Restricted accessOtherFirst published online 1985-11
A New Intravenous Emulsion Containing Medium-Chain Triglyceride: Studies of its Metabolic Effects in the Perioperative Period Compared with a Conventional Long-Chain Triglyceride Emulsion
The effects of carbohydrate, lipid, and nitrogen metabolism of recently available lipid emulsions containing either 50% medium-chain triglyceride (MCT) and 50% long-chain triglyceride (LCT) or 100% LCT were compared in elective surgical patients. Postoperative urinary urea excretion was similar during isocaloric MCT/LCT and LCT infusions (1.9 mg/kg/min) and was decreased compared with a standard infusion of 5% glucose (1 mg/kg/min). Plasma glucose and insulin concentrations were similar during both lipid and low dose glucose infusions. However, plasma triglyceride and nonesterified fatty acid concentrations were decreased during the MCT/LCT infusion compared with the LCT infusion, suggesting that the MCT/LCT emulsion was cleared from the circulation faster than pure LCT. Ketone body concentrations were similar during all three infusions. MCT/LCT emulsion can be safely infused perioperatively and has similar nitrogen conserving properties to LCT in these circumstances (Journal of Parenteral and Enteral Nutrition9:720-724, 1985)
Get full access to this article
View all access options for this article.
References
1.
Hallberg D.: Studies on the elimination of exogenous lipids from the blood stream. The effect of fasting and surgical trauma in man on the elimination rate of a fat emulsion injected intravenously. Acta Physiol Scand65:153-163, 1965
2.
Schuberth O. , Wretlind A.: Intravenous infusion of fat emulsions, phosphatides and emulsifying agents: clinical and experimental studies. Acta Clin Scand278(suppl):1-12, 1961
3.
Dudrick SJ, Wilmore DW, Vars HM, et al: Long term total parenteral nutrition with growth, development and positive nitrogen balance. Surgery64:134-42, 1968
4.
Wretlind A.: The toxicity of low molecular triglycerides. Acta Physiol Scand46:338-43, 1957
5.
Sailer D., Muller M.: Medium chain triglycerides in parenteral nutrition. JPEN5:115-19, 1981
6.
Eckart J., Adolph M., van der Muhlen U., et al: Fat emulsions containing medium chain triglycerides in parenteral nutrition of intensive care patients. JPEN4:360-6, 1980
7.
Sailer D., Berg G.: Verhalten der Serumfettsauremuster unter Zufuhr einer MCT-Haltigen fettemulsion . Infusionstherapie6:171-4, 1979
8.
Niederau VC, Erckenbrecht Hellman A., et al: Intravenose infusionen von fettemulsion mit mittel- and langkettigen triglyzeriden (MCT/LCT) haben keine ausioirkungen auf die basale und die sekretin-stimulierte pankreassekretion bein menschen. Z Gastroenterol22:42-6, 1984
9.
Bach A., Guisard D., Debry G., et al: Metabolic effects following a medium chain triglyceride load in dogs-influence of the perfusion rate. Arch Int Physiol Biochem82:705-19, 1974
10.
Eckart J., Adolph M.: Elimination of parenterally administered medium chain triglycerides in intensive care patients. JPEN4:427, 1980
11.
Baba N., Bracco EP, Hashim SA: Enhanced thermogenesis and diminished deposition of fat in response to overfeeding with diet containing medium chain triglyceride. Am J Clin Nutr35:678-85, 1982
12.
Guisard D., Debry G.: Metabolic effects of a medium-chain triglyceride emulsion injected intravenously in man. Horm Metab Res4:509, 1972
13.
Yeh YY, Zee P.: Relation of ketosis to metabolic changes induced by acute medium chain triglyceride feeding in rats. J Nutr106 :58-67, 1976
14.
Bach AC, Babayan VK: Medium chain triglycerides: an update. Am J Clin Nutr36:950-62, 1982
15.
McGarry JD, Foster DW: Regulation of ketogenesis and clinical aspects of the ketotic state . Metabolism21:471-89, 1972
16.
Jeejeebhoy KN, Anderson GH, Nakhooda AF, et al: Metabolic studies in total parenteral nutrition with lipid in man. J Clin Invent57:125-36, 1976
17.
MacFie J., Smith RC, Hill GL: Glucose or fat as a non-protein energy source. A controlled clinical trial in gastroenterological patients requiring intravenous nutrition. Gastroenterology80:103-7, 1981
18.
Kirkpatrick JR, Dahn M., Lewis L.: Selective versus standard hyperalimentation : a randomized prospective study. Am J Surg141:116-21, 1980
19.
Babayan VK, Maiz A., Sobrado J., et al: Use of non-traditional lipid sources for parenteral feeding of injured animals. Clin Nutr2(suppl):97, 1983
20.
Pomposelli JJ, Vacicenti AJ, Babayan VK, et al: Medium chain triglycerides (MCT) are efficient energy sources in hepatic insufficiency . JPEN8:88, 1984
21.
Crowe PJ, Dennison AR, Royle GT: The effect of pre-operative glucose loading on post-operative nitrogen metabolism . Br J Surg71:635-7, 1984
22.
Albano JDM , Ekin RP, Maritz G., et al: A sensitive and precise radioimmunoassay for serum insulin. Acta Endocrinol (Copenh)70:487-509, 1972
23.
Williamson DH, Mellanby J., Krebs HA: Enzymic determination of D(-)-β-hydroxybutyric acid and acetoacetic acid in blood. Biochem J82:90-6, 1962
24.
Shimizu S., Inove K., Tani Y., et al: Enzymatic microdetermination of serum free fatty acids. Anal Biochem98:341-5, 1979
25.
Freund H., Yoshikura N., Fischer JE: Does intravenous fat spare nitrogen in the injured rat?Am J Surg140:377-43, 1980
26.
Bark S., Holm I., Hakansson I., et al: Nitrogen sparing effect of fat emulsion compared with glucose in the post-operative period. Acta Chir Scand142:423-7, 1976
27.
Maiz A., Yamazaki K., Sobrado J., et al: Protein dynamics using dextrose and different lipid emulsions in burned rats. JPEN6:592, 1982
28.
Craig RP, Davidson HA, Tweedle D., et al: Intravenous glucose, amino acids and fat in the post operative period. A controlled evaluation of each substrate. Lancet2:8-11, 1977
29.
Brennan MF, Fitzpatrick GF, Cohen KH, et al: Glycerol: major contributor to the short term protein sparing effect of fat emulsions in normal man. Ann Surg182:386-92, 1975
30.
Nordenstrom J. , Carpentier YA, Askanazi J., et al: Free fatty acid mobilization and oxidation during total parenteral nutrition in trauma and infection. Ann Surg198:725-35, 1983
31.
Allison SP: Changes in insulin secretion during open heart surgery. Br J Anaesth43:138-43, 1971
32.
Thiebaud D. , Defronzo RA, Jacot E., et al: Effect of long chain triglyceride infusion on glucose metabolism in man. Metabolism31:1128-36, 1982
33.
Berg G., Sailer D., Bartels O., et al: Komplette parenterale Ernahrung mit MCT- haltigen fettemulsion bei Schwerstkranken einer internistischen intensive pflegestation. Infusionstherapie3:129-32, 1976
34.
Scheig R.: Hepatic metabolism of medium chain fatty acids. IN Medium Chain Triglycerides, Senior JR (ed). Philadelphia, University of Pennsylvania Press, 1968
35.
Newsholme EA, Start C.: Regulation in Metabolism. John Wiley and Son, London, 1973
36.
Foster KJ, Alberti Kgmm, Binder G., et al: Lipid metabolites and nitrogen balance after abdominal surgery in man. Br J Surg66:242-5, 1979
37.
Birkhaln RH , Long CL, Fitkin DL, et al: A comparison of the effects of skeletal trauma and surgery on the ketosis of starvation in man. J Trauma21:513-18, 1981
