bluuebunny/crossref_metadata_2025 huggingface dataset:
Indirect Calorimetry: Comparison of Hood and Mask Systems for Measuring Resting Energy Expenditure in Healthy Volunteers
Authors: Mcanena Oliver J. , Harvey Lillian P. , Katzeff Harvey L. , Daly John M.
Published: May 2008

Controversy exists as to the validity and reliability of hood and mask systems in measuring indirect calorimetry. The purpose of this study was to evaluate the accuracy and reproducibility of repeat measurements of resting energy expenditure (REE) in volunteers. Paired REE measurements were performed in 23 subjects after an overnight fast using hood and mask systems. Lean body mass was calculated from four skinfold measurements and body weight determinations. Data were normalized to body weight and lean body mass and were calculated as percent predicted REE in paired tests taken within 5 minutes on the same subject. No significant difference in mean REE was noted between hood and mask systems. Linear regression analysis showed a strong positive correlation (r = 0.91, p < 0.001) between hood and mask measurements of REE. (Journal of Parenteral and Enteral Nutrition 10 :555–557, 1986)
Endoscopic, Radiographic, and Clinical Response to Prolonged Bowel Rest and Home Parenteral Nutrition in Crohn's Disease
Authors: Kushner Robert F. , Shapir Jonathan , Sitrin Michael D.
Published: May 2008

Total parenteral nutrition is widely used as a therapeutic measure is patients with severe, active Crohn's disease unresponsive to conventional medical management. We have reviewed our experience with 10 patients with nonfistulous Crohn's disease treated by home parenteral nutrition (HPN) and bowel rest (nothing‐by‐mouth) assessing the nutritional, radiologic, endoscopic, and clincial responses. After a mean of 4.1 months of treatment, all patients had a marked improvement in nutritional status and resolution of gastrointestinal symptoms; 90% reduced their corticosteroid dose. Eight of nine patients had endoscopic and/or radiographic evidence of mucosal healing. Although 60% of patients were able to avoid surgery and tolerate refeeding, all six patients continue to require steroids to control symptoms.

Our study suggests that HPN and bowel rest is a useful therapeutic approach to selected patients with active Crohn's disease, which permits a reduction in corticosteroid dosage and partial healing of mucosal lesions in most. Further studies are required to determine which patients should receive HPN and its optimal duration. (Journal of Parenteral and Enteral Nutrition 10:568–573, 1986)
Protein Synthesis in Skeletal Muscle in Relation to Nitrogen Balance after Abdominal Surgery: The Effect of Total Parenteral Nutrition
Authors: Wernerman Jan , Von Der Decken Alexandra , Vinnars Erik
Published: May 2008

Protein synthesis in skeletal muscle was studied in patients after elective abdominal surgery, using the concentration and size distribution of ribosomes. The patients were given either an electrolyte solution or total parenteral nutrition postoperatively. The analyses were performed on muscle biopsy specimens taken prior to surgery and on days 1 and 3 following surgery.

The percentage content of polyribosomes, total ribosome concentration and the polyribosome concentrations per milligram of tissue DNA were determined. Elective abdominal surgery caused a significant decrease (p < 0.05) in the three variables. Total parenteral nutrition did not prevent the decrease. The negative nitrogen balance was significantly improved by total parenteral nutrition, but it did not reach equilibrium. The results show that total parenteral nutrition given postoperatively did not maintain protein synthesis activity in skeletal muscle. The improvement in nitrogen balance suggests that amino acids are utilized by tissues other than skeletal muscle. (Journal of Parenteral and Enteral Nutrition 10:578–582, 1986)
Effect of Enteral Formula Infusion Rate, Osmolality, and Chemical Composition upon Clinical Tolerance and Carbohydrate Absorption in Normal Subjects
Authors: Zarling Edwin J. , Parmar Jitendra R. , Mobarhan Sohrab , Clapper Maureen
Published: May 2008

It is a common clinical practice to initiate enteral hyperalimentation using low flow rates or diluted formula. These adjustments are made in an effort to minimize patient intolerance. Using complex and elemental enteral formulas, we investigated whether various flow rates or osmolalities effected clinical intolerance or carbohydrate malabsorption in 20 healthy volunteers. Our infusion rates ranged between 50 and 150 kcal/hr and the osmolalities ranged between 325 and 690 mOsm/Kg of water. Even at the maximal flow rate and osmolality, our results show that both types of enteral formulas were well tolerated as assessed by the frequency of abdominal pain, bloating, passage of rectal gas and stooling. No carbohydrate malabsorption was detected as measured by breath hydrogen. In well nourished subjects, our findings do not support the common clinical practice of initiating alimentation with low flow rates or diluted formula. (Journal of Enteral and Parenteral Nutrition 10:588–590, 1986)
Exogenous Lipid Clearance in Compensated Liver Cirrhosis
Authors: Muscaritoli Maurizio , Cangiano Carlo , Cascino Antonia , Ceci Fabrizio , Caputo Velia , Martino Piero , Serra Pietro , Rossi Fanelli Filippo
Published: May 2008

The tolerance to exogenous fats has been evaluated in patients with liver cirrhosis. A three‐stage lipid clearance test with continuous infusion (3 hr) of a triglyceride emulsion, Intralipid, was performed on 10 patients with well compensated liver cirrhosis and 10 normolipidemic volunteers. During the infusion, blood samples were collected for the measurement of particulate triglycerides (TG) by nephelometry; samples were also collected for total TG, free fatty acids (FFA) and free trytophan (TRP) determinations. Plasma endogenous triglycerides were calculated as the total minus exogenous, particulate, TG. The fractional removal rate (K2) and the maximal clearing capacity (K1) for exogenous TG were lower in patients than in controls, though a significant difference (p < 0.05) was found only for K1. Endogenous TG and FFA showed a comparable rise in patients and controls during Intralipid infusion. A significant increase in free TRP was noted in cirrhotics upon maximal infusion rate. It is concluded that: 1) in patients with well compensated liver cirrhosis the maximal clearing capacity (K1) for exogenous TG is impaired. Nonetheless, moderate amounts of fat may be removed at a normal rate from the bloodstream; 2) a normal synthesis rate of exogenous TG may be maintained even in a severely damaged liver; 3) considering the possible role of free TRP in the pathogenesis of hepatic encephalopathy (HE), the use of large amounts of lipids should be discouraged in patients with decompensated liver cirrhosis, or even avoided in those with impending or overt HE. (Journal of Parenteral and Enteral Nutrition 10:599–603, 1986)
Association of Parenteral Nutrition Catheter Sepsis with Urinary Tract Infections
Authors: Kovacevich Debra S. , Faubion Walter C. , Bender Josephine M. , Schaberg Dennis R. , Wesley John R.
Published: May 2008

The infection rate (IR) of central venous catheters (CVCs) used for parenteral nutrition (PN) was prospectively evaluated over a 12‐month period, with emphasis on the relationship between CVC sepsis and preexisting sites of infection. Sepsis was presumed if the CVC tip or blood culture was positive, or if defervescence followed CVC removal. Four hundred seventy‐three CVCs were placed for PN for a total of 5,422 patient days, with a mean length of stay of 11.5 days. Twenty two CVCs led to sepsis for an IR of 4.65% or 4.06 infections per 1000 patient days. Twenty of the 22 septic CVCs were in patients with other sites of infection. The IR was 12.0% (20/166) when other sites of infection were present and 0.65% (2/307) in the absence of a second site. The mean length of stay was 13.2 days for CVCs with other sites of infection and 10.3 days for CVCs with no other site of infection. Fifty nine percent of septic CVCs had secondary sites of infection that included urinary tract infections (UTI). Of all septic CVCs, 22.7% had no site of infection other than UTI. The presence of UTI appears to present a high risk of CVC sepsis. Appropriate identification and treatment of UTI prior to CVC insertion is recommended. (Journal of Parenteral and Enteral Nutrition 10:639–641, 1986)
Use of an Intercostal Vein for Central Venous Access in Home Parenteral Nutrition: A Case Report
Authors: Lammermeier David , Steiger Ezra , Cosgrove Delos , Zelch Margaret
Published: May 2008

A key factor in the success of a home parenteral nutrition program is prolonged and safe access to the central venous system. There are some patients, however, in whom the cephalic, external jugular, internal jugular, subclavian, and saphenous veins cannot be used. In these patients, cannulation of an intercostal vein can be useful for central venous access. Such a patient was recently presented to our medical care facility with bilateral subclavian vein thrombosis, left external iliac vein thrombosis, and superior vena cava obstruction above the level of the azygous vein.

A Broviac catheter was successfully introduced via a right intercostal vein cutdown with the catheter tip lying in the azygous arch. This is the first known description in an adult patient in the use of an intercostal vein to gain access into the central venous system. (Journal of Parenteral and Enteral Nutrition 10:659–661, 1986)
Mild Peripheral Neuropathy but Biochemical Chromium Sufficiency during 16 Months of “Chromium‐Free” Total Parenteral Nutrition
Authors: Kien C.L. , Veillon C. , Patterson K.Y. , Farrell P.M.
Published: May 2008

A 6‐yr, 4‐month‐old boy was started on total parenteral nutrition (TPN) because of chronic diarrhea. The TPN regimen (3 liter/day) initially included supplemented Cr (3 μg/day) in addition to standard components (including FreAmine III). At age 8 yr, 8 months, the serum Cr level was elevated: 3.7 ng/ml (normal 0.03–0.85). A repeat level at the same time by another commercial laboratory was also high (7.0). Cr supplementation was stopped. At age 10 yr, he was noted to have mild peripheral neuropathy although glucose tolerance was excellent (α‐linolenic acid was undetectable in the plasma). Cr status was reevaluated in a research lab. The serum level was 1.4 ng/ml (normal 0.05–0.4). The urine chromium excretion was 1.27 μg/day (normal 0.22). The TPN regimen (unsupplemented with Cr) provided 4 μg/day. Normal Cr intake is about 60 μg/day with 0.4% absorption (net 0.24 μg/day). We conclude that Cr contamination of standard PN fluid may prevent biochemical evidence of low Cr status. In addition, α‐linolenic acid‐free parenteral nutrition for 46 months was not associated with clinically significant neurological dysfunction. (Journal of Parenteral and Enteral Nutrition 10:662–664, 1986)
The effect of the route of nutrient delivery on gut structure and diamine oxidase levels
Authors: Thompson JS , Vaughan WP , Forst CF , Jacobs DL , Weekly JS , Rikkers LF
Published: May 2008

Diamine oxidase (DAO) is an intestinal mucosal enzyme which serves as a marker of cellular maturity and integrity in ontogeny and after mucosal injury in the gastrointestinal tract. Since total parenteral nutrition is known to result in intestinal hypoplasia, this study was done to determine the effect of enteral and parenteral delivery of nutrients on gut structure and DAO levels. Central venous catheters were placed in 27 Sprague‐Dawley rats (180–260 g), which received nutrients for 12 days via parenteral nutrition (GpI n = 10), oral intake of the parenteral solution (GpII n = 8), or standard rat chow (GpIII n = 9). Gross and microscopic measurements were made at sacrifice. Mucosal DAO levels were determined by metabolism of [3H] putrescine. Group III animals had a greater caloric intake than groups I and II, and were the only group with a significant increase in body weight. Gut weight, mucosal weight, and villous height were significantly less in group I vs groups II and III; group II values were less than group III (p less than 0.05). Both DAO specific activity and total gut DAO were significantly less in group I and group II. Mucosal DAO content correlated with total gut and mucosal weight. DAO mucosal levels decrease with parenteral nutrition, reflecting the intestinal hypoplasia that occurs. Mucosal DAO content may be dependent on both caloric intake and diet composition. Since serum DAO levels are known to correlate with mucosal DAO content, DAO activity may prove useful as a circulating marker of the effect of nutritional therapy on the intestinal mucosa.
Efficacy of metoclopramide as an adjunct to duodenal placement of small‐bore feeding tubes: a randomized, placebo‐controlled, double‐blind study
Authors: Kittinger JW , Sandler RS , Heizer WD
Published: May 2008

We examined whether metoclopramide would improve the success rate of transpyloric intubation of a weighted Corpak feeding tube when fluoroscopic guidance is not used. Seventy patients were randomized in a prospective, double‐blind fashion to receive either placebo (n = 35) or metoclopramide, 10 mg (n = 35) parenterally, administered immediately after the feeding tube was inserted. Tube location was determined independently by two observers who examined radiographs obtained after barium was instilled via the tube. There was no significant increase in the success rate of duodenal intubation in the total group following metoclopramide, 60%, compared to placebo, 49%. However, analysis of subgroups among the placebo‐treated patients revealed that diabetes mellitus, but not other medical conditions, decreased the success rate for duodenal intubation, 20 vs 60% (p less than 0.05). Among diabetic patients, metoclopramide resulted in a significant increase in duodenal placement compared to placebo (p less than 0.05). We conclude that parenteral metoclopramide significantly increases the frequency of transpyloric intubation with small feeding tubes without fluoroscopic guidance in diabetic patients but not in nondiabetic patients.
Low blood selenium levels in patients with cystic fibrosis compared to controls and healthy adults
Authors: Dworkin B , Newman LJ , Berezin S , Rosenthal WS , Schwarz SM , Weiss L
Published: May 2008

Frank clinical selenium deficiency has been described in cystic fibrosis (CF), and a relative deficiency has been proposed as contributing to the pathogenesis of the disease. Because of these possibilities, we investigated the relationship between overall nutritional status in CF with measures of selenium nutriture. Fifteen stable outpatients with CF (group I) were compared to 13 age‐matched controls (group II) and 27 healthy adults (group III). Whole blood, plasma, and red blood cell selenium levels were reduced by 31%, 29%, and 33%, respectively, in CF patients vs controls (all p less than 0.001). In addition, both groups I and II showed significantly lower blood selenium levels than healthy adults (p less than 0.005). Nutritional assessment revealed CF patients to be undernourished, with significant decreases in serum albumin (p less than 0.025), weight‐for‐height deficit (p less than 0.01), and weight‐for‐age (p less than 0.025) vs controls. However, only the triceps skinfold (TSF) measurement correlated significantly with selenium status (r = 0.56: p less than 0.05 for whole blood selenium vs TSF). We conclude, based on the magnitude of decrement in blood selenium, that it is unlikely that selenium plays a significant primary pathogenic role in cystic fibrosis. However, these patients are at high risk for developing clinical selenium deficiencies. The measurement of blood selenium levels using appropriate age‐matched normal standards should be mandatory in all CF patients with malnutrition, or in those requiring parenteral nutritional support.
The incidence and clinical significance of intravenous fat emulsion contamination during infusion
Authors: Ebbert ML , Farraj M , Hwang LT
Published: May 2008

So that the actual contamination rate of intravenous fat emulsions, as well as the type of microbial contamination, could be quantified, 103 bottles of 10% fat emulsion were collected near infusion completion from patients' bedsides. All samples were cultured and compared according to actual hanging time, in addition to the amount and type of microbial contamination. Recovered organisms included Escherichia coli, Staphylococcus epidermidis, diphtheroids, and Micrococcus. Sample analysis failed to demonstrate significant differences in extrinsic microbial contamination rate or organism multiplication between samples infusing for less than or equal to 12 hr and those infusing longer. Although these products support microbial growth, the contaminants introduced into the infusate by environmental or touch contamination yielded minimal colony growth. No patient developed signs or symptoms of bacteremia during the study period. Therefore, infusion of intravenous fat emulsion products over extended periods of time in this study did not increase the risk of developing infectious complications.
Pancreatic enzyme secretion during intravenous fat infusion
Authors: Burns GP , Stein TA
Published: May 2008

The nutritional support of patients with pancreatic and high gastrointestinal fistulas and severe pancreatitis frequently involves intravenous fat infusion. There are conflicting reports on the effect of intravenous fat on pancreatic exocrine secretion. In 10 dogs with chronic pancreatic fistulas, pancreatic juice was collected during secretin (n = 10) or secretin + cholecystokinin (n = 4) stimulation, with and without intravenous fat infusion (5 g/hr). The hormonal‐stimulated secretion of lipase, amylase, trypsin, total protein, bicarbonate, and water was unchanged during fat infusion. This study supports the use of intravenous fat as a nutritional source when it is desirable to avoid stimulation of the pancreas.
Total parenteral nutrition‐associated cholestasis in rats: comparison of different amino acid mixtures
Authors: Belli DC , Fournier LA , Lepage G , Yousef I , Weber AM , Tuchweber B , Roy CC
Published: May 2008

It has been suggested that the quantity of amino acids perfused is a pathogenetic factor in total parenteral nutrition (TPN)‐associated hepatotoxicity. However, the effect of the qualitative pattern of amino acid solutions has not been studied. Rats on parenteral nutrition for 5 days received 10.2 g of dextrose and 3.4 g of amino acids daily. Bile flow (microliter/min/g liver protein) after administration of Vamin was 16.2 +/‐ 0.8, which was similar to that in controls given chow and dextrose iv, but it was significantly higher (p less than 0.001) than those on Travasol (12.3 +/‐ 0.8). The decrease in bile flow was not related to the large concentrations of alanine and glycine present in Travasol. However, the addition to Travasol of serine present only in Vamin increased bile flow significantly. Bile acid secretion rate, biliary lipid constituents, calcium, sodium, and glucose showed little change. In contrast, alpha‐amino nitrogen was increased (p less than 0.05) in Vamin‐perfused animals. Steatosis was noted in only a few animals in the Travasol group, and was not associated with an increase in the triglycerides content of the liver. Glycogen and protein content of the livers did not differ. The data show that the composition of amino acid solutions may be a determinant of TPN‐induced cholestasis and suggest that the presence of methyl donor amino acids may have a protective effect.
A rapid, accurate, precise assay for determination of plasma transferrin
Authors: Leonberg BL , Crosby LO , Buzby GP
Published: May 2008

Plasma transferrin (TFN) levels are valid as markers of protein‐calorie malnutrition (PCM). Current methods for determining TFN, specifically, radial immunodiffusion (RID) plates or derivation from total iron‐binding capacity (TIBC), are relatively expensive, time consuming (20–50 hr) and technically demanding, limiting the use of TFN levels in the routine screening for PCM. A rapid (60–90 min), accurate and precise TFN assay, easily performed with common laboratory equipment, was developed for use in a study of hospitalized patients. This assay requires 15 microliter of plasma and is based on an antigen‐antibody reaction using commercially available TFN antibody. After a 30‐min incubation, turbidity is measured at 413 nm on a spectrophotometer with a 1‐cm path length. Values by this method are linear over the range of 50–760 mg/dl. Plasma samples (n = 72) were assayed for TFN by this turbidimetric (TURB) technique and the standard RID technique. Correlation between the two assays was r = 0.942 over the range of TFN = 81–403 mg/dl (TFNRID = 30.7 + (0.931) TFNTURB). Coefficient of variation (CV) for TFNTURB was 4.0%. RID kit insert reports a CV = 2.9% at a value of 380 mg/dl. This assay overcomes many of the difficulties associated with TFN determination by RID or derived from TIBC and may allow more widespread application of plasma TFN levels as a clinically relevant PCM screening tool.
Total parenteral nutrition in pregnancy complicated by Crohn's disease
Authors: Jacobson LB , Clapp DH
Published: May 2008

Despite the widespread use of total parenteral nutrition (TPN) in nonpregnant patients, the literature reflects limited experience with TPN in pregnancy. However, since maternal nutritional deprivation may cause adverse fetal effects, its use appears warranted. We present a case of a pregnant patient with a poor reproductive history and recently diagnosed Crohn's disease who required TPN. We discuss the use of TPN with fat emulsions in this patient who was unable to tolerate enteral feedings during pregnancy. The patient underwent a 4‐week period without oral intake. Total parenteral nutrition enabled continued fetal growth, resulting in a good outcome for the patient and her infant. This report supports the early use of TPN in pregnancy complicated by inadequate caloric intake.
Method For Evaluating Utilization of Infused Oligosaccharides in Postsurgical Patients
Authors: Stegink Lewis D. , Andersen Dean W. , Zike Wilbur L.
Published: May 2008

Oligosaccharides are potential sources of carbohydrate‐derived energy for use in parenteral nutrition regimens. Clinical studies indicate that although some patients utilize infused oligosaccharides well, many patients do not. These results suggest that oligosaccharides might be useful as a parenteral energy source for selected patients. This report describes a method, suitable for use by nursing staff on the ward, to determine oligosaccharide utilization and identify patients utilizing oligosaccharides well. Oligosaccharides excreted in urine are hydrolyzed enzymaticallly to glucose using α‐glucosidase and α‐amylase, and the glucose released is measured by a test tape method. The results obtained agree well with the acid hydrolysis‐spectrophotometric assay for oligosaccharide excretion used in earlier studies. The method readily identified postsurgical patients utilizing infused oligosaccharides poorly in both prospective and retrospective studies. (Journal of Parenteral and Enteral Nutrition 11:124–128, 1987)
Close Association of Accelerated Rates of Whole Body Protein Turnover (Synthesis and Breakdown) and Energy Expenditure in Children with Newly Diagnosed Acute Lymphocytic Leukemia
Authors: Kien C. Lawrence , Camitta Bruce M.
Published: May 2008

Using a single‐dose [15N]glycine turnover technique, we studied protein metabolism in 15 children with newly diagnosed acute lymphocytic leukemia (ALL). As in our previous study, we observed increased rates of whole body protein synthesis (S) and breakdown (B) in comparison to healthy controls. In eight patients, we assessed basal metabolic rate (BMR). There was a significant linear regression between BMR (kcal/d) (Y) and S (g protein/d) (X): y = 3.7 X + 850 (R = 0.925, p < 0.001). There was also a significant linear correlation between BMR, expressed as a percentage of the normal value, and S expressed as a percentage of the mean value in the healthy children (r = 0.79, p < 0.05). There were also significant positive correlations between BMR and body weight (r = 0.75, p < 0.05) or age (r = 0.83, p < 0.05) and between S and weight or age (both, r = 0.86, p < 0.01). BMR (kcal/d) also correlated with B (g protein/d) (r = 0.91, p < 0.01). Multiple regression analysis revealed that BMR was much more highly related to S than to weight. These data suggest that increased rates of S are closely related to increased energy requirements in patients with ALL. Furthermore, these data provide evidence for the biological relevance of whole body protein kinetics. (Journal of Parenteral and Enteral Nutrition 11:129–134, 1987)
Assessing the Efficacy of Intravenous Nutrition in General Surgical Patients: Dynamic Nutritional Assessment with Plasma Proteins
Authors: Church James M. , Hill Graham L.
Published: May 2008

We have compared the direction of changes in four plasma transport proteins measured weekly with the direction of nitrogen balance in general surgical patients receiving intravenous nutrition (IVN). Fifty four patients had IVN for 2 weeks, and 15 had IVN for 3 or 4 weeks. Change in plasma prealbumin followed the direction of nitrogen balance in both weeks of IVN in 39 of 54 of the former group, whereas none of the other plasma proteins achieved 50% accuracy. A weekly rise in plasma prealbumin had a sensitivity of 88%, specificity of 70%, positive predictive value of 93%, and negative predictive value of 56% in detecting positive nitrogen balance. Results in the patients who received 3 or 4 weeks of IVN showed an improvement in negative predictive value to 79%. None of the other plasma proteins performed as well. Twelve patients suffered a major complication of their disease or died, following their course of IVN. Nitrogen balance was the best prognostic indicator of these patients, whereas a fall in prealbumin was the best of the plasma proteins, with a sensitivity of 67%, specificity of 79%, positive predictive value of 40%, and negative predictive value of 92% in determining the incidence of complications. Prealbumin was the most suitable plasma protein for use as a dynamic index of nutritional progress in the type of patient seen in this study. (Journal of Parenteral and Enteral Nutrition 11: 135–139, 1987)
The Potential Toxicity to Neonates of Multivitamin Preparations Used in Parenteral Nutrition
Authors: Macdonald Mhairi G. , Fletcher Anne B. , Johnson Emily L. , Boeckx Roger L. , Getson Pamela R. , Miller Marilea K.
Published: May 2008

This study compares two groups of infants weighing less than 1500 g at birth. In the propylene glycol (PG) group, 30 infants received MVI‐Concentrate containing 300 mg of PG daily with their intravenous nutrition (ivn), and vitamin E, 50 mg/week by intramuscular injection. In the mannitol group, 30 infants received MVI‐Pediatric (containing 245 mg mannitol), 65% of a vial/day. Serum and urine osmolality, serum PG, blood‐urea‐nitrogen, creatinine, sodium, and glucose were measured on days 0, 2, 5, 12, 19, 26, 33 and 40 of ivn. Weight, urine output, and fluid intake were measured daily. Vitamin E levels were measured on days 5, 26, and 33 of ivn. There were no significant differences between the groups in birth weight, gestational age, sex, age, or weight at start of ivn. Our results indicated that neither MVI‐Concentrate nor MVI‐Pediatric was associated with a clinically significant diuresis. MVI‐Pediatric, 65% of a vial/day, may produce higher than desirable blood levels of vitamin E, and use of drugs containing PG can produce significant blood levels of PG, in very low birth weight infants. (Journal of Parenteral and Enteral Nutrition 11:169–171, 1987)
Parenteral Nutrition in a Pregnant Cystic Fibrosis Patient
Authors: Cole Bruno N.L. , Seltzer Murray H. , Kassabian John , Abboud Sami E.
Published: May 2008

This case report describes a 30‐year‐old pregnant woman with cystsic fibrosis who had marasmus as evidenced by clinical examination. The patient was maintained on central venous hyperalimentation for 18 days in her last trimester. The patient delivered a full‐term infant via cesarian section with Apgar of 8 and 9, at 1 and 5 minutes, respectively, and adverse affects. (Journal of Parenteral and Enteral Nutrition 11:205–207, 1987)
Amino Acid Requirements of a Rat Sarcoma as Determined by a Stem Cell Assay
Authors: Miller Timothy J. , Franco Robert S. , Chance William T. , Martelo Orlando J. , Popp Martin B.
Published: May 2008

Knowledge of the amino acid requirements of a neoplasm is valuable in determining optimal nutritional support and antineoplastic therapy for the tumor‐bearing host. The standard human tumor stem cell assay (HTSCA) was modified by reducing an individual amino acid below the normal plasma concentration of the Fischer 344 rat. All other amino acids were maintained at levels sufficient for normal HTSCA tumor colony growth. Twenty‐two amino acids were tested at a mean concentration of 12% (range 3% to 35%) of their normal plasma level. Results indicated that all amino acids except L‐glutamine and L‐asparagine were present in sufficient quantity for normal tumor growth. Dose‐response curves have shown more than 70% inhibition of tumor growth with a glutamine concentration of 50% and an asparagine concentration of 25%. Glutamine and asparagine levels of 4% and 1%, respectively, resulted in 100% inhibition. The data indicate that rat sarcoma stem cells are sensitive to decreased glutamine and asparagine concentrations. (Journal of Parenteral and Enteral Nutrition 11:223–228, 1987)
Water‐Soluble Vitamins in Cancer Patients on Parenteral Nutrition: A Prospective Study
Authors: Inculet Richard I. , Norton Jeffrey A. , Nichoalds George E. , Maher Michelle M. , White Donald E. , Brennan Murray F.
Published: May 2008

Forty‐three patients with mild weight loss were studied prospectively to determine whether the parenteral water‐soluble vitamin doses in a commercially available preparation (MVI concentrate; USV Laboratories, Tarrytown, NY) maintained serum, red blood cell (RBC), and urinary concentrations of water‐soluble vitamins in stressed cancer patients receiving total parenteral nutrition (TPN). Patients were divided into three groups: (1) oral diet, no intravenous vitamins given; (2) TPN plus 5 ml MVI; and (3) TPN plus 10 ml MVI. Vitamins C, B1, B2, B3, B6, and niacin were measured initially and weekly during a 6‐week study period. Caloric and nitrogen balances were quantified. Most of the patients in all three groups had normal blood or urine levels of all water‐soluble vitamins. No clinical evidence of vitamin deficiency or MVI toxicitv was detected. The recommended parenteral dosages of vitamin C (100 mg/day) and B3 (15 mg/day) provided measurably adequate levels in all patients. Levels of vitamins B1, B2, B6, and niacin that were less than the normal range were noted in 4–40% of patients receiving the recommended daily dosages of 3 mg, 3.6 mg, 4 mg, and 40 mg, respectively. These deficiencies appeared to improve in group III patients who received twice the recommended parenteral vitamin dosages, although they did not completely disappear. Niacin deficiency appeared to be the most prevalent, occurring in 40% of patients studied. Since intravenous doses of B1, B2, B6, and niacin are safe and well tolerated, it appears that increased daily amounts of these vitamins should be given to cancer patients on parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 11:243–249, 1987)
Comparative Study of Maltitol and Sucrose by Means of Continuous Indirect Calorimetry
Authors: Felber J.P. , Tappy L. , Vouillamoz D. , Randin J.P. , Jéquier E.
Published: May 2008

The metabolism of the hydrogenated disaccharide maltitol was compared to that of sucrose in a group of eight normal subjects. On two separate days, with an interval of at least one week each subject ingested a load of 30 g of either substance. The evolution of the levels of plasma glucose, insulin, and free fatty acids was followed during the 6 hr following the oral load. Carbohydrate and lipid oxidation rates were assessed simultaneously by continuous indirect calorimetry during the 6 hr following the oral load. Plasma glucose and insulin peaks occurred 30 min after ingestion of the load for both sugars. The peak of the delta glucose concentration was significantly smaller after maltitol than after sucrose (21 ± 4 us 38 ± 4 mg/100 ml, p < 0.02), as was the peak of the delta insulin concentration (9.3 ± 2.7 μU/ml after maltitol vs 25.5 ± 5.0 μU/ml after sucrose, p < 0.001). The peak of the stimulation of glucose oxidation occurred 60 min after the load of sucrose and 90 min after the load of maltitol. The delta glucose oxidation was significantly lower with maltitol than with sucrose during the first 90 min after the ingestion of the load. It was slightly higher (although not significantly) with maltitol than with sucrose starting from the 210th min. Maltitol resulted in a cumulated suprabasal glucose oxidation which amounted to 40% that obtained with sucrose after 180 min. (Journal of Parenteral and Enteral Nutrition 11:250–254, 1987)
Double‐Blind Study of Glycerol vs Glucose in Parenteral Nutrition of Postsurgical Insulin‐Treated Diabetic Patients
Authors: Lev‐Ran A. , Johnson M. , Hwang D.L. , Askanazi J. , Weissman C. , Gersovitz M.
Published: May 2008

Twenty‐five insulin‐treated diabetic patients were randomly assigned postoperatively to 5 days of intravenous infusions of ProcalAmine (3% amino acids, 3% glycerol, and electrolytes) or FreAmineIII + dextrose and electrolytes. The solutions were given isocalorically and isonitrogenously. Insulin was adjusted to keep glycemia at the level of 150–200 mg/dl. The ProcalAmine group by the 5th day had plasma glucose of 158 ± 25 mg/dl and required 1.20 ± 0.10 U/hr insulin. The FreAmine + dextrose group had plasma glucose of 169 ± 53 mg/dl and required 2.28 ± 0.13 U/hr. At all time points postsurgically, the ProcalAmine group required less insulin. (Journal of Parenteral and Enteral Nutrition 11:274–274, 1987)
Studies on the Tolerance of Medium Chain Triglycerides in Dogs
Authors: Grancher Denis , Jean‐Blain Claude , Frey Anny , Schirardin Henri , Bach André C.
Published: May 2008

Two groups of five conscious dogs received total parenteral nutrition (about 100 kcal/kg body weight per 24 hr) continuously for 96 hr (0.28 g triglycerides/kg body weight per hr, constituting more than 55% of the energy supply). The only difference between the two groups was the nature of the 20% lipid emulsion. In one group, this emulsion contained only long‐chain triglycerides (LCTs), and in the other it contained a mixture (vol/vol) of medium chain triglycerides (MCTs) and LCTs. MCTs thus were given in an amount of about 30% of the total energy supplied.

During infusion with the MCT/LCT mixture, C8, C10, and C12 fatty acids appeared in the total plasma fatty acids. When the infusion was stopped, the medium‐chain fatty acids disappeared; those with shorter chains did so more rapidly. The plasma triglyceride clearance was faster for the MCT/LCT mixture than for the LCTs, whereas phospholipid and cholesterol clearance seemed slower for the MCT/LCT mixture. With this mixture, there was a slight increase in the plasma concentrations of ketone bodies, lactate, and pyruvate, and a slight decrease in plasma glucose. The MCT/LCT mixture was well tolerated, causing no discernible problems, and, in particular, no signs of narcosis or encephalopathy. (Journal of Parenteral and Enteral Nutrition11:280–286, 1987)
Resting Energy Expenditure in Patients with End‐Stage Liver Disease and in Normal Population
Authors: Shanbhogue Ragu L.K. , Bistrian Bruce R. , Jenkins Roger L. , Jones Catherine , Benotti Peter , Blackburn George L.
Published: May 2008

Resting energy expenditure (REE) was measured in 10 patients with end‐stage liver disease (ELD) and in 31 normal controls. Basal energy expenditure (BEE) was also predicted by the Harris‐Benedict equation. In order to correlate REE to lean body mass, the 24‐hr urinary creatinine was measured in patients with ELD and in normal controls and expressed as kcal/g urinary creatinine. Linear regression analysis showed a statistically significant (p < 0.0001) correlation (r = 0.72) between the REE and the 24‐hr urinary creatinine in normal controls, irrespective of age and sex. Mean BEE (1580 ± 160 vs 1575 ± 210) and REE (1755 ± 215 vs 1800 ± 330) were not significantly different between patients with ELD and controls. However, the mean REE was 1900 ± 610 kcal/g creatinine in patients with ELD and 1180 ± 260 (p < 0.0001) in controls. When related to lean tissue, patients with ELD had increased energy expenditure, confirming the hypermetabolic state suggested on clinical grounds. The use of urine creatinine to estimate energy expenditure may be a simple clinical technique to predict dietary energy needs in malnourished, unstressed patients. When this estimated energy expenditure/g creatinine (EEE) is compared to measured energy expenditure/g creatinine in malnourished, stressed patients, the EEE provides an index of the extent of hypermetabolism. (Journal of Parenteral and Enteral Nutrition 11:305–308, 1987)
Parenteral Nutrition‐Induced Anaphylaxis
Authors: Pomeranz Shlomo , Gimmon Zvi , Ben Zvi Amos , Katz Schmuel
Published: May 2008

A case report of a 4‐yr‐old child who developed an anaphylactic reaction to parenteral nutrition is presented. Dermal allergy tests demonstrated a sensitivity to Travasol solution and Armour multivitamin 2 solution. This is the first reported case known to us of such a response to elemental parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 11:314–315, 1987)
Studies on the Toxicity and Efficacy of a New Amino Acid Solution in Pediatric Parenteral Nutrition
Authors: Coran Arnold G. , Drongqwski Robert A.
Published: May 2008

The optimum composition and concentration of crystalline amino acid solutions necessary for growth and brain maturation in critically ill infants requiring total parenteral nutrition (TPN) are unknown. Either an excess or a deficiency of amino acids could theoretically impair normal brain development in the neonate. The purpose of this study was to compare the toxicity and efficacy of two intravenous amino acid solutions, Neopham, modeled after the amino acid pattern found in human breast milk, and Aminosyn, a marketed product, designed for general usage.

Sixteen infants and children requiring continuous intravenous nutrition for at least 7 days received the Neopham amino acid solution, and eight infants and children received the Aminosyn amino acid solution as part of a total parenteral nutrition regimen which included glucose, the fat emulsion Intralipid, as well as routine mineral and vitamin additives.

There were no significant differences in mean gestational age, body weight, postnatal age, or mean daily nutrient intake between the patients receiving Aminosyn or Neopham. The daily nitrogen intake, excretion, and retention were similar in both groups. In addition, there were no statistically significant differences in either hematological or biochemical parameters between the two study groups.

The plasma levels of three essential amino acids, isoleucine, methionine, and valine, rose significantly higher in the Aminosyn‐treated patients. The plasma levels of all the essential amino acids increased in both study groups. (Journal of Parenteral and Enteral Nutrition 11:368–377, 1987)
A Comparison of Intestinal Adaptation to Short‐Term Intravenous Versus Intragastric Diet in Adult Rats
Authors: Raul Francis , Galluser Michel , Doffoel Michel
Published: May 2008

This study was designed to determine, on intestinal function, the comparative effects of a fat emulsion, a carbohydrate solution, and a mixture of lipids and carbohydrates given for 4 days to adult rats either intragastrically or intravenously. The rats were separated into three groups (n = 24 in each group). Each group was divided into two populations fed either intragastrically or intravenously. Each group received one of the following nutrients: a 20% Intralipid emulsion, a mixture (1:1, V/V) of Intralipid 20% and Vamine N containing 25% glucose (W/V), a solution of Vamine‐glucose supplemented with fructose to reach a final concentration of 20% (W/V). Sham‐operated rats that received laboratory chow orally were used as controls. The daily caloric intake was 0.21 to 0.22 kcal/g body weight. The studies on villus morphology and on brush border enzyme activities were performed on the proximal part of the jejunum. For all nutrients, intragastric infusion provoked an increase in the villus height. The lipids were the only nutrients to cause villus lengthening by the intravenous route. Intragastric or intravenous infusion of fat provoked a deficiency in intestinal disaccharidases: the presence of carbohydrates in the diet inhibited this effect slightly. Carbohydrates given alone, either intragastrically or intravenously, caused an elevation of lactase activity. Independent of diet composition, aminopeptidase activity was reduced after intravenous feeding.

In conclusion, the disaccharidase activities are largely dependent on changes occurring in the nutrient composition given either intragastrically or intravenously, whereas aminopeptidase activity was related to the route of diet administration. (Journal of Parenteral and Enteral Nutrition 11:389–393, 1987)
Total Parenteral Nutrition in Pregnancy: Conception to Delivery
Authors: Nugent F. Warren , Rajala Mary , O'Shea Regina A. , Kolack Peter F. , Hobin Maureen A. , Haimes Marisa K. , Ingalls Marilyn L.
Published: May 2008

The delivery of safe and nutritionally successful total parenteral nutrition (TPN), including intravenous lipid emulsion, to a pregnant woman with Crohn's disease and short bowel syndrome from conception to delivery is reported. Maternal nutritional status improved during the pregnancy. Fetal development was normal, and a healthy, full‐term infant was delivered. The placenta was normal. Specific intravenous macronutrient and micronutrient requirements during pregnancy are not well defined. Our experience has resulted in the generation of additional recommendations to optimize the intravenous nutritional therapy of this high‐risk population. (Journal of Parenteral and Enteral Nutrition 11:424–427, 1987)
Plasma Vitamin and Mineral Status in Home Parenteral Nutrition Patients
Authors: Davis Alan T. , Franz F. Perry , Courtnay Debra A. , Ullrey Duane E. , Scholten Donald J. , Dean Richard E.
Published: May 2008

Home parenteral nutrition (HPN) provides long‐term nutritional support for persons whose absorptive capacity is compromised by a variety of intestinal malabsorption problems. However, the presence of vitamin and mineral deficiency syndromes that normally would not have time to develop in the hospitalized patient receiving total parenteral nutrition has been reported in patients receiving HPN. This study entails a longitudinal survey of plasma concentrations of vitamins A, E, and 1,25‐dihydroxyvitamin D, as well as the minerals zinc, copper, and selenium, in patients receiving HPN. Plasma samples from eight patients who had been on HPN for 1–92 months before the study began were obtained once a month over a 12‐month period. The blood was drawn immediately before their evening infusion of TPN in order to approximate fasting plasma nutrient concentrations. Patient values were compared to fasting control values and to published norms. Values for vitamin A, 1,25‐dihydroxyvitamin D, and zinc all were within the normal range, and there was no evidence of metabolic bone disease. Plasma vitamin E and copper concentrations exceeded the normal range for most of the 12‐month period. Of all of the nutrients studied, only plasma selenium concentrations were consistently in the low‐normal to below‐normal range. Selenium levels in patients on HPN should be monitored regularly, and supplementation may be necessary if clinical conditions warrant. (Journal of Parenteral and Enteral Nutrition 11:480–485,1987)
Nutritional Intake of Gut Failure Patients on Home Parenteral Nutrition
Authors: Dicecco Sara , Nelson Jennifer , Burnes Jan , Fleming C. Richard
Published: May 2008

Nutrient intake patterns were analyzed in 23 patients with gut failure who were receiving home parenteral nutrition (HPN). All patients had stable weights without changes in intravenous calories or protein for 3 consecutive months. Our objectives were to assess oral intake of calories, carbohydrates, fat, and protein, to examine relationships between oral nutrient intakes and disease categories, and to compare oral and intravenous intakes to calculated resting energy expenditure (REE). Two patterns of oral nutrient intake were identified among the patients. Patients with short bowel syndrome, regardless of the underlying disease, consumed calories by mouth that clearly exceeded calculated resting energy expenditure (short bowel, non‐Crohn's, 170% of REE; short bowel, Crohn's, 200 of REE); however, calories approximating the REE had to be given via HPN, suggesting that efficiency of absorption was at a very low level. Patients with diffuse gut diseases (radiation enteritis or pseudo‐obstruction syndromes) had very low intakes of oral nutrients. The distribution of oral calories among carbohydrate, protein, and fat did not differ among the disease categories. (Journal of Parenteral and Enteral Nutrition 11:529–532, 1987)
The Effect of Total Parenteral Nutrition on Hepatic Drug Oxidation
Authors: Burgess P. , Hall R.I. , Bateman D.N. , Johnston I.D.A.
Published: May 2008

Hepatic dysfunction is a frequent complication of total parenteral nutrition (TPN), indicated by derangement of standard liver function tests. However, such changes are variable and nonspecific, and represent hepatic injury rather than changes in hepatic function. Antipyrine (Phenazone) clearance is a sensitive indicator of hepatic microsomal enzyme activity and provides a more specific indication of hepatic function. This was used to investigate the effect of different TPN regimens. Patients receiving a postoperative 2000 kcal TPN regimen providing all nonprotein calories as dextrose (n = 16) showed a 34% reduction of mean antipyrine clearance after 7 days of TPN compared to controls (n = 13, p < 0.05). This effect was seen also in patients receiving a 1600 kcal dextrose‐based regimen (n = 8). In patients receiving a 2000 kcal TPN regimen in which 500 kcal were provided as lipid (n = 10), mean antipyrine clearance was not significantly different from that of the control group. This study indicates the sensitivity of hepatic microsomal oxidative function, an important route of drug metabolism, to different TPN regimens. (Journal of Parenteral and Enteral Nutrition 11:540–543, 1987)
The Effect of Different Intravenous Nutritional Regimens on Renal Function during Acute Renal Failure in the Rat
Authors: Freund Herbert R. , Muggia‐Sullam Michael , Lafrance Richard , Holroyde Jane , Edwards Laura L. , Fischer Josef E.
Published: May 2008

Acute renal failure in the surgical patient is accompanied by a state of hypermetabolism and increased catabolism. Nutritional therapy is therefore directed at the preservation of body cell mass and protein synthesis for repair of wounds and damaged renal tubuli and for maintenance of host defense mechanisms. We examined the effect of two levels of protein intake (18.4 ± 1.4 and 30.8 ± 2.4 mg N/100 g BW/ day) and three different amino acid formulations (Freamine III, Nephramine, and a made‐up mixture of Nephramine + Freamine HBC)† on renal function following mercurv chloride‐induced acute renal failure in the rat. All animals suffered severe renal failure manifested by increased plasma urea and creatinine levels, decreased creatinine clearance, and increased fractional excretion of sodium. On day 4 of acute renal failure, rats receiving low dose amino acids had better‐preserved renal function than those receiving high dose amino acids. However, the type of solution infused did not affect recovery of renal function. (Journal of Parenteral and Enteral Nutrition 11:556–559, 1987)