[Progress in the field of parenteral feeding].Fortschr Med. 1979 Oct 25; 97(40):1804-8.FM
A calorie sufficient intravenous nutrition for the severely ill is possible today with practically no limitations. Carbohydrates and fats are available as energy-donators. The maximum administration rate for glucose is 0.5 g/kg/h, however, in the postoperative phase it is only 0.25 g/kg/h. The dosage limit for fructose and sorbitol is likewise 0.25 g/kg/h and only 0.125 g/kg/h for xylitol. By taking advantage of the various metabolic pathways for the individual carbohydrates, a mixed-carbohydrate solution has been developed which is utilizable in a dosage of 0.5 g/kg/h. The fat emulsions which are commercially available today consist of soy bean oil with egg lecithin or phosphatides as emulsifiers. They are well tolerated and offer several advantages in contrast to high-percentage carbohydrate solutions. In newer developments, MCT fats are added as quickly utilizable substrates. Only L-amino acids should be used today in parenteral nutrition because of their specific utilization by the organism. In addition to the administration rate (0.1 g/kg/h), the relationship between essential and non-essential amino acids is decisive for utilization, whereby the so-called E/T ratio should be as high as possible. Improved substrate utilization can be achieved through the simultaneous administration of carbohydrates, protein and fat as well as minerals and vitamins, whereby the total daily requirement can be administered within 12 hours without metabolic dysfunction.