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Hepatic and Peripheral Glucose Metabolism in Intensive Care Patients Receiving Continuous High- or Low-Carbohydrate Enteral Nutrition

Institute of Physiology, University of Lausanne, Switzerland

Mette Berger, MD

Surgical Intensive Care Unit, Lausanne University Hospital, Switzerland

Jean-Marc Schwarz, PhD

Department of Nutritional Sciences, University of California, Berkeley

Mark McCamish, MD, PhD

Abbott-Ross Laboratories, Columbus, Ohio

Jean-Pierre Revelly, MD

Surgical Intensive Care Unit, Lausanne University Hospital, Switzerland

Philippe Schneiter, PhD

Institute of Physiology, University of Lausanne, Switzerland

Eric Jéquier, MD

Institute of Physiology, University of Lausanne, Switzerland

René Chioléro, MD

Surgical Intensive Care Unit, Lausanne University Hospital, Switzerland

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 [²H ₇]glucose was similarly increased in both groups, indicating absence of its suppression by carbohydrate feeding. Gluconeogenesis estimated from [¹³C]glucose synthesis during [¹³C]bicarbonate infusion also was not suppressed by EN-C compared with EN-L. Systemic appearance of exogenous glucose was monitored by enteral infusion of [6,6-²H] 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)

Journal of Parenteral and Enteral Nutrition, Vol. 23, No. 5, 260-268 (1999)
DOI: 10.1177/0148607199023005260


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