COMPARISON OF A STANDARDIZED ALL-IN-ONE N UTRITIONAL SOLUTION (ZPE-GE) WITH A STANDARD MIXED INFUSION THERAPY (HER)

Objective: Comparison of a standardized all-in-one nutritional solutio n with appropriate electrolytes in an one-liter system (ZPE-GE) with a standard hospital mixed infusion therapy (hER). Design: Prospective r andomized study. Setting: Surgical intensive care unit of a university hospital. Patients: Surgical postoperative patients who stayed a mini mum of 6 days on the ICU. Interventions: Administration of a ZPE-GE or an hER. Metabolic parameters (glucose, urea. triglyzerides) and elect rolytes in serum and urine were measured. Results: The two groups of p atients were comparable in terms of their physiological data and of th e severity of illness. Complications and incompatibility were not obse rved with the given regimens. Calories (mean 1,201 kcal/day in the hER group vs. 1,331 kcal/day in the ZPE-GE group) and substrates (glucose : 228 vs. 252 g/day; amino acids: 56 vs. 64 g/day) administered were d eemed balanced. No metabolic imbalances were seen. Electrolyte supply (sodium: 56 mmol/day in the hER group vs. 92 mmol/day in the ZPE-GE gr oup; potassium: 65 vs. 65 mmol/day: phosphate: 15 vs. 19 mmol/day) app ears to be somewhat volatile. Conclusions: All in all, the standardize d all-in-one solution appears advantageous when compared to the custom ary hospital mixtures and is easier to use for ICU and postoperative p atients. A 2,000-ml infusion (300 g glucose and 100 g amino acids) of this solution appears adequate, while a larger amount could supply too many carbohydrates and amino acids. Electrolyte supply should be limi ted to 2,000 ml (120 mmol sodium). Sodium can be reduced to 50 mmol/l in order to prevent corresponding sodium loading. Phosphate supply sho uld be increased to 12 mmol/l. This solution can be used as standard p arenteral nutrition for a large percentage (about 80%) of postoperativ e and posttraumatic patients. Only in extreme situations the individua l components (glucose, amino acids, fats and electrolytes) must be spe cially tailored to prevent metabolic complications. This standardized solution also poses advantages in the qualify of patient care (the tim e savings from not having to mix the solution and the hygiene advantag es).