Reduced metabolic complications in total parenteral nutrition: pilot study using fat to replace one-third of glucose...

The limitations of glucose-based TPN solutions are high glucose concentration, high osmolality, lack of fat, and essential fatty acids, which result in glucose intolerance and hepatotoxic effects. We replaced one-third of the calories in a standard amino acid-glucose solution with Liposyn 10% for 14 days in 23 critically ill men who needed total parenteral nutrition. Serial measurements included weight, albumin, glucose, triglyceride concentrations, and liver function tests. Serum osmolality was calculated, and found to remain constant. Body weight and serum albumin were maintained. Minor changes occurred in hepatic enzymes which were physiologically insignificant. Glycosuria occurred in 15%. Adverse side effects of hypoglycemia, hyperosmolar coma, and hypertriglyceridemia were avoided. Our results show that the addition of fat reduced glucose and hepatic related metabolic complications.