Intravenously administered amino acids with either dextrose or lipid as nutritional support in surgical patients

The relative efficacy of exogenous fat or glucose in preserving lean body mass in surgical patients is controversial. In this study, peripheral intravenously administered amino acids with either lipid or dextrose were given to well nourished patients undergoing elective total cystectomy and ileal diversion. Patients were well matched for age, sex, nutritional status and degree of operative stress. Twenty-eight patients received 1.2 grams per kilogram per day of amino acids plus either dextrose (440 kilocalories per day) (17 patients) or 10 per cent fat emulsion (550 kilocalories per day) (11 patients) for three days preoperatively and seven days postoperatively. No significant differences between the groups were noted in mean nitrogen balances during the preoperative and postoperative periods or in the mean cumulative adjusted (for change in blood urea nitrogen and body weight) nitrogen balances for the total study time. Mean nitrogen excretion per 100 nonprotein calories infused was also similar. Changes in mean body weight, blood urea nitrogen, serum glucose and serum albumin were similar in the two groups. No deaths or major infectious complications occurred in either group. In well nourished patients matched for age, sex, nutritional status and degree of operative stress, the addition of either hypocaloric fat or dextrose to intravenously infused amino acid solutions resulted in an equivalent metabolic and clinical outcome.