[Effect of intravenous glucose versus glucose-xylose (1:1) administration on carbohydrate and lipid metabolism after trauma and during infection].

OBJECTIVE

To detect the effects of glucose-xylitol infusion versus glucose infusion alone on carbohydrate and lipid metabolism in postoperative stress and during sepsis.

DESIGN

Prospective randomized study (study I after cardiac surgery) and intraindividual cross-over control study (study II in septic patients), respectively.

SETTING

Intensive care unit of a university hospital.

PATIENTS: 18 patients after aortocoronary bypass (ACVB) and 5 patients with sepsis.

INTERVENTIONS: In study I during the first 24 postoperative hours one group (K I, n = 6) received glucose only (2 mg/kg BW/min), a second group (K II, n = 6) a mixture of glucose and xylitol (1:1; 2 mg/kg BW/min) and a third group (K III, n = 6) a glucose-containing electrolyte solution (0.8 mg/kg BW/min). Glucose, lactate, insulin and free fatty acid concentrations were measured pre- and postoperatively in 6-hour intervals over 36 h. In study II patients were firstly given 4 mg glucose/kg BW/min over 6 h, then infusion was changed to a 1:1 glucose-xylitol mixture (4 mg/kg BW/min) for another 6 h. Hepatic glucose production, palmitate oxidation rates and lactate concentrations were determined at the end of both infusion regimens.

RESULTS

Glucose and insulin concentrations were significantly lower in K II and K III than in K I. The highest lactate values were observed 6 h postoperatively in K I. Concentrations of all fatty acids were lower in K I than in K II and K III during the infusion periods. In study II the glucose production and lactate values were significantly reduced during xylitol infusion, whereas palmitate oxidation rates were significantly increased when the infusion regimen changed from glucose to glucose-xylitol mixture.

CONCLUSIONS

These data indicate that energetically ineffective high glucose concentrations were avoided and lactate production was diminished by infusion of glucose-xylitol in study I. In addition, xylitol achieved a higher endogenous release and oxidative utilisation of free fatty acids representing important fuel substrates after trauma and during sepsis.