[Behavior of the metabolism in gastric patients during a 4-day-long postoperative complete parenteral feeding with amino acids and a glucose-levulose-xylitol combination solution]

Serum enzyme, bilirubin, uric acid, and cholesterol concentration changes during 7 days of total parenteral nutrition

Lactic dehydrogenase, glutamic oxalacetic transaminase, and alkaline phosphatase remained within normal limits during 7 days of total parenteral nutrition. Five patients showed a rise of total bilirubin up to 1.1 mg/100 ml on the fifth postoperative day, with no change in serum enzymes. Uric acid concentration fell continuously up to the third postoperative day (but within normal limits) and remained decreased until the end of infusion. During the preoperative nutrition period and after surgical intervention, cholesterol concentration showed a steep fall. Very low cholesterol concentrations can cause an alteration of erythrocyte membrane synthesis and should, therefore, be avoided.

[Differences in postoperative metabolism in reference to pre- and postoperative initiation of total parenteral nutrition. I]

We investigated the postoperative metabolism of patients undergoing gastric resection by beginning total parenteral nutrition pre- (group 1) and postoperatively (group 2). A third group remained fasting until 3 h after the surgical intervention. Because of the high serum glucose concentrations and the high glucose losses in the 24-h urine on the operation day in group 1 and 2 only the base glucose requirement (150--250 g/24/h) should be given in the early postoperative period. The low blood glucose concentration in group 3 and the elevated lactate values in group 2 underline this recommandation. Compared with group 2 and 3, group 1 had low free fatty acid concentrations of 250 micronVal/l because of the continuous pre-, intra-, and postoperative infusion. Compared with normal metabolic conditions, the free fatty acids do not seem to have the same insulin-antagonizing effect in the posttraumatic state. The fall of cholesterol after the surgical trauma reached its maximum after 12--15 h and amounted to about 40 mg% in the first two groups. Albumin and total protein fell continuously in group 1 and 2. The electrophoresis in group 1 showed a rise of alpha 1- and alpha 2-globulin to more than double the initial value, the beta-globulin showed only slight changes, the gamma-globulin dropped only slightly up to the 4th postoperative day. As a sign of an augmented catabolism the serum urea concentration rose during the postoperative state. Group 1 and 2 had a favourable nitrogen balance. The postoperative bilirubin rise could be held lower in group 1 compared to group 2.

[Changes in several important metabolic parameters and insulin level during a 7-day total parenteral nutrition under pre- and postoperative conditions]

After the 24 hours preoperative infusion period 0.37% glucose, 0.05% fructose and 1.28% xylitol of the infused amount were excreted in the urine. Postoperatively fructose was the best metabolized energy donator before xylitol and glucose. As a sign of an undisturbed hepatic synthesis of lipoproteins the triglycerides rose up to the 5th postoperative day. During the parenteral nutrition and the additional surgical intervention the cholesterol fell from 192.3 to 128.5 mg/100 ml on the first postoperative day. The infusion solutions caused a rise of the insulin concentration from 23.2 to 46.3 U/l on the operation day. There is a positive nitrogen balance of 3.5 g/24 h on the operation day. The slight negative balance of - 1.15 g/24 h on the first postoperative day is reduced to - 0.61 g/24 h on the postoperative day. The changes of the enzymes LDH, GOT and AP were at normal range. The postoperative changes were due to the surgical intervention. Without a simultaneous change of enzymes, 5 patients had a rise of bilirubin up to 1.1 mg/100 ml. To avoid a too great loose of phosphate during a long-term parenteral nutrition period, it is important to put up a balance.