Patients with antibody deficiency syndromes provide excellent models to study safety and efficacy of new immune globulin (IG) preparations for intravenous use. In a long term study of such patients we showed that a reduced and alkylated IG preparation given intravenously was as effective in preventing infections as Cohn fraction II given intramuscularly. Mild side effects occurred in 50% of infusions; addition of maltose reduced side effects to 3%. Adverse reactions appeared to be related to IG concentration: they were slightly higher if the IG concentration was increased from 5% to 10%. The striking effect of maltose may relate to the observation that maltose and other disaccharides, added to Cohn fraction II, prevent heat aggregationin vitro. The stabilizing effect of these sugars was most pronounced at pH 6-6.5. Thus, modified IG formulated as a 5% solution in 10% maltose seems to be safe, effective and suitable for rapid intravenous infusion.

Modified immune globulin: its use in the prophylactic treatment of patients with immune deficiency

Intravenously administered maltose has been suggested as a useful carbohydrate source of greater caloric density per mol than glucose, and its utilization may be significantly influenced by insulin. To study the effect of insulin on the metabolism of parenteral maltose, a 10% maltose solution containing 25 μCi [U-14C/]maltose/liter was infused iv (2.5 or 5.0 mg/ kg.min) in healthy males (21–26 yr) for a 12-h period either with or without insulin. Blood glucose, maltose, insulin, and FFA as well urine maltose, glucose, and 14C and breath 14CO2 were measured hourly. At the 2.5 mg/kg-min rate, 18.8% and 25.3% of the administered dose were recovered as 14CO2 in the expired mg/kg-min rate, 18.8% and 25.3% of the administered dose were recovered as 14CO2 in the expired breath over a 12-h period without and with insulin, respectively. At the 5.0 mgmg/kg-min rate, 10.7% and 11.8% of the infused maltose were expired as 14CO2 without and with insulin, respectively. Serum maltose increased to 100 and 225 mgmg/100 ml...

The Effect of Insulin on the Metabolism of Parenteral Maltose in Man Maltose in Man

Parenteral nutrition is regarded as a form of nutrition in some countries and as an extension of intravenous fluid therapy in others. The optimum clinical application of parenteral nutrition as a form of therapy requires detailed knowledge of the nutrient solutions themselves, including the commonly used solutions such as dextrose, soybean oil emulsion, synthetic crystalline L-amino acid solutions; older solutions such as xylitol, protein hydrolysates; and newer solutions such as glycerides and special purpose amino acid solutions. Additionally, information has accumulated over the past 10 years, leading to the rational use of vitamins and trace elements in parenteral nutrition. Metabolism of the substrates has been correlated with known pathways of intermediary metabolism in normal, starved and stressed subjects. Several new concepts have arisen: a) Infusion of excessive quantities of dextrose results in lipogenesis and increased carbon dioxide production. Hyperalimentation of this type is being replaced by infusion of lesser quantities of dextrose, supplemented by intravenous infusion of lipid as a calorie source. b) Protein hydrolysates and racemic synthetic crystalline amino acid solutions have been replaced by synthetic crystalline L-amino acid solutions. c) A new fat emulsion based on safflower oil is competing successfully with the traditional soybean oil emulsion. d) Newer substrates are being explored. These include branched chain amino acids, keto analogues of amino acids, synthetic glycerides and maltose. e) Deficiencies of essential fatty acids, trace elements and vitamins have been studied in patients on long term parenteral nutrition and their mechanisms elucidated. Official recommendations for intravenous administration of these nutrients have been made. f) Several techniques have been applied in several circumstances, including protein sparing therapy, cyclic nutrition, home therapy, and parenteral nutrition in liver and renal failure. Parenteral nutrition is now used extensively, not only in major hospitals where the resources of a team approach with physician, nurse, pharmacist and dietitian are available, but also in smaller hospitals where all of these facilities may not be at hand. However, whatever the setting, the principles behind the clinical application of parenteral nutrition should be well understood by those involved, including current approaches to safe preparation and infusion of parenteral nutrition solutions.

Parenteral Nutrition: Current Status and Concepts

It is suitable to examine the utilization of carbohydrates and fats using stable isotope-labelled substrates in neonates because of their non-radioactivity. Administering medium-chain triglycerides (MCT) and oligosaccharides is of use in enteral nutrition for a patient with a limited water intake such as a neonate. In this study, the oxidation of MCT and maltose administered orally as an energy supplement in neonates has been examined using a stable isotope-labelled breath test. Five normal term neonates and five growing preterm infants were given [13C]-trioctanoin orally and three growing preterm infants were given [13C]-glucose and [13C]-maltose orally. The [13C] enrichment in carbon dioxide was analyzed by isotope ratio mass spectrometry, and oxidation rates over 6 hr and 12 hr respectively, were calculated. The oxidation rates for [13C]-octanoin after 6 hr were 46.2 +/- 3.6% in preterm infants and 53.5 +/- 13.8% in normal neonates, respectively (no significant difference), and 58.4 +/- 9.4% and 52.8 +/- 6.0% for [13C]-glucose and [13C]-maltose, respectively (not significant). The results demonstrate that orally administered MCT and maltose are oxidized sufficiently in preterm infants.

[13C] Breath Test of Medium‐chain Triglycerides and Oligosaccharides in Neonates

The ability of intravenously administered maltose or glucose to supply 12% of the energy requirements of growing miniature pigs was compared. All pigs were fed a stock diet from days 5 to 28 of life, and a central venous catheter was placed at 28 days. For the next 30 days, all pigs were fed orally and intravenously. Positive control pigs were fed the stock diet with infusions of an isotonic balanced electrolyte solution. Negative control and test animals were fed a diet containing cellulose to replace 12% of energy. Negative control animals received the balanced electrolyte solution intravenously, while test animals received either intravenous glucose or maltose at levels providing 12% of energy. Carbohydrate utilization was measured by loss of urinary carbohydrate, as well as by growth and body composition. Chemical analyses of the urine indicated utilization of both maltose and glucose, but maltose was utilized less well (87%) than glucose (greater than 99%). Growth and body composition data also indicate maltose utilization. The data suggest a possible role for maltose infusion as a supplemental energy source.

Utilization of intravenously administered maltose by growing miniature pigs.

Die Eignung von Maltose fur die Infusionstherapie wurde bei stoff-wechselgesunden Probanden uberpruft. Den nuchternen Versuchs-personen wurden uber einen Zeitraum von 4 Stunden 20%ige Maltoselosungen

Sind Maltoseinfusionen für die Infusionstherapie geeignet

Suitability of maltose for parenteral nutrition.

Intravenous infusions of maltose were performed using human volunteers. Four volunteers received maltose in a dose of 0.25 g/kg bodyweight and hour during eight hours. A follow-up period of three hours was added. Six volunteers received maltose in a dose of 0.125 g/kg bodyweight and hour during twelve hours. Only with the lower dose of maltose (0.125 g/kg b.w.) a steady state is reached after six hour continuous infusion. However even under these conditions maltose concentration in blood reaches the high concentration of 70 mg/100 ml. Using the double infusion rate, no steady state is attained when the infusions lasted for eight hours, despite maltose concentration in blood measured 150 mg/100 ml at this time. By measuring different metabolic parameters (fatty acid concentration, phosphate concentration) it is shown that parenterally applicated maltose is metabolized in the human. On the other hand, adverse reactions were not observed. The concentrations of uric acid and bilirubin remain constant and the activity of SGOT is not altered. Renal excretion of sugar measures 25-35% of the maltose administered parenterally. It is concluded that the glucose in urine stems from direct intra tubular hydrolysis of maltose achieved by the neutral maltase of the kidneys. The lack of attaining constant blood concentration for maltose during the infusions and the high renal loss of sugar shows that maltose is not suited as the single substrate for parenteral nutrition. However, there remains the possibility to use maltose in combination with glucose substitutes. The metabolic behaviour of maltose is similar to glucose, it differs from glucose substitutes.

Versuche mit Probanden zur parenteralen Verwertung von Maltose

The suitability of maltose for parenteral nutrition was investigated in metabolically healthy volunteers. A solution containing 20% of maltose was infused intravenously for four hours using three different doses (0.125 g/kg; 0.25 g/kg; 0.5 g/kg BW/h). Following cessation of the infusions the laboratory controls were carried on for four more hours. The infusions of maltose were tolerated without any complications. However, only when using the lowest dosage a steady state in blood concentration of maltose was reached, i.e. in the case of 0.125 g/kg BW/h. The results show that in humans the metabolic capacity for maltose is limited. The glucose concentration in blood remained almost unaltered during maltose infusion, while the serum insulin concentration was slightly elevated. A further sign for metabolism of maltose was the decrease in free fatty acid concentration. Because of the low metabolic capacity for maltose the urinary loss (in the form of maltose and glucose) is high with greater infusion rates and amounts to 20-30% of the intravenous load. A greater part of the sugar excreted in the urine consists of glucose, despite an almost normal blood glucose concentration. Considering the results of the experiments with volunteers it is concluded that maltose is not suited for intravenous therapy. Because of the low metabolic capacity of the human organism the renal losses are too great.

Are maltose infusions suitable for infusion therapy

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Sind Maltoseinfusionen für die Infusionstherapie geeignet

Suitability of maltose for parenteral nutrition.

Versuche mit Probanden zur parenteralen Verwertung von Maltose

Are maltose infusions suitable for infusion therapy