[Glucide intolerance and its pathogenic mechanisms during parenteral feeding]

Hyperglycaemia during parenteral alimentation occurs either as a result of an error in the supplies provided or as a result of diminished carbohydrate tolerance. The circumstances surrounding the development of carbohydrate intolerance are essentially : severe infections, major catabolic states, renal insufficiency, extensive burns, pancreatic problems and diabetes. From a pathogenic standpoint, there are two dominant elements : disturbances in hepatic gluconeogenesis and changes in insulin secretion and in resistance to insulin. The physiopathology is dominated by the risk of hyperosmolarity. Hypoglycaemia occurs most frequently as the result of a manit fest error : too sudded interruption of carbohydrate supplies or two high dosage of exogenous insulin.