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Biomedical subjects

M Adolph

Publications and source records attributed to M Adolph.

27 records · Page 2Linked to original sources
PubMed1990

[Energy requirements of surgically treated, injured and infected patients].

There is always a distinct increase in energy expenditure in postoperative, posttraumatic and septic patients. In order to predict this increase in energy expenditure an enormous number of formulas have been developed. However, the problem with all these formulas is that they cannot sufficiently take into account the peculiarities of the underlying disease, the general and nutritional condition or the varying influence of the phase of disease. Furthermore, all these patients continuously show a considerable change in body weight which can be attributed to a shifting of the water balance. In all of these cases any calculation of energy expenditure based on body weight will inevitably be incorrect. Therefore, it is recommended that predicting formulas only be used as orienting guidelines in all uncomplicated postoperative or posttraumatic courses. In patients with multiple injuries or septic complications the real energy expenditure should be measured by indirect calorimetry in order to adapt energy intake during enteral or parenteral nutrition to the very different metabolic situations.

Burns↗
PubMed1989

[Distribution and elimination of medium- and long-chain fatty acids of a fat emulsion in lipoproteins of severely injured patients following bolus injection].

A fat emulsion containing 20% fat as medium chain triglycerides (MCT) and long chain triglycerides (LCT) (1:1) was injected as a bolus in an amount of 0.2g fat per kg body weight to six patients, three to five days after a serious injury. Triglyceride concentrations increased within two min in lipoprotein fractions d less than 0.95 g/ml (Chylomicrons), d less than 1.006 g/ml (VLDL), d less than 1.063 g/ml (LDL) and d less than 1.21 g/ml (HDL). Sixty minutes after injection triglyceride concentrations had again reached preexperimental values in all lipoprotein fractions. Cholesterol values did not change. According to the composition of the fat emulsion, linoleic acid content increased in triglycerides of all lipoprotein fractions, whereas octanoic and decanoic acid did so only in triglyceride-rich lipoproteins (d less than 1.006). Half-life values of elimination of octanoic acid (3.3 min) and decanoic acid (3.9 min) in triglycerides of lipoprotein fraction d less than 1.006 were nearly half as short as that of long chain fatty acids (linoleic acid, 6.4 min; oleic acid, 6.5 min; palmitic acid, 7.5 min). Thus in contrast to LCT, MCT are only found in triglyceride-rich lipoproteins (d less than 1.006) and are also eliminated more rapidly.

Fat Emulsions, Intravenous↗
PubMed1989

[Side effects and complications of parenteral nutrition].

Despite increasing advances in total parenteral nutrition, a lot of partly serious side effects have been seen. This includes among other things the lactic acidosis after high amounts of carbohydrates or the deficiency and excessive expenditure respectively, of thiamine in carbohydrate metabolism. Metabolic changes in bone system, especially with long term parenteral nutrition are reported by american groups. Cholestasis is often caused by intravenous feeding. In patients with malnutrition a carefully balanced supply of calories and phosphate should be offered. Without misuse of TPN, the rate of complications is very low.

Acid-Base Equilibrium↗
PubMed1987

[Clinical studies with fat emulsions containing LCT and MCT].

In an effort to supply energy carriers with a high utilization rate specifically in parenteral nutrition during postaggression metabolism, fat emulsions were developed containing long- and medium-chained triglycerides in a 1:1 ratio. The special advantage of the medium-chained fatty acids is, among other things, their low rate of accumulation and high oxidation rate in the organism. Using a graduated schedule, intensive-care patients who were being parenterally fed exclusively were administered either an MCT/LCT mixture or an LCT emulsion alone as a bolus injection and later continuously. Among other things, the behavior of the triglyceride concentrate and the individual fatty acids in serum and of individual lipid fractions, as well as the effect on various parameters of carbohydrate and fat metabolism, were measured. In addition, the oxidation rate of an MCT/LCT emulsion labelled with 13C was measured. The results of the comparative lipid studies were compared. The expected result-that the oxidation rate of medium-chained triglycerides exceeds that of long-chained triglycerides-was confirmed. It was surprising that the median oxidation rate with a continuous fat supply within a complete nutrition program was only 32 +/- 6.8%. Why some patients showed higher triglyceride levels with the MCT/LCT emulsion than with the supply of LCT alone is still unclear. It remains to be investigated whether the rapid splitting of medium-chained triglycerides leads to a temporary loss of activity of the lipoprotein lipase accompanied by a rise in triglycerides in serum. More research will be necessary before we know what role MCT/LCT emulsions will play in future. Such an emulsion would possibly be suitable in severely injured patients, whereby the MCT portion could preferentially supply the organism with energy carriers and the long-chained triglycerides structural components.

Critical Care↗
PubMed1982

[Serum apolipoproteins and lipids in severe injury as influenced by nutrition. A pilot study].

In 10 patients with polytrauma and 2 patients with sepsis a relation of the severity of trauma and the change of lipoproteins has been found. Cholesterol and triglycerides as well as apolipoproteins A-I and B decrease significantly in the first days after the injury. During the following rise of cholesterol and triglycerides apolipoprotein A-I increases also to a concentration of lower normal range; apolipoprotein B remains lowered. Apolipoprotein C-III2 is determined in 3 patients and is increased. The concentration of apolipoprotein A-I decreases in three of five patients, who had parenteral fat administration. Apolipoprotein B increases during fat administration. The following fat free parenteral nutrition causes a decrease of apolipoprotein B again. The composition of lipoproteins is similarly changed in 2 patients with sepsis. The apolipoproteins as well as the lipids decrease more in patients who died later than in the case of reconvalescence, in which the increase of concentrations of lipids and apolipoprotein B may be accelerated with parenteral nutrition. Apolipoprotein A-I reacts variably, A-II is lowered.

Adolescent↗