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E Shronts

Publications and source records attributed to E Shronts.

6 recordsLinked to original sources
PubMed1989

Nutritional support in acute pancreatitis.

Acute pancreatitis often results in a hyperdynamic, consumptive state. Hallmarks of this condition are decreased peripheral resistance with increased cardiac output. Hemodynamic and cardiovascular changes are accompanied by metabolic alterations. Increased protein catabolism, increased ureagenesis, glucose intolerance, increased lipolysis, and reduced servoregulation are metabolic changes commonly seen in this syndrome. To preserve organ structure and function, biochemical processes must be metabolically supported. Substrate needs change as stress level increases. The per cent of total calories provided as protein must increase. Branched-chain-enriched amino acid solutions have been shown to improve nitrogen utilization in hypermetabolic patients and may therefore be beneficial for the patient with acute pancreatitis. Glucose utilization decreases and free fatty oxidation increases. A mixed fuel system that provides fat, protein, and glucose is suggested for these patients. IV fat has been shown to be a safe energy substrate for patients with pancreatitis in the absence of hyperlipidemia. Failure to use fat as an energy substrate in conjunction with TPN may result in hepatic steatosis and excess carbon dioxide production. The decision of whether to use the parenteral or enteral route to nutritionally support the patient with pancreatitis remains controversial. TPN may allow maintenance of pancreatic rest. The role of enteral feedings is less clear. However, it has been shown that the further down the alimentary tract the feeding is infused, the less pancreatic stimulation occurs. Therefore, it seems wise to support the patient with TPN during severe acute pancreatitis. Jejunal enteral feedings should be initiated as a transitional feeding when the acute inflammatory episode begins to subside.

Acute Disease↗
PubMed1983

Nitrogen retention in critically ill patients is proportional to the branched chain amino acid load.

The nitrogen retention effect of branched chain enriched parenteral nutrition (BcAA) during surgical stress and polytrauma was evaluated in a prospective, randomized, double blind study in 32 patients. The doses of BcAA were 0.16, 0.3, 0.5, and 0.7 g/kg . day with a total amino acid load of 1 or 1.5 g/kg . day. It was provided in a setting of 30 glucose cal/kg . day with 7 cal/kg . day of iv fat also given to 16 patients. After the 7-day study was completed, analysis of the 4 treatment groups of 8 patients each demonstrated that there was an increased nitrogen retention effect of BcAA, that the effect was proportionate to BcAA load, that the effect started at 0.5 g of BcAA/kg . day in a setting of balanced nutritional support, and that the effect was consistent with a BcAA influence on protein synthesis. There were no complications or side-effects from high dose BcAA. Metabolic support of the stress response in ICU patients has become a clinical reality.

Adult↗
PubMedDate not supplied

Free amino acid formula: nitrogen utilization and metabolic effects in normal subjects.

A previous study indicated increased urea production and low nitrogen (N) retention on a free amino acid elemental formula (FAA; Vivonex-HN). The limitations of this earlier study were: irregular nitrogen absorption in the malabsorption patients, high nitrogen intake, and failure to match FAA to control formula (hydrolyzed casein; CAS; Criticare-HN) with respect to kcal/nitrogen. A more critical test of FAA quality was sought in the current study. Four healthy males received the minimal daily nitrogen requirements (0.6 g protein/kg) from either FAA or CAS in a 10-day balance study; a second balance on the alternate formula followed. Maintenance energy, minerals, and vitamins were supplied in each period. The results indicated a higher apparent nitrogen absorption (p less than 0.05) from FAA relative to CAS in the first 5 days of the balance, although these differences were no longer present in the remaining 5 days of the period. Urinary total nitrogen increased on FAA, most of which could be accounted for by urea nitrogen; urinary creatinine nitrogen, ammonia nitrogen, and uric acid nitrogen were nearly identical between formulas. The unmeasured fraction of urinary nitrogen was markedly diminished on FAA while the urea nitrogen to total nitrogen ratio was significantly increased (p less than 0.05) compared to CAS. During the initial 5 days of study nitrogen balance was lower on FAA than on CAS and this difference became significant during the last 5 days of the period (mean +/- SD for FAA = -0.42 +/- 0.59 g/D vs CAS = 0.98 +/- 0.30 g/day, p less than 0.001). Hyperglycinemia was consistently present during FAA infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗