[Disturbances of lipoprotein and fatty acid metabolism in patients with heavy injuries (author's transl)]

Abstract

Critically ill patients after a heavy accident suffer from major disturbances of hormones and metabolism. To study the origin of these alterations and the mechanisms of lipid transport through plasma in this critical situation plasma lipoproteins and fatty acid distribution were analyzed consecutively in four patients after a heavy accident and during convalescence up to 30 days. In all patients whole plasma cholesterol is reduced below 100 mg/dl, predominantly by a decrease of LDL-cholesterol, but HDL-cholesterol is also reduced. Triglycerides start with very low levels and the following increase of whole plasma triglycerides. Thus, a negative relationship between HDL-cholesterol and VLDL- as well as LDL-triglycerides was found. In HDL the ratio of cholesterol to phospholipids changes from 1.4 to 0.2, indicating major alterations in the composition of this lipoprotein fraction. Apolipoprotein B and total protein in lipoprotein fractions are also decreased by injury. Within 3-5 days linoleic acid levels are decreased in all lipid and lipoprotein fractions of plasma, but most pronounced in cholesterol esters. Arachidonic acid is only decreased in two patients in the phospholipid fraction. As parameter of essential fatty acid deficiency in tissues eicosatrienoic acid (C20:3/9) increases in phospholipids of plasma. Total parenteral nutrition with fat emulsions obtains good results in the normalization of plasma lipoproteins and fatty acid distribution by influencing the composition of VLDL, LDL, and HDL. A supply of up to 56 g linoleic acid per day is necessary to normalize linoleic acid and arachidonic acid levels in plasma lipids. After cessation of the acute reactions of circulation and metabolism fat emulsions can be used in total parenteral nutrition of patients after injury in an amount of 30-40% of energy.