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During sepsis in adults, fat becomes a preferred fuel; however, oxidation may be impaired relative to the circulating fatty acid levels. Little is known about the ability of infants and children to oxidize lipids during systemic inflammation (SIRS) and sepsis. The aim of this study was to examine the oxidation of exogenous lipid in these patients. Sixteen patients with SIRS/sepsis and eight controls with no evidence of sepsis were studied by indirect calorimetry during an i.v. lipid utilization test (1 h of 0.3 g/kg/h glucose followed by 3 h of 0.1 g/kg/h glucose plus 0.15 g/kg/h lipid). The respiratory quotient (RQ) (1.0 for carbohydrate utilization and 0.7 for fat utilization) was measured. Results were compared by repeated-measures analysis of variance (ANOVA), paired or unpaired t tests. There was no difference in baseline RQ between controls and patients with SIRS/sepsis (mean ± SD; 0.82 ± 0.08 versus 0.82 ± 0.04). The RQ of controls dropped significantly to 0.78 ± 0.08 at 240 min (p < 0.001). The RQ of patients with SIRS/sepsis also fell to 0.78 ± 0.06 (p < 0.01). Infants and children with SIRS/sepsis are able to oxidize i.v. lipid.