Single unit infusions of a 10% soy bean emulsion (Intralipid) were evaluated in convalescing men and hypermetabolic thermally injured patients. No significant thermogenic responses to the emulsions occurred in either group. Vital signs, CBC, and liver function studies remained unchanged. Fat clearance curves demonstrated an accelerated plasma disappearance of the emulsion in the acutely burned patients. 133Xenon perfusion diffusion studies were normal, and pulmonary diffusion capacity, using the carbon monoxide rebreathing technic, was also normal following the infusion. Blood gas levels did not change following infusion of single or multiple units of Intralipid. An essential fatty acid deficiency of the red cell membrane was identified in five patients, with a marked decrease in linoleate, arachidonic, decosahexanoic acids, all members of the polyunsaturated fatty acid series which cannot be synthesized de novo. All patients had extensive burns, and most were on long term, fat free, parenteral diets before this essential fatty acid deficiency occurred. Infusing quantities of soy bean emulsion high in polyunsaturated fatty acids corrected the fatty acid deficiency in the red cell membranes. Administering an isocaloric fat free diet to an individual for 2 months resulted in weight gain and wound healing but failed to correct the compositional fatty acid deficiency. Thus, the fatty acid deficiency in red cell membranes appears to be a combination of the stress of thermal injury and nutritional inadequacies, and can be successfully treated by the inclusion of polyunsaturated fatty acids in the diet. Finally, fat emulsion was administered, along with other caloric support, to 10 critically injured individuals. The fat appeared to be utilized without complication, and the fat emulsion contributed 38% of the total caloric intake in this group of patients. The nitrogen and caloric support of these patients resulted in protein sparing in all, as manifested by varying degrees of nitrogen retention related to both extent of injury and the degree of nutritional support. The availability of this emulsion as an isotonic, high caloric, noncarbohydrate, energy source increases the flexibility of the surgeon's repertoire for nutritional support in the severely injured patient.
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