[Regulation of ketone body levels before and following elective surgical operations during different intravenous feedings]

Abstract

44 patients who had to undergo gastric resection and 28 patients who had to undergo cholecystectomy were divided into 4 groups each. Each group received parenterally a different energy source and calorie-nitrogen ratio. We intended to investigate the influence of different intravenous regimens on pre- and postoperative acetoacetate and beta-hydroxybutyrate levels. Patients undergoing gastric resection who received 0.36 g glucose/kg BW x h together with 1.14 g/kg BW x day 1-crystalline amino acids had the lowest postoperative ketone body concentration. A comparable group who received 0.36 g/kg BW x day of a carbohydrate-mixture solution consisting of glucose-fructose and xylitol in a proportion of 1:1:1 had significantly higher ketone bodies. The comparison of glucose with xylitol in a hypocaloric dosage of 0.11 g/kg BW x h led to a physiologic ketosis only in the group with xylitol as energy source from postoperative day 2 on. In patients undergoing cholecystectomy, the sole infusion of amino acids in a dosage of 1.14 g/kg BW x h led to the highest ketone bodies from the operation day on. The intravenous infusion of a polyol-mixture solution containing xylitol and sorbitol in a relation of 1:1 in a dosage of 4.2 g/kg BW x day led to the lowest ketone body production. The infusion of a polyol-mixture solution in a dosage of 2 g/kg BW x day enabled the development of a physiologic ketosis. In this study we could demonstrate that the infusion of xylitol or a polyol-mixture solution in a dosage of 2-3 g/kg BW x day after elective surgery enables the development of physiologic ketosis.