Oxidation of Intravenous Lipid in Infants and Children With Systemic Inflammatory Response Syndrome and Sepsis

Abstract

During sepsis in adults, fat becomes a preferred fuel; however, oxidation may be impaired relative to the circulating fatty acid levels. Little is known about the ability of infants and children to oxidize lipids during systemic inflammation (SIRS) and sepsis. The aim of this study was to examine the oxidation of exogenous lipid in these patients. Sixteen patients with SIRS/sepsis and eight controls with no evidence of sepsis were studied by indirect calorimetry during an i.v. lipid utilization test (1 h of 0.3 g/kg/h glucose followed by 3 h of 0.1 g/kg/h glucose plus 0.15 g/kg/h lipid). The respiratory quotient (RQ) (1.0 for carbohydrate utilization and 0.7 for fat utilization) was measured. Results were compared by repeatedmeasures analysis of variance (ANOVA), paired or unpaired t tests.

Lipid Peroxidation and Antioxidant Consumption as Early Markers of Neurosurgery-Related Brain Injury in Children

“…Plasma and CSF malondialdehyde (MDA) levels, a marker of lipid peroxidation, were measured by the high-performance liquid chromatography. Plasma MDA was measured as previously described using 25 μl plasma [6]. For CSF, 100 μl CSF was incubated with 2.5 μl (0.2% w/v) butylated hydroxytoluene in ethanol plus 375 μl 1% (v/v) phosphoric acid for 10 min, and 345 μl 0.22% thiobarbituric acid and incubated for 60 min at 100 °C for 60 min.…”

“…After cooling, the MDAthiobarbituric acid derivative was extracted with 400 μl butanol. To an autosampler vial, 250 μl butanol phase was transferred, butanol evaporated off under N2 at 80 °C, and the MDAthiobarbituric acid derivative redissolved in 150 μl buffer and analyzed by HPLC as for plasma [6].…”

Monitoring CO2 in shock states

“…However, the expected change in _ VCO 2 is not necessarily equal to the change in _ VO 2 . For example, when the metabolic rate is increased as a result of injury or sepsis, fat metabolism tends to increase and the RQ decreases [12][13][14].…”

Nutritional support to patients within the pediatric intensive setting

“…Parenteral lipid emulsions (ILE) supplies essential fatty acids and energy and are calorie dense so that the volume required for nutrition can be reduced, which is important considering the frequent need of fluid restriction among patients in the PICU. Even infants with systemic inflammatory response syndrome (SIRS) and sepsis have the capacity to oxidize intravenously administered ILE without increased lipid peroxidation, provided a limited glucose supply is given simultaneously (100). When PICU patients are parenterally fed, it is advisable to provide approximately 30% of the nonprotein calories as ILE (90).…”