Effect of added insulin on body composition of gastroenterologic patients receiving intravenous nutrition--a controlled clinical trial.

The administration of insulin of hypercatabolic patients with burns or multiple fractures has been shown to be associated with increased nitrogen retention during intravenous nutrition (IVN) with solutions of amino acids and hypertonic dextrose. It is not known if gastroenterologic patients in whom the degree of stress is much less, show a similar response. In a controlled study of two comparable groups of 16 gastroenterologic patients on a surgical service who received IVN for 2 wk the changes in body weight, fat, water, protein, and potassium that occurred were measured. The control group received a nutrient solution of hypertonic glucose and amino acids (44.7 +/- 9.0 kcal/kg/day) and the comparative group (45.9 +/- 6.6 kcal/kg/day) in addition had 30 IU of soluble insulin added to each 1006 kcal of nutrient solution. Both groups of patients gained similar amounts of weight, fat, and water, and body protein was maintained to the same extent. Those patients receiving insulin demonstrated a gain of total body potassium (p less than 0.001). The results show that the routine administration of insulin is not indicated in this type of patient, provided that glucose intolerance is absent.