Parenteral Infusion of Long‐ and Medium‐Chain Triglycerides and Reticuloendothelial System Function in Man

Abstract

Previous study demonstrated that patients who received total parenteral nutrition (TPN) with standard intermittent infusion of long chain triglyceride (LCT) at 0.13 g kg^-1hr^-1 over 10 hr for each of three days showed a significant decline in ⁹⁹Tc-sulfur colloid (TSC) clearance rate by the reticuloendothelial system (RES). The present studies evaluated eight patients who received the same total lipid dose of LCT infused continuously as in a three-in-one admixture, and another nine patients receiving the same amount of fat as a medium chain triglyceride (MCT)/LCT (75%/25%) emulsion intermittently over 10 hr at 0.13 g kg^-1hr^-1 for three consecutive days. Patients were given continuous total parenteral nutrition (TPN) comprised of protein, 1.5 g kg^-1day^-1, and dextrose, 4.5 g kg-1day-l. RES function was examined by measuring the clearance rates of intravenously injected TSC while receiving TPN containing only protein and dextrose, and again after three days of fat infusion. Mean (±SEM) clearance rate constants before and after continuous LCT infusion were 0.38 ± 0.09 and 0.41 ± 0.08 min^-1, respectively, while those before and after intermittent MCT/LCT infusion were 0.50 ± 0.18 and 0.73 ±- 0.24 min^-1, respectively. In contrast to intermittent LCT infusion, the administration of continuous LCT or an intermittent MCT/LCT mixture does not impair TSC clearance by the RES. These findings suggest that condensing the daily period of LCT infusion at standard dosage may exceed the rate of metabolic utilization, resulting in increased fat removal and diminished TSC uptake by the RES. The provision of fat principally as MCT or by a continuous mode of administration may enable adequate metabolism of lipid emulsion without RES dysfunction, and so may be of particular benefit in critically ill or septic patients. (Journal of Parenteral and Enteral Nutrition 14: 467-471, 1990)