[The sugar substitutes fructose and sorbite: an unnecessary risk in parenteral nutrition]

The glucose substitutes fructose, sorbitol and xylitol are still widely used in parenteral nutrition throughout central Europe. Their main advantage, which has led to their widespread use, is their diminished blood glucose raising effect and the absence of a browning reaction during sterilization with amino acids. During infusions with glucose substitutes in severely ill patients with glucose intolerance it is sometimes possible to avoid insulin therapy since the first steps in the metabolism of these carbohydrates are insulin-independent. These advantages are less relevant today since fat emulsions frequently replace some of the glucose given as energy substrate in parenteral nutrition and glucose intolerance is easier to monitor and to treat. - Specific advantages of xylitol are proposed, but this issue needs further clarification. The major objection to fructose, and therefore also to sorbitol, which is metabolized via fructose, is the life-threatening risk in patients with hereditary fructose intolerance. This congenital disorder affects 1 in 21,000 and there have been more than twelve severe complications due to these solutions, most of which were lethal. All the complications occurred in German-speaking countries where fructose and sorbitol are most widely used in parenteral nutrition. Experience over the years has demonstrated that a history of fructose intolerance cannot be obtained, and warning labels on infusion bottles do not avoid this complication. The central European countries are isolated with regard to their use of fructose and sorbitol containing infusion fluids, which involve doubtful advantages but documented lethal risks. Therefore, fructose and sorbitol containing infusion fluids have no further place in our hospital pharmacies.