METABOLIC EFFECTS OF A D-BETA-HYDROXYBUTYRATE INFUSION IN SEPTIC PATIENTS - INHIBITION OF LIPOLYSIS AND GLUCOSE-PRODUCTION BUT NOT LEUCINE OXIDATION

Objective: To study the effect of a D-beta-hydroxybutyrate infusion on protein metabolism, lipolysis, and endogenous glucose production in septic patients. Design: Prospective, randomized trial. Setting: Intensive care unit (ICU) and metabolic unit at a university hospital. Patients: Twelve ICU patients with sepsis and six healthy normal subjects. Interventions: Septic patients were administered 4-hr infusions of either D-beta-hydroxybutyrate or a control solution, 12 hrs after parenteral nutrition was replaced with an isotonic saline infusion. Measurements and Main Results: The appearance and oxidation rates of leucine (L[1-C-13]leucine) and endogenous glucose production (D[6,6-H-2(2)]glucose), plasma fatty acids, and glycerol values were measured before and at the end of infusion of D-beta-hydroxybutyrate or control solution. Unlike the control test, the D-beta-hydroxybutyrate infusion decreased glucose production, fatty acids, and glycerol concentrations, but failed to decrease the leucine oxidation rate. Conclusion: Exogenous ketone-bodies infusion decreased lipolysis and glucose production in septic patients but had no beneficial effect on protein metabolism, as evaluated with L[1-C-13]leucine.