AKTUELLER STAND DER PARENTERALEN ERNAHRUNG MIT FETTEMULSIONEN. KLINISCHE ERFAHRUNGEN MIT SEPTISCHEN PATIENTEN

In sepsis the utilization of endogenous and administered fuel sources is sometimes impaired. The precise origin of this metabolic failure is currently unknown. In long term and severe septic processes an increased peripheral energy deficit appears accompanied by a drastically augmented muscle protein catabolism. Branched chain amino acids released by this protein breakdown, at least temporarily, meet the energy needs of the muscles. Ketone bodies as energy source for the muscle are not available because their production is diminished in sepsis. The question of whether or not fat emulsions can be administered to septic patients still remains unanswered, although some recent investigations have demonstrated that fat is utilized and oxidized by septic patients. Results from our patients indicate that a marked reduction of cholesterin ester quotient, an increase of total and VLDL triglycerides and a severe reduction of HLDL cholesterin are particularly characteristic changes in lipid metabolism during sepsis. The proportional decrease of the linoleic acid levels in cholesterol esters of plasma observed in septic patients was even more pronounced followed severe injury. Together with others we believe that parenteral fat application is not contraindicated in sepsis. The decision to infuse fat emulsions depends more on the metabolic situation of a patient than on a specific diagnosis; in other words, a sufficient peripheral oxygen supply, the level of the serum triglycerides and the reaction of the blood glucose concentration to an intravenously administered fat emulsion are, among others, the decisive factors.