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At least 19 recordsLinked to original sources
PubMed1979

Alterations in the enzyme profile in intensive care patients undergoing total parenteral nutrition.

Total parenteral nutrition (TPN) has been demonstrated to be an effective therapeutic means in improving the clinical course of the critically ill patients. Various metabolic complications are described; the cause of some of these remain unclear. The changes in some plasma enzyme indices (GOT, GPT, GIDH, LDH, HBDH, CPK, ChE, AP, gamma-GT) in two groups of critically ill patients undergoing TPN (group with more marked enzyme alterations and group with less marked alteration) were examined. Two types of alterations were found: (1) early increase of some enzymes (GOT, GPT, GIDH); (2) constant increase of plasma enzyme level during TPN (AP, gamma GT). These two evolutionary patterns were more evident in the complicated group and the enzyme changes were statistically significant for GOT and GPT (P = 0.05) and not significant for initial values of G1DH, ap and gamma-GT. Both groups presented constant elevated plasma values of LDH, HBDH, CPK and depressed constant ChE value during treatment; the difference was not significant in both groups for the same enzymes. The data were interpreted from a functional point of view; that is they were related to both the metabolic post-aggressive state and TPN. A relationship between the rate of protein catabolism and the inductive increase of some enzymes (GOT, GPT, G1DH) was found. Whereas a final induction in the energy metabolism is suggested for other enzymes (LDH, HBDH), the alteration of CPK, AP, gamma-GT and ChE was interpreted as dependent on: (1) direct muscular trauma (CPK); (2) functional increase in relation to the duration of TPN (AP and gamma-GT); (3) possible depressed malnutritive synthesis (ChE). The improvement of the enzymatic patterns with the early use of TPN and with the improvement of clinical and nutritional conditions was emphasized.

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↗
PubMed1978

Meeting exceptional nutritional needs. 1. Total parenteral nutrition.

The provision of adequate nutrition to hospitalized patients with exceptional caloric requirements has been a problem until the recent advent of intravenous hyperalimentation. With total parenteral nutrition (TPN), the nutritional needs of any patient can be met by infusion. TPN solution is hypertonic, and administration requires central venous cannulation. The subclavian vein is usually chosen as route of access to the superior vena cava. Strict aseptic technique must be used in inserting the catheter and making up and administering the solution. TPN is not without risk. Infection is always a possibility, as are metabolic alterations, such as electrolyte imbalance, fluid overload, osmotic dehydration, and essential fatty acid deficiency.

Catheterization↗
PubMed1977

An experience with total parenteral nutrition in children.

Total parenteral nutrition has been used in the treatment of more than 100 children with gastrointestinal illnesses, including 90 under the age of 6 months. The incidence of complications has been reduced markedly as experience was acquired. Total parenteral nutrition has been especially valuable in patients with intractable diarrhea syndrome and it has been used successfully in the management of infants with overwhelming systemic infections.

Child↗
PubMed1979

Pharmacist as team leader for total parenteral nutrition therapy.

A total parenteral nutrition program in a 635-bed private nonteaching institution which uses the pharmacist as team leader is described. To initiate TPN therapy, the attending physician writes a request for a consulation with the pharmacist. Prior to initiation of TPN therapy, the pharmacist reviews the chart, conducts a physical and nutritional assessment of the patient, orders any laboratory tests needed for further assessment of the patient and uses these results to classify the patient's nutritional status. The pharmacist then writes all TPN-related orders, including orders for laboratory tests and nursing care. Communications between the pharmacist and the attending physician concerning the progress of the patient and TPN changes are conducted orally on rounds and via chart notes. The number of patients receiving TPN therapy has increased each year--from six patients during 1976, to 19 patients during 1977 and 54 in 1978. Of the two preventable complications that developed in these 79 patients, both were quickly resolved by the pharmacist. Physicians who, in the past, opted not to place patients on TPN because of lack knowledge or lack of a TPN consultant, now rely on the pharmacist for this service.

Florida↗
PubMedDate not supplied

[Estimates of trace elements requirements of children receiving total parenteral nutrition].

Ten children on total parenteral nutrition were studied. Plasma copper, zinc, manganese and selenium levels were determined by neutron activation and gamma spectrometry, every 10 days. With a copper intake of 20 microgram/kg/24 h, the average level 120 microgram% (94-144) was normal (N: 118 microgram +/- 11%). With a manganese intake of 40 microgram/kg/24 h, the level increased to 2.6 microgram% (1.3-4.5) (N: 1.1 microgram +/- 0.2%). With a zinc intake of 30 microgram/kg/24 h, the level decreased to 45.9 microgram % (20-63) (N: 83 microgram +/- 28%); with an intake of 50 microgram/kg/24 h the level remained under normal. With a selenium intake of 1 microgram/kg/24 h, the level decreased to 10.6 ng/ml (3.6-21.6) (N: 38.2 ng/ml +/- 11.9), but was normalized with an intake of 3 microgram/kg/24 h. From these results, with all reserves that estimation implies, the authors suggest that the disorders due to deficit or excess of trace elements could be avoided by daily intakes per kg of body weight: copper 20 microgram, zinc 100 microgram, manganese 10 microgram and selenium 3 microgram, with supplementation of iron, iodine and fluoride.

Child↗
PubMed1975

Essential fatty acid deficiency in human adults during total parenteral nutrition.

Three patients undergoing prolonged total parenteral nutrition at home developed skin lesions, characterized by dryness and scaly appearance, initially confined to the folds but becoming subsequently generalized. Fatty acid measurements in plasma of these patients showed a markedly abnormal lipid pattern: accumulation of 5,8,11-eicosatrienoic acid (20:3omega9) and a high 20:3omega9-to-20:4omega6 ratio. When parenteral fat (Intralipid) was administered, 500 ml/day, serial measurements of fatty acids showed a progressive normalization of the abnormal pattern and a dramatic improvement in the skin lesions. It appears that the daily requirement for linoleic acid in the adult, particularly during the period of rapid anabolism, has not been clearly established. Because more and more patients are becoming partly or totally dependent on parenteral nutrition for prolonged periods of time, the availability of parenteral fat preparations is urgently needed.

Adolescent↗
PubMed1979

Total parenteral nutrition, An important therapeutic advance.

Total parenteral nutrition (TPN) is a potent form of therapy. It is particularly useful in patients who must undergo surgery or those with conditions that preclude normal feeding. The procedure is not without risk, but better understanding of the basic principles involved, refinements in technique, and experience with its use in different situations have combined to improve the results of therapy over those first obtained. TPN represents an important therapeutic advance and emphasizes the need for an undertanding of nutritional principles by physicians and for a team approach to the management of complicated conditions.

Bacterial Infections↗
PubMed1978

A zinc-deficiency dermatitis in patients on total parenteral nutrition.

Three patients on home total parenteral nutrition utilizing a synthetic amino acid solutions developed a dermatitis consistent with acrodermatitis enteropathica after 30, 43 and 62 days of therapy. The dermatitis resolved after changing to casein hydrolysate in 2 patients and after full oral alimentation in the third. Although measured serum zinc levels were repeatedly normal to elevated in all patients, sufficient retrospective data analysis combined with literature review on this subject, clearly implicates zinc deficiency as the etiology for their dermatitis. Adequate zinc supplementation of synthetic amino acid solutions is essential in order to avoid this complication.

Adolescent↗
PubMedDate not supplied

Regulation of appetite during total parenteral nutrition.

To study effects of total parenteral nutrition (TPN) on appetite, in an effort to obtain an objective assessment of hunger separated from underlying pathology, caloric intake and levels of TPN were measured in two male rhesus monkeys. TPN was found to affect appetite by reducing voluntary food intake. One monkey showed precise regulation of daily oral caloric intake and maintained stable body weight during this period. The other monkey did not show such precise regulation. When TPN was stopped, both continued suppression of oral intake for a time. Implications are discussed.

Animals↗
PubMed1979

Clinical-pharmacological aspects, application and effectiveness of total parenteral nutrition in surgical patients.

The term "total parenteral nutrition" (TPN) refers to the maintenance of an adequate nutritional status, normal body weight and positive nitrogen balance solely by intravenous means. It requires solutions providing calories, amino acids and other nutrients in amounts much greater than those indicated for maintenance of normal body weight. Nutrient solutions have been studied, selected and prepared in our Hospital Pharmacological Service utilizing a sterile closed system, which allows large-volume filtering, sterilizing and bottling devices. For maintenance of weight gain in adults, a basic formula is employed, which provides 1,100 Kcal/1 with pure crystalline amino acids mixed with 50% anhydrous dextrose in water in a ratio of 5.8:1 (160 Kcal:1 g nitrogen). Minerals and vitamins are added to the base solution prior to use and may be increased or decreased by simple addition or omission depending on the patient's condition. This paper is based on 192 surgical patients who received TPN and have been followed in strict cooperation between the Hospital Pharmacological Service and the Surgical Department. The patients, ranging from 23 to 79 years of age, with life threatening diseases and unable to maintain adequate nutrition by the oral route, received TPN through a central catheter inserted via subclavian puncture (146 cases) or through a surgically created internal A-V fistula (46 cases). The condition of the patients generally improved within a few days after starting TPN; and weight gain, wound healing, general improvement and a shorter period of hospitalization were observed. TPN could be efficiently combined with oncologic treatment, and a significant improvement of the patients' performance status and decrease of toxic side-effects due to chemotherapeutic agents were observed. TPN has been successfully applied also in patients with fistulas of the alimentary tract obtaining spontaneous closure and in patients with ulcerative colitis, showing its beneficial effect in allowing complete bowel rest for healing. No major complications or deaths could be attributed to TPN or to the route of administration.

Adult↗
PubMed1977

Total parenteral nutrition: a guide to therapy in the adult.

Total parenteral nutrition (TPN), often referred to as intravenous hyperalimentation, is a complex technique for parenteral feeding that can be lifesaving. A basic knowledge of the theory behind, indications for, and hazards of TPN can help the practitioner determine which of his patients will benefit from this procedure. In the community hospital, where a skilled hyperalimentation team is not available, TPN can be managed safely by a physician, pharmacist and floor nurse if there is rigid adherence to a strict protocol. This paper presents the basic theory, indications, and contraindications associated with TPN, and details a protocol for administering total parenteral nutrition to the adult, hospitalized patient (Appendices 1, 2).

Adult↗
PubMed1978

Total parenteral nutrition in inflammatory bowel disease.

Nutritional depletion is a common feature of inflammatory bowel disease. The advent of total parenteral nutrition (TPN) has allowed nutritional repletion or maintenance while total bowel rest is achieved. The experience with total parenteral nutrition in inflammatory bowel disease is varied; our recommendations for use of total parenteral nutrition in specific situations are presented with a description of the techniques for administration in patients with inflammatory bowel disease.

Child↗
PubMed1977

Chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation, in a patient receiving long-term total parenteral nutrition.

A white female, now age 40 and receiving total parenteral nutrition for more than 5 years, developed unexpected 15% weight loss after 3 1/2 years of regimen, together with peripheral neuropathy confirmed by nerve conduction measurements. An intravenous glucose tolerance test showed that the fractional rate (K) had decreased to 0.89%/min (normal greater than 1.2). There was observed during this glucose infusion a borderline normal insulin response with a fall in plasma free fatty acids and in plasma leucine. During daily infusion of well over 400 g of glucose, the respiratory quotient was 0.66. Chromium balance was negative. Chromium levels were, in blood 0.55 ng/ml (normal 4.9 to 9.5) and in hair 154 to 175 ng/g (normal greater than 500). Regular insulin daily (45 micron) in the infusate nearly maintained euglycemia but despite this, and even with further glucose intake to restore weight loss, intravenous glucose tolerance test (K) and respiratory quotient were unchanged. Administration of insulin was then stopped and 250 microng of Cr added to the daily total parenteral nutrition infusate for 2 weeks. After this the intravenous glucose tolerance test (K) and respiratory quotient became normal (1.35 and 0.78, respectively). Over the next 5 months insulin was not needed and glucose intake had to be reduced substantially to avoid overweight. In this period nerve conduction and well-being returned to normal. With a maintenance addition of chromium to the total parenteral nutrition infusate (tentatively this addition is 20 microng/day) the patient has remained well for 18 months (to July 1976). These results suggest that relatively isolated chromium deficiency in man, hitherto poorly documented, causes 1) glucose intolerance, 2) inability to utilize glucose for energy, 3) neuropathy with normal insulin levels, 4) high free fatty acid levels and low respiratory quotient and, 5) abnormalities of nitrogen metabolism.

Adult↗
PubMed1979

Utilization of D-methionine during total parenteral nutrition in postsurgical patients.

Utilization of intravenously administered D-methionine was measured by morbidly obese subjects fed parenterally after elective gastric bypass surgery. Five patients were infused with a 25% glucose--4.25% amino acid solution containing DL-methionine, and four were treated with a 25% glucose--3.5% amino acid solution containing only L-methionine. Mean (+/- SD) total daily methionine excretion was 0.06 +/- 0.04 mmoles (of 28 +/- 4 mmoles infused) in patients treated with the L-methionine containing solution, and was 15.2 +/- 4.2 mmoles/day (of 45.2 +/- 5 mmoles DL-isomer infused) in patients treated with the DL-methionine containing solution. In these latter patients, 90 to 98% of the excreted methionine was the D-isomer. The data indicate 64 +/- 23% of infused D-methionine is excreted in the urine. Four patients excreted between 70 to 85% of infused D-methionine in the urine, but one patient excreted only 35 to 55%, suggesting better utilization. Plasma methionine levels were higher (9.9 +/- 1.9 mumoles/100 ml) in patients infused with solutions containing DL-methionine than those infused with the L-methionine solution (4.5 +/- 1.0 mumoles/100 ml). In the former case, 49% of plasma methionine was the D-isomer. The data indicate poor D-methionine utilization by postsurgical patients during total parenteral nutrition when given as DL-methionine in the presence of other amino acids and glucose.

Adult↗
PubMed1978

Radiography of hydrocephalus after total parenteral nutrition.

An infant with chronic diarrhea developed hydrocephalus following treatment with total parenteral nutrition (TPN) via jugular vein catheterization. Total parenteral nutrition is used when nutritional needs cannot be met adequately by oral alimentation. Serial computerized tomograms showed progression of communicating hydrocephalus. Superior sagittal sinograms demonstrated bilateral internal jugular vein occlusion with extensive venous collateralization. Lumboperitoneal shunt effectively decreased raised CSF pressure. A judicious approach to alternative venous routes for hyperalimentation is suggested. Radiographic delineation of communicating hydrocephalus by computerized tomography and superior sagittal sinography is presented.

Brain↗
PubMed1979

Utilization of L-alanyl-L-tyrosine by nephrectomized rats when infused as part of a total parenteral nutrition regimen.

L-Alanyl-L-tyrosine is well utilized as a tyrosine source in parenterally fed rats. Such utilization may depend upon filtration of peptide into the glomerular filtrate, reabsorption into renal epithelial cells, hydrolysis to component amino acids in or at the surface of epithelial cells, and release of component amino acids to the blood. Bilaterially nephrectomized rats were infused with a parenteral solution providing L-alanyl-L-[U-14C]-tyrosine at 0.5 mmoles/kg over a 2 hour period to test this hypothesis. Despite the absence of kidneys, peptide did not accumulate in plasma or tissues. Plasma and liver tyrosine and alanine levels increased significantly over values noted in animals infused without peptide. One-quarter to one-third of the infused radioactivity was released as 14CO2, with the remainder found in the tissues. Between 15 and 51% of radioactivity in individual tissues was free tyrosine, the remainder was incorporated into protein. Isolation of this protein, acid hydrolysis and simultaneous radioactivity-amino acid analysis demonstrated that 94 to 99% of the radioactivity in protein was tyrosine. The data indicate good utilization of alanyl-tyrosine by nephrectomized rats when administered as part of a total parenteral nutrition regimen.

Animals↗