Twenty
critically-ill surgical patients who needed
total parenteral nutrition were randomly enrolled in a double-blind study comparing two
intravenous fat emulsions: one containing a mixture of 50% medium-chain
triglycerides and 50% long-chain
triglycerides and another containing 100% longchain
triglycerides. The purpose of this study was to investigate metabolic and biochemical differences between both
emulsions with special reference to liver
enzymes. After a baseline period of 24 h with only
glucose and NaCl infusion, the
lipid emulsion was added continuously during 24 h over 5 days. The
parenteral nutrition was administered in mixture bags containing
amino-acids,
glucose and
lipids together. Two-thirds of the non-
protein calories were administered as
glucose 40% and one third as either long-chain
triglycerides or a mixture of medium-chain
triglycerides and long-chain
triglycerides. The total amount of non-
protein calories received was the measured energy expenditure during the baseline period plus 10% and was fixed during the study. Plasma substrate concentrations, energy expenditure, and
nitrogen balance were determined and arterial blood samples were taken. No toxic effects or complications attributable to one of the two
emulsions were observed. There was no significant difference in energy expenditure,
nitrogen balance, liver function tests,
carnitine,
transferrin, pre-
albumin,
albumin,
cholesterol,
triglycerides and
free fatty acids. The only parameter that showed a different pattern of reaction between the two
emulsions was serum
bilirubin concentration. In this study no evidence of any advantageous effect of a mixture of medium-chain
triglycerides and long-chain
triglycerides was seen.