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KMID : 0356019880030010035
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Koean Jounral of Critical Care Medicine
1988 Volume.3 No. 1 p.35 ~ p.41
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Resting Period during Total Parenteral Nutrition
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Abstract
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It has been believed that the continuous infusion of the hypertonic solution can prevent the metabolic complications, such as, hyperglycemia, hypoglycemia, osmotic diuresis or dehydration. However, man, as a$quot; meal eater$quot; usually has a cyclic elevation in serum glucose and insulin level. This cyclic phenomenon is very different from the persistently elevated levels of serum glucose and insulin with the continuous glucose infusion in total parenteral nutrition. Hypertonic glucose solutions induce high plasma insulin concentration, which inhibit the action of the hormone-sensitive lipase and decrease the body fat mobilization. The excess of glucose is converted into fat synthesis and on occasions, use fatty infiltration of the liver.
The present study was undertaken to assess the impact of the resting period during total parenteral nutrition on serum glucose, insulin and free fatty acid levels and on the generation of symptomatic hypoglycemia. In this study, we set the resting period four hours during which no dextrose solution was given. Serum glucose, insulin and free fatty acid levels were measured at the end of infusion of TPN solution, 2 hours and 4 hours after rest.
In conclusions;
1) Blood glucose level went down maximally 2 hours after rest and then slightly elevatea.
2) High plasma insulin level decreased sharply to normal range, and then it made a plateau curve after 2 hours of rest.
3) The increased lipolytic effect was observed. with the increase of the free fatty acid levels in plasma during resting period.
4) In spite of acute discontinuation of the hypertonic glucose solution during resting period, no hypoglycemic symptoms were developed in any case.
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