JAMA · 1980 · 351 citations · 0 references
Life SciencesNutritionPhysiologyClinical NutritionMetabolic PhysiologySepsisClinical Nutritional PhysiologyNutritional SupportRespiratory PathophysiologyEnergy Expenditure AnalysisEnergy Expenditure In SepsisGlucose ExposureMinute Ventilation ResponseRespiratory Failure In SepsisRespiratory RegulationTrauma Energy Expenditure
Total parenteral nutrition (TPN) using glucose as nonprotein calories was associated with increases in O<sub>2</sub>consumption (V̇O<sub>2</sub>) and CO<sub>2</sub>production (V̇CO<sub>2</sub>). The magnitude of the changes was a function of the patient's clinical state and glucose load. Depleted patients showed a minimal increase in V̇O<sub>2</sub>, while V̇CO<sub>2</sub>increased 23%. Minute ventilation (V̇<sub>E</sub>) increased 32%. Hypermetabolic patients (major trauma, sepsis) had a 30% increase in VO<sub>2</sub>and a 57% increase in V̇CO<sub>2</sub>, while V̇<sub>E</sub>increased 71%. Patients with mild to moderate injuries (energy expenditure ±15% of normal) showed a 21% increase in V̇O<sub>2</sub>and a 53% increase in V̇CO<sub>2</sub>, while V̇<sub>E</sub>increased 121%. Large carbohydrate intakes were associated with increases in CO<sub>2</sub>production in all patients, while increases in O<sub>2</sub>consumption were seen primarily in hypermetabolic patients. These changes suggest that the high glucose loads of TPN may be a physiologic stress. (<i>JAMA</i>243:1444-1447, 1980)