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Hepatic and Peripheral Glucose Metabolism in Intensive Care Patients Receiving Continuous High‐ or Low‐Carbohydrate Enteral Nutrition
Author(s) -
Tappy Luc,
Berger Mette,
Schwarz JeanMarc,
McCamish Mark,
Revelly JeanPierre,
Schneiter Philippe,
Jéquier Eric,
Chioléro René
Publication year - 1999
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607199023005260
Subject(s) - parenteral nutrition , carbohydrate , medicine , enteral administration , carbohydrate metabolism , endocrinology , gluconeogenesis , insulin , metabolism , endogeny , glucose uptake
Background: The suppression of endogenous glucose production during parenteral nutrition is impaired in critically ill patients. It is, however, unknown whether enteral administration of carbohydrates, which normally promote hepatic glucose uptake, improves hepatic glucose metabolism in such patients. Methods: We studied two groups of 7 patients during a 3‐day continuous isocaloric enteral nutrition. A high‐carbohydrate, low‐lipid (EN‐C) or a high‐lipid, low‐carbohydrate (EN‐L) nutrient mixture was administered. Results: Endogenous glucose production assessed with [ 2 H 7 ]glucose was similarly increased in both groups, indicating absence of its suppression by carbohydrate feeding. Gluconeogenesis estimated from [ 13 C]glucose synthesis during [ 13 C]bicarbonate infusion also was not suppressed by EN‐C compared with EN‐L. Systemic appearance of exogenous glucose was monitored by enteral infusion of [6,6‐ 2 H] glucose and was not different from the rate of glucose equivalent administered enterally, indicating no significant hepatic uptake of glucose in both groups. Plasma glucose and insulin concentrations were slightly higher with EN‐C, although not significantly, and plasma triglycerides were similar in both groups. Both nutrition formulas were well tolerated clinically. Conclusions: These results indicate that enteral carbohydrate administration, whatever its quantity, fails to suppress endogenous glucose production and to promote net splanchnic glucose uptake in critically ill patients. (Journal of Parenteral and Enteral Nutrition 23: 260–268, 1999)