A STUDY OF TOTAL PARENTERAL NUTRITION FOR PATIENTS WITH TERMINAL STAGE GASTROINTESTINAL MALIGNANCY

In order to evaluate glucose metabolism in patients with terminal stage gastrointestinal cancer, an intravenous glucose tolerance test was performed before and during total parenteral nutrition (TPN). At the same time, blood biochemical and nutritional assessments were made. Before TPN, glucose tolerance had decreased with low insulin secretory response in almost all of the patients. Moreover, the levels of blood glucagon, adrenaline, noradrenaline and cortisol had increased in the patients who died in the early period of treatment. Thus it seemed that the decreased glucose tolerance was due not only to impaired insulin secretion but also to elevated blood glucagon, adrenaline, noradrenaline and cortisol levels. A high rate of anaerobic glycolysis in neoplastic cells was suggested by the high levels of serum lactic and pyruvic acids in patients with early death. The patients receiving TPN for 4 weeks or more were divided into 3 groups: Group 1 consisted of patients provided with less than 35kcal of TPN per kg/day; group 2 consisted of patients with 36-45kcal/kg/day, and group 3 with 46 or more kcal/kg/day. In group 3, glucose tolerance was improved after 2 weeks of TPN, and the nutritional state was maintained during the period of TPN treatment. On the other hand, no glucose tolerance improvement nor nutritional maintainance was observed in group 1 and 2 patients. On the basis of the above findings, it seems that TPN with 46kcal/kg/day or more is needed even in patients with terminal stage malignancey, though it should be kept in mind that impaired glucose tolerance occurs in some of the patients receiving high-caloric amounts of total parenteral nutrition.