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Biomedical subjects

M V Kaminski

Publications and source records attributed to M V Kaminski.

At least 55 records · Page 3Linked to original sources
PubMed1978

A review of hypersomolar hyperglycemic nonketotic dehydration (HHND): etiology, pathophysiology and prevention during intravenous hyperalimentation.

The records of 200 patients, nutritionally supported by synthetic means, were reviewed for evidence of clinical hyperosmolar hyperglycemic nonketotic dehydration (HHND). There was a 3% incidence of morbidity, with a single mortality. Laboratory values demonstrated a positive correlation between persistent glucosuria and HHND. The pathophysiology of HHND demonstrated a relative insulin lack with sufficient insulin to prevent lipolysis, but insufficient to prevent hyperglycemia, glucosuria and osmotic diuresis. The mechanism and management of the pseudodiabetes of stress is reviewed. It is concluded that HHND is an avoidable iatrogenic morbidity. Prevention of osmotic diuresis secondary to glucosuria and, therefore, prevention of HHND is achieved by providing exogenous insulin sufficient to prevent glucosuria.

Adolescent↗
PubMed1977

Total parenteral nutrition.

Total parenteral nutrition has evolved as a distinct therapeutic reality within the past decade. Starvation or malnutrition need no longer be accepted as a necessary component of prolonged illness. Though current TPN techniques can be both safe and effective, the prevention of potential complications must always have a high priority. Changes in technique are to be anticipated as further knowledge and improved materials allow the pursuit of more basic clinical problems. The recent experience with the use of high caloric TPN solutions for prolonged gastrointestinal failure in 73 patients at the Loyola University Medical Center has been summarized. The need for the involvement of an experienced TPN team in the care of these patients cannot be overemphasized if the numerous and diverse potential complications of the TPN system are to be minimized.

Catheterization↗
PubMed1977

Specific metabolic effects imposed by Streptococcus pneumoniae upon the response to femoral fracture in the rat.

The possible potentiation of an infection upon the metabolic consequences of trauma was tested in rats using a 2 X 2 block design which included control, femoral fracture, pneumococcal infection, and fracture plus infection groups. Infection introduced unique metabolic effects different from those of starvation, femoral fracture, or both together. Infection-induced effects included an accelerated conversion of 14C-alanine to glucose, higher serum haptoglobin, alpha2-macrofetoprotein, copper, and ceruloplasmin values, and lower serum iron, zinc, and transferrin concentrations. The first three of these infection-induced effects were diminished in rats with a femoral fracture. No measured effect of infection was increased in traumatized rats.

Animals↗
PubMed1977

Specific muscle protein-sparing postoperative dextrose-free amino acid infusions.

The protein-sparing and ketogenic effect of postoperative infusion of maintenance solutions containing either 3.5% amino acids or 5% dextrose in 0.33 normal (N) saline was compared by nitrogen balance and urinary acetone determination in 31 patients. A specific muscle protein sparing effect was determined by quantitation of excretion of 3-methylhistidine in seven patients of the amino acid group and eight patients in the dextrose group. In addition, an extensive hormone and substrate profile was determined. It was found that amino acid infusions not only produce a less negative nitrogen balance but also significantly reduce excretion of 3-methylhistidine indicating specific preservation of the muscle compartment.

Amino Acids↗
PubMed1976

Enteral hyperalimentation.

Parenteral hyperalimentation, when used free of associated morbidity, usually produces a dramatic reversal in the deteriorating clinical course of the patient. However, most patients who need nutritional support have at least a minimally functioning gastrointestinal tract. By using a continuous enteral gavage of a chemically defined diet through a 4F tube, the same positive nitrogen balance, weight gain and accelerated wound healing can be achieved. As with parenteral hyperalimentation, there are avoidable iatrogenic morbidities. A policy and procedure for safe and effective enteral hyperalimentation, results of clinical experience and a simplified method for assessing achievement of a therapeutic goal are presented.

Diarrhea↗
PubMedDate not supplied

Enteral nutrition: frequency of formula modification.

A retrospective study was undertaken to determine with what frequency one of the 12 standard enteral formulations routinely used by the Metabolic Support Service could not be used without modification. Forty-three percent of the 83 patients studied required modification of one or more of the 5 individual components of the enteral product being utilized (ie, carbohydrate, protein, fat, electrolytes, and vitamins). Organ dysfunction was the reason for 31% of those changes in formula, other conditions included vitamin deficiencies (30%), electrolyte imbalances (27%), and essential fatty acid deficiencies (12%). The results of the study confirm the fact that no single formula can be effective in meeting every patient's fluid and electrolyte requirements while addressing the specific nutritional aspects of their disease. It would appear that a totally modular system for enteral nutrition similar to that used in parenteral nutritional support would allow maximum flexibility in the preparation of formulae that conform to patient's needs.

Acute Kidney Injury↗
PubMedDate not supplied

Unique effects of infectious or inflammatory stress on fat metabolism in rats.

Infectious or inflammatory stress in the rat causes very typical functional and metabolic alterations. Among the most typical are elevation in body temperature, insulin, and glucagon and depression in the concentrations of plasma ketones and free fatty acids. These changes occur only with infectious or inflammatory stress and not with noninflammatory stresses such as femoral fracture, screen restraint, or exercise. It appears that the depression in plasma ketone bodies during infection or inflammation is closely related to the rise in plasma insulin. During infection imposed on experimentally induced diabetes, inhibition of plasma ketones is not apparent. In a similar fashion, infection in hypophysectomized rats causes no elevation in plasma insulin and no depression in plasma ketones. Discussion concerning the implications of these observations in the rat and primate is included.

Animals↗
PubMedDate not supplied

Comparative study of clearance of 10% and 20% fat emulsion.

The rate of fat emulsion clearance from the blood of 10 healthy adult male volunteers administered 0.1 gram of fat per kilogram body weight as 10% or 20% safflower oil emulsion (Liposyn) was studied. The subjects were hospitalized for 2 days and each was given the predetermined amount of one of the two fat emulsions (10% or 20%) by rapid injection into a peripheral vein and the rate of clearance of the emulsion determined over a 60-minute period, beginning when half of the emulsion had been injected. There was no significant difference in the clearance rate between the two emulsions. It is concluded that 20% fat emulsion is a safe as 10% fat emulsion for use in intravenous nutritional support.

Adult↗
PubMedDate not supplied

Vitamin C supplementation of total parenteral nutrition formulas.

The effect of a wide range of daily vitamin C intake (350-2250 mg, mean 975 mg) on the serum and urine vitamin C levels was studied in 20 adult hospitalized patients receiving total parenteral nutrition for a period greater than 15 days. Serum vitamin C levels increased with vitamin C administration, but remained within the normal range. Urine vitamin C levels were above normal during total parenteral nutrition in all but one patient. A positive vitamin C "balance" was achieved in all patients. The vitamin C intake positively correlated with the vitamin C urine concentration and vitamin C "balance." Maximal vitamin C retention was 800 mg/day. It is concluded that administration of vitamin C in doses greater than 1000 mg/day is unjustified in those patients receiving total parenteral nutrition who are not hypermetabolic.

Adult↗