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Postoperative parenteral nutrition can only be optimally effective if the characteristics of post-traumatic metabolism are taken into account. Two main possibilities are discussed for the carbohydrate component of parenteral nutrition during this phase: glucose with high doses of insulin or non-glucose carbohydrates (sugar substitutes) possibly in a suitable combination with glucose. The risks as well as the technical and organisational problems involved in the use of them are discussed and the authors prefer the second of the two alternatives. Possible side effects of non-glucose carbohydrates are pointed out and it is shown how these can be avoided by observing dose guidelines. So far a combination of frucose : glucose : xylitol in a ratio of 2 : 1 :1 with a total dose of 0.50 g/kg/hour has been studied most thoroughly. This combination normalises the fat metabolism and improves glucose tolerance without requiring exogenous insulin. Experiences with this combination as well as individual non-glucose carbohydrates on operated patients have been given continuously for up to 7 days and in some cases even for several weeks. No side effects, no deviations from a steady state and no abnormal changes of the laboratory values occurred. The authors are of the opinion that non glucose carbohydrates are necessary if the facilities for frequent blood sugar controls are not available.

We studied 20 patients following vaginal hysterectomy until the third postoperative day. 10 patients (group I) in this randomized controlled study were infused only with water and electrolytes in a volume of 40 ml/kg BW. 10 patients (group II) received a 3.5% amino-acid solution with 6% carbohydrates in the same volume. In group II the nitrogen balance was significantly better than in group I. The nitrogen retention of 81% was judged as rather good. We have shown that there were no changes in the concentration of free plasma amino acids in group II, opposite we found significant changes especially in the branched-chain amino acids and alanine in group I. The normalization of metabolized amino acids and the normal concentration of the nonesterified fatty acids in group II demonstrated that the utilization of added amino acids took place not only in peripheral but also in visceral tissues. Our study indicates that the proven amino-acid solution can be recommended as peripheral-venous parenteral nutrition in the postoperative phase.

The pattern of the amino acids in plasma of 22 polytraumatized patients who obtained a standardized total parenteral nutrition over a period of 3-10 days was studied. Following to the trauma - before the infusion period - a rapid decrease of concentration of a part of the amino acids appeared. During the period of parenteral nutrition nearly all of the amino acids showed a different increase in plasma, partly manifold over their normal range which resulted in a disturbance of the pattern of the amino acids. Particularly the influence of the infusion therapy on the sulfur-containing amino acids, the branched-chain amino acids and the glycine level in plasma is discussed.