[Reduced parenteral calorie administration after severe multiple injuries]

15 polytraumatized patients were treated within 5 posttraumatic days with reduced calorie and normal amino-acid supply (17 kcal/kg BW as carbohydrates and 1.0 g AA/kg BW). Changes in carbohydrate and protein metabolism were investigated. The fluid volume for parenteral nutrition did not exceed 2,000 ml/day. In spite of restricted carbohydrate dosage, we still needed 28IU of insulin daily to keep the blood glucose within a range of 8-10 mmol/l. Nitrogen balance ranged between -7 and -12 g per day. The unstable serum proteins transferrin, prealbumin, retinol-binding protein and the cholinesterases remained within normal values. Plasma AA showed the familiar pattern of the posttraumatic state with elevated levels of nearly all AA including BCAA although we were using a solution with a reduced BCAA content. The free fatty acids in serum reached values 40% above normal, the triglycerides remained within normal values. Infusion therapy can be considerably simplified by reducing carbohydrate dosage. The risk of intensifying existing metabolic disturbances declines. After five posttraumatic days a combined parenteral/enteral nutrition offering more calories was possible in 70% of our patients.