Total Parenteral Nutrition with Vamin and Intralipid

Abstract

The present study was undertaken to evaluate the efficacy of total parenteral nutrition (TPN) with a solution containing 10% fructose and 7% crystalline amino acid (Vamin), administered with equal volumes of a 10% soybean oil emulsion (Intralipid). The two solutions are available in separate sterile containers and therefore solution preparation is not required. Because the 10% Intralipid emulsion is isotonic, a central venous catheter is not required. Patients referred for TPN were randomly allocated to receive either the Vamin and Intralipid combination or a solution containing 2.5% L-amino acids (Travasol) and 25% dextrose. The efficacy of each solution was assessed by determining body composition by multiple isotope dilution, at the onset, at 2-week intervals during, and at the completion of, TPN. In 49 patients receiving Vamin and Intralipid, 109 body composition studies were performed to evaluate 61 periods of TPN of 14.6 ± 0.5 days duration. One hundred and sixty-seven studies were performed in 73 patients receiving TPN with hypertonic dextrose to evaluate 92 periods of TPN of 15.3 ± 0.5 days. In the absence of preexisting malnutrition, both solutions maintained body composition. In the presence of preexisting malnutrition, TPN with the Vamin and Intralipid combination maintained, but did not improve, body composition. However, TPN with the hypertonic dextrose solution resulted in a significant improvement in the nutritional state with an increase in the body cell mass, accompanied by a contraction of the extracellular mass. Conventional TPN with 2.5% crystalline amino acids and hypertonic dextrose was superior to TPN with Vamin and Intralipid.