Energy sources for intravenous nutrition

Controversy exists concerning the appropriate use of carbohydrate solutions and fat emulsions as energy sources in intravenous nutritional regimens. Current evidence suggests that glucose is the carbohydrate energy source of choice and that when infused with appropriate quantities of protein it provides cheap and effective nutritional support in the majority of patients and clinical circumstances. During glucose infusion, blood glucose and acid-base balance should be closely monitored and, when indicated, exogenous insulin should be added to the regimen to combat hyperglycaemia and improve protein anabolism. Fat emulsions, although expensive, may justifiably be used in patients with moderate or severe stress to provide up to 50% of non-protein energy, especially in circumstances where attempts to satisfy energy requirements exclusively with glucose would impose an additional metabolic stress.