SERUM PHOSPHOLIPID FATTY-ACIDS IN SEVERELY INJURED PATIENTS ON TOTAL PARENTERAL-NUTRITION WITH MEDIUM-CHAIN LONG-CHAIN TRIGLYCERIDE EMULSIONS

The final goals of parenteral nutrition of severely injured patients i s to satisfy energy and nitrogen requirements and simultaneously to pr event deficiency of essential nutrients as well as to reduce trauma-re lated metabolic disturbances. To evaluate clinical benefits either by a combination of carbohydrates and a medium-chain/long-chain triglycer ide (MCT/ LCT) lipid emulsion versus carbohydrates as the sole energy donor, 24 ventilated patients with multiple injuries and major head tr auma were investigated. All patients received an isocaloric, isonitrog enous total parenteral nutrition (TPN) regimen consisting of either a no-lipids carbohydrate regimen (CH regimen) or a combined regimen of c arbohydrates plus MCT/LCT emulsion (CH + MCT/LCT regimen), for 8 days in equal groups in the format of a prospective randomized study. After 5 days on the CH regimen, serum phospholipid measurements suggested l inoleic acid deficiency and after 7 days alpha-linolenic acid deficien cy. As a consequence significant decreases in the concentrations of bo th the n-6 and n-3 fatty acids along with a compensatory increase in n onessential n-9 fatty acids were observed. By contrast, the CH + MCT/L CT regimen maintained the concentrations of phospholipid linoleic acid and alpha-linolenic acid, thus preventing fatty acid pattern imbalanc es. The linoleic acid and alpha-linolenic acid metabolite balance was similarly maintained with the CH + MCT/LCT regimen.