What is the optimal infusion rate for maximum efficiency of glucose use in total parenteral nutrition (Total Parenteral Nutrition), which is approximately how many milligrams per kilogram per minute?

From the Guidelines

The maximum efficiency of glucose use in total parenteral nutrition occurs at the infusion rate of 5 mg/kg/min. This rate is recommended based on the most recent and highest quality study available, which suggests that the optimal nutritional composition of macronutrients is defined by minimal requirements and upper limits, and for carbohydrates, the upper limit should be 5 mg/kg body weight/min 1. The body's physiological glucose oxidation capacity is a key factor in determining the optimal infusion rate, and exceeding this rate can lead to increased lipogenesis, potential hyperglycemia, and metabolic stress. The recommended glucose administration should not exceed 5 mg/kg/min, as excessive glucose-based energy provision is associated with hyperglycemia, enhanced CO2 production, enhanced lipogenesis, increased insulin requirements, and no advantage in protein sparing in comparison with a lipid-based energy provision 1. Some key points to consider when determining the optimal infusion rate include:

• The body's capacity to oxidize glucose efficiently
• The risk of metabolic complications, such as hyperglycemia and lipogenesis
• The importance of minimizing adverse metabolic effects during parenteral nutrition therapy
• The need to balance energy needs with the risk of metabolic stress. In critically ill or stressed patients, it is particularly important to carefully manage glucose infusion rates to avoid exacerbating metabolic complications, as supported by earlier studies 1.

From the Research

Maximum Efficiency of Glucose Use in Total Parenteral Nutrition

• The maximum efficiency of glucose use in total parenteral nutrition occurs at an infusion rate of 4 mg/kg/min, as supported by studies 2, 3, 4.
• Infusion rates above 4 mg/kg/min may lead to hyperglycemia and increased risk of in-hospital mortality 2, 5.
• A study found that glucose production from nonrecycled carbon sources was suppressed to 17% of the basal level at a glucose infusion rate of 4 mg/kg/min, and further increases in infusion rate had minimal effect on glucose production 3.
• Another study suggested that glucose infusion rates above 4 mg/kg/min may lead to increased net lipogenesis, as indicated by a respiratory quotient (RQ) >1.0 4.
• The optimal glucose infusion rate may vary depending on individual patient factors, such as insulin resistance and metabolic state 6.