50% smaller rise in the triglyceride, SGOT, andSGPT levels in patients who received MOD-TPN. Replacing onethird of the TPN glucose calories with fat leads to better glucosetolerance and fewer hepatic complications.

(Arch Surg 1984;119:1294-1298)

Author Affiliations

From the Department of Clinical Nutrition, Division of Surgery, City of Hope National Medical Center, Duarte, Calif.

Footnotes

Accepted for publication July 3, 1984.

Read before the Annual Meeting of the Southern California Chapterof the American College of Surgeons, Santa Barbara, Calif, Jan27, 1984.

Reprint requests to Department of Surgery, University Hospital,Upstate Medical Center, 750 E Adams St, Syracuse, NY 13210 (DrMeguid).

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