Skip to main content

Glucose absorption following gastric and small intestinal nutrient administration in the critically ill

Introduction

Glucose absorption from the stomach is abnormal related to slow gastric emptying and impaired in critically ill patients (CIP) with normal gastric emptying, suggesting that small intestinal (SI) factors may also be responsible. Small intestinal absorption of nutrient has not been formally quantified in this group. The aim was to quantify and compare glucose absorption following gastric and SI administration in CIP and healthy volunteers (HV).

Methods

Data from studies where glucose absorption had been measured were analysed. Sixty-six CIP (age: 51 ± 2, APACHE II: 17 ± 1) and 50 HV (age: 43 ± 3) were administered 100 ml Ensure (liquid nutrient 1.06 kcal/ml), labelled with 3 g 3-O-methylglucose (3-OMG) to evaluate glucose absorption. Nutrient was administered via nasogastric (n = 44; CIP = 24; HV = 20) or SI (n = 72; CIP = 42; HV = 30) catheters. Plasma 3-OMG concentrations were measured at intervals for 240 minutes; peak, time to peak and area under the concentration curve (AUC) were calculated. Feed-intolerant patients were defined by gastric residual volume >250 ml in the 24 hours prior to study or requiring prokinetics for pre-existing feed intolerance. Data are mean ± SEM or median (range) and were analysed using nonpaired Student's t tests.

Results

Glucose absorption was markedly reduced in patients following both intragastric (AUC 0 to 240: CIP: 49 ± 7 vs. HV: 80 ± 4 mmol/l/minute; P < 0.001; peak concentration CIP: 0.32 (0.004 to 0.804) vs. HV: 0.51 (0.343 to 0.679) mmol/l; P < 0.001; time to peak CIP: 140 (30 to 240) vs. HV: 74 (45 to 120) minutes; P < 0.001) and SI nutrient (AUC 0 to 240: CIP: 57 ± 4 vs. HV: 72 ± 4 mmol/l/minute; P = 0.008; peak concentration CIP: 0.37 (0.01 to 0.88) vs. HV: 0.47 (0.28 to 0.88) mmol/l; P = 0.02; time to peak CIP: 87 (15 to 240) vs. HV: 54 (15 to 120) min; P = 0.01). Gastric glucose absorption was delayed when compared with SI administration in CIP (time to peak; gastric: 140 (30 to 240) vs. SI: 86 (15 to 240) minutes; P = 0.005); however, there was no difference in overall glucose absorption when comparing gastric and SI administration in both HV and CIP. Feed-intolerant patients had reduced SI glucose absorption (AUC 240: intolerant 44 (2 to 98) vs. tolerant 75 (15 to 101) mmol/l; P = 0.01).

Conclusions

Glucose absorption is substantially impaired in the CIP even when delivered directly into the SI. This suggests mechanisms in the SI contribute to nutrient malabsorption. Delivery of nutrient directly into the SI (particularly in those CIP who are feed intolerant) may not result in improved nutrient absorption.

Author information

Affiliations

Authors

Corresponding author

Correspondence to M Chapman.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Chapman, M., Deane, A., Di Bartolemeo, A. et al. Glucose absorption following gastric and small intestinal nutrient administration in the critically ill. Crit Care 15, P387 (2011). https://doi.org/10.1186/cc9807

Download citation

Keywords

  • Healthy Volunteer
  • Small Intestinal
  • Glucose Absorption
  • Gastric Emptying
  • Gastric Residual Volume