Carbohydrate

Adults A high carbohydrate:fat ratio is associated with better maintenance of body weight. However, this may reflect increased fat accumulation rather than an increase in protein synthesis. Hyperglycemia alone can increase alanine efflux from skeletal muscle, without stimulating protein synthesis. Euglycemia, using exogenous insulin with high glucose delivery, can inhibit amino acid oxidation and favor amino acid synthesis. This may reflect an effect of IGF-1, which is released in response to insulin. In addition, hyper-glycemia stimulates hepatic lipogenesis and increased CO2 production, which may prevent weaning from ventilatory support. Hyperglycemia must therefore be prevented.

Children In children, carbohydrate is more effective than fat in promoting nitrogen retention by reducing the need for protein catabolism and subsequent gluconeogenesis. In infants, 5% dextrose in water parenterally can be used at 5mg/kg/min initially and increased to a maximum of 15mg/kg/ min over the course of the first few days postinjury to provide 40-50% of calorie requirements. In older children, as in adults, glucose administration at a maximum rate of 5-7 mg/kg/min is recommended. These are parenteral recommendations; enteral feeding guidelines have not been established, although in general, carbohydrate should be limited to 50% of calorie intake.

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