bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of the Energy Source on Changes in Energy Expenditure and Respiratory Quotient During Total Parenteral Nutrition
Authors: Macfie J. , Holmfield J.H.M. , King R.F.G. , Hill G.L.
Published: May 2008

It has been suggested that malnourished patients respond to glucose intake in excess of energy needs by a rise in respiratory quotient (RQ) above 1.0, indicating net fat synthesis. This would represent inefficient utilization of glucose as an energy source. It is unclear, however, whether this also occurs when some of the energy source is provided as a fat emulsion.

Energy expenditure was measured by indirect calorimetry using a canopy hood and RQ, calculated from the analysis of 2 X 5 minute collections of expired air, were measured every 3rd day in two groups of surgical patients who received a 14‐day course of intravenous nutrition [total parenteral nutrition (TPN)]. Group I (mean ± 1 S.D. 57.4 ± 15.4 yers, 9 females, 3 males) received glucose as the only source (46.6 ± 9.2 kilocalories per kilogram per day and group II (55.8 ± 14.2 years, 5 males, 3 females) 60% of their calories as fat (44.0 ± 7.5 kilocalories per kilogram per day). Both groups were given similar amounts of crystalline amino acid solution (0.34 ± 0.007, 0.32 ± 0.005 gram nitrogen per kilogram per day, respectively) and no other intake. There was no significant difference between the groups mean values of body weight (52.3 ± 7.9 versus 57.9 ± 12.5 kilograms) or energy expenditure before TPN commenced (31.3 ± 6.5, 32.3 ± 3.0 kilocalories per square meter per hour). In group I there was a persistent elevation (p < 0.001) of mean RQ above 1.0 from the 9th day of TPN, together with a significant increase (p < 0.001) in mean energy expenditure which attained the value of 38.0 ± 4.8 kilocalories per square meter per hour on the 14th day. In group II, the mean RQ never exceeded 1.0. The rise in the mean expenditure in group II was significantly less (p < 0.02) than that observed in group I.

This study shows that the use of glucose as the only energy source during TPN is associated with a greater rise in energy expenditure than is observed with a glucose‐fat regime and a persistent elevation of RQ above 1, indicating net lipogenesis. These results suggest, therefore, that complete oxidation of glucose occurs when it is the only source of nonprotein calories given during TPN.
Delivery of Vitamins A, D, and E in Total Parenteral Nutrition Solutions
Authors: Gillis Jonathan , Jones Glenville , Pencharz Paul
Published: May 2008

The ward delivery of fat‐soluble vitamins in parenteral nutrition solutions was simulated in a laboratory situation. Radioactively labeled vitamins A, D, and E were used in tracer studies to follow their nonradioactive counterparts during addition to a parenteral solution and subsequent passage through a standard infusion set. Using this quick convenient method, it was possible to monitor delivery over an entire 24‐hour infusion period. Average recovery for vitamins A, D, and E was 31%, 68% and 64%, respectively. From comparison of various sampling sites during the experimental period, it seems clear that the fat‐soluble vitamins appear to adhere to the bag and tubing. In light of these findings, we suggest a reexamination of the method of solubilization of fat soluble vitamins and of the materials used in the manufacture of clinical infusion equipment.
Limited Value of Nephelometry in Monitoring the Administration of Intravenous Fat in Neonates
Authors: D'Harlingue Arthur , Hopper Andrew O. , Stevenson David K. , Shahin Susan M. , Kerner John A.
Published: May 2008

To evaluate the usefulness of nephelometry in predicting hyperlipidemia in neonates receiving intravenous fat (IVF), 23 infants in our neonatal intensive care nursery had simultaneous measurements of the serum IVF level (as determined by nephelometry), triglyceride, cholesterol, and free fatty acid/albumin molar ratio. There was a positive correlation between the serum IVF level and triglycerides, but the IVF level did not reliably predict elevated triglycerides, cholesterol, or free fatty acid‐albumin molar ratio. Thus, neonates receiving IVF emulsions cannot be monitored by nephelometry alone. Adequate monitoring requires measurement of specific lipid fractions.
Hemoglobin A1C in Home Parenteral Nutrition
Authors: Mirtallo Jay M. , Fabri Peter J.
Published: May 2008

Hemoglobin A1C or glycosylated hemoglobin has been described as being effective in monitoring long‐term glucose control in diabetics. The usefulness of HbA1C in reflecting glucose homeostasis during chronic hypertonic dextrose infusions in 6 patients receiving cyclic home TPN was studied at monthly intervals. Grouped data for the 34 values representing study periods of 5 to 10 months averaged 7.5 ± 0.2% (Mean ± SEM) indicating that HbA1C levels were not elevated above normal (4–8%) in these patients while receiving a dextrose based diet. Final values of HbA1C (7.3 ± 0.4%, mean ± SEM) although lower than early values (8.7 ± 0.6%, mean ± SEM) were not significantly different (p > 0.05, Student's paired t‐test). The change in HbA1C that occurred in these patients probably reflects the response to an altered glucose load infused by the patient.

HbA1C is a convenient and apparently accurate method of evaluating chronic glucose tolerance in patients receiving home TPN and may be used as an alternate method for monitoring glucose tolerance on an outpatient basis.
A Study of the Percutaneous Absorption from Topically Applied Zinc Oxide Ointment
Authors: Derry John E. , McLean William M. , Freeman Joel B.
Published: May 2008

The systemic absorption from topical applications of 40% zinc oxide ointment was investigated in a series of healthy subjects (phase one) and in patients receiving total parenteral nutrition (phase two). In the first phase, six subjects completed a controlled, cross‐over trial involving 3 hourly serum sample determinations for zinc concentration following a massive application of 40% zinc oxide ointment and plain petrolatum ointment. There was a mean increase in serum zinc from 107.3 ± 5.32 to 116.1 ± 5.02 μg/dL 1 hr after application of 40% zinc oxide ointment (p > 0.05). Three patients receiving total parenteral nutrition completed phase two of the protocol in which 40% zinc oxide ointment was applied daily to a specified area of the thigh. Analysis of these patients' serum revealed that the zinc concentrations remained relatively constant over the 10‐day study period. These findings suggest that topical applications of 40% zinc oxide ointment do not result in significant absorption. This study serves as a starting point for further investigation.
In Vitro Study of Inline Filtration of Medications Commonly Administered to Pediatric Cancer Patients
Authors: Ennis Carol E. , Merritt Russell J. , Neff Donald N.
Published: May 2008

Intravenous administration of drugs commonly used in patients with acute nonlymphocytic leukemia was simulated using a.22 μm air‐eliminating filter. Drug concentrations were measured pre‐ and postfiltration using standard pediatric drug doses and concentrations. The percentage of administered dose recovered in the postfilter sample for chemotherapy drugs was adriamycin, 92%; dactinomycin, 87%; cytarabine, 96%; and vincristine, 90%. For antibiotics, the per cent recovery was carbenicillin, 90%; cephalothin, 96%; and gentamicin, 38%. Gentamicin, and perhaps other drugs evaluated, should not be administered through a filter of the type used in this study.
Carnitine Deficiency with Hyperbilirubinemia, Generalized Skeletal Muscle Weakness and Reactive Hypoglycemia in a Patient on Long‐term Total Parenteral Nutrition: Treatment with Intravenous L‐Carnitine
Authors: Worthley L.I.G. , Fishlock R.C. , Snoswell A.M.
Published: May 2008

Low levels of plasma carnitine and reduced urinary carnitine excretion with persistently elevated plasma bilirubin levels, reactive hypoglycemia and generalized skeletal muscle weakness are described in a patient requiring long‐term total parenteral nutrition (TPN). Intravenous administration of L‐carnitine at 400 mg/day for 7 days and subsequently a maintenance dose of 60 mg/day corrected the plasma carnitine deficiency and reactive hypoglycemia and was associated with a return to normal plasma bilirubin levels and a restoration of skeletal muscle strength.
Gluconeogenesis and Nitrogen Loss after Stomach Resection
Authors: Sauerwein Hans P. , Michels Robert P.J. , Cejka Vaclav
Published: May 2008

The relationship between gluconeogenesis from alanine and nitrogen balance after stomach resection was investigated in 13 patients. Partial stomach resection was done in eight patients and total stomach resection was done in five patients. Alanine turnover, carbon flux from alanine to glucose, and glucose turnover were determined by tracer methodology, using the single injection of [U ‐14C]alanine and [2‐3H]glucose. The patients were divided in two groups according to the quantity of administered glucose. Six patients with partial stomach resection received 2.1 to 2.8 g glucose ‐ kg−1·day−1 and 0.07 to 0.09 g nitrogen·kg−1. day−1, amounting to 11 to 13 kcal‐ kg−1. day−1 (group 1). In group 2 the subjects received 5.4 to 8.2 g glucose·kg−1·day−1 and 0.12 to 0.26 g nitrogen·kg−1·day−1; five patients received also 1.2 to 1.8 g fat emulsion·kg−1 ·day−1. Total caloric supply was 28 to 60 kcal·kg−1 · day−1. In group 1 the mean potential contribution of gluconeogenesis from alanine to nitrogen loss was between 31 and 67%; in group 2 this contribution was at least 7 to 63%. No correlation was found between nitrogen balance and carbon flux from alanine to glucose. A significant correlation (p < 0.001) was found between nitrogen balance and, respectively, nitrogen intake and caloric supply. These results suggest that not gluconeogenesis from alanine but nitrogen and caloric demand are major factors influencing nitrogen balance after stomach resection.
Central Catheter Fibrin Sleeve—Heparin Effect
Authors: Ruggiero Robert P. , Aisenstein Terry J.
Published: May 2008

Intravascular abnormalities were well documented with central venous catheters. A prospective randomized study was undertaken to assess the actual incidence of such abnormalities with a silicone catheter and the effect of heparin in small doses on the formation of such abnormalities. Silicone catheters placed via the subclavian route were inserted for intravenous nutritional support. A standard solution of 5% amino acid and 20 to 25% dextrose was utilized and patients were randomized to receive 1000 units of heparin per liter or no heparin. Catheter venograms were performed at the conclusion of therapy. Thirty‐four patients were completed with 17 patients in the heparin group and 17 in the control group. There was obvious fibrin sleeve formation in nine of 17 (53%) in the heparin group and 11 of 17 (65%) in the control group. The duration of catheter stay correlates with the incidence of intravascular fibrin sleeve formation. Intravascular reactions to central catheters occur, regardless of catheter compositions, and result in fibrinous material adherent to the venous wall. Low doses of heparin do not eradicate this problem. Although fibrin sleeve formation was a significant problem, there was no incidence of central venous thrombosis when silicone catheters were utilized.
The Handling of Glucose and Insulin Response before and after Weight Loss with Jejuno‐ileal Bypass: A Preliminary Report
Authors: Sanderson Ian , Deitel Mervyn , Bojm Morris A.
Published: May 2008

Glucose and insulin response were studied in morbidly obese patients before and after jejuno‐ileal bypass. Postbypass studies were performed after weight loss >30% (9–48 mon). Six‐hour oral glucose tolerance tests were performed on 33 patients before bypass and on 13 of these 33 patients after bypass. Thirteen patients had preoperative intravenous glucose tolerance tests performed, and 11 had postbypass intravenous glucose tolerance tests performed. Plasma insulins were drawn concomitantly. Before bypass, fasting blood sugars and insulins were elevated and both glucose intolerance and hyperinsulinemia were found on the tests. After bypass, oral glucose tolerance test curves were flat (malabsorption effect), while intravenous glucose tolerance tests revealed nonsignificant changes in the glucose curves but plasma insulin response returned toward normal (p > 0.05). The glucose intolerance and hyperinsulinemia found in these massively obese patients reverted toward normal after weight loss from jejuno‐ileal bypass. Thus elevated plasma insulin does not appear to be a primary etiological factor in obesity.
Enhanced Tumor Response to Cycle‐Specific Chemotherapy by Parenteral Amino Acid Administration
Authors: Torosian Michael H. , Mullen James L. , Miller Elizabeth E. , Zinsser Kendall R. , Stein T. Peter , Buzby Gordon P.
Published: May 2008

Forced feeding has been shown to effectively stimulate tumor metabolism in numerous animal models. Significant acceleration of tumor growth by exogenous nutrient administration is generally considered to be detrimental to the host. The present study was performed to determine if substrate‐induced alterations in tumor metabolism could be exploited to enhance tumor response to cycle‐specific chemotherapy. Following subcutaneous mammary tumor implantation (AC‐33) and protein depletion, 39 female Lewis/Wistar rats were randomly assigned to one of four nutritional regimens for 48 hr: (1) protein‐depleted food (0.03% protein) ad libitum po, (2) parenteral carbohydrate (18.6% dextrose), (3) parenteral amino acids (2.8% amino acids), or (4) total parenteral nutrition (18.6% dextrose/2.8% amino acids). Methotrexate (5 mg/kg im) was administered to all animals 2 hr after initiating these nutritional regimens. Tumor volume and host toxicity were monitored throughout the study. At sacrifice, significant reduction in tumor volume was observed in animals receiving parenteral amino acids (0.37 ± 0.24 cm3) and total parenteral nutrition (0.25 ± 0.18 cm3) compared to the group receiving protein‐depleted food po (0.70 ± 0.22 cm3) (p < 0.01). In this animal model, the parenteral administration of amino acids with or without the addition of hypertonic dextrose was found to effectively potentiate tumor response to methotrexate without increasing host toxicity. (Journal of Parenteral and Enteral Nutrition 7:337–345, 1983)
Nutritional Parameters in Homebound Persons of Greatly Advanced Age
Authors: Sherman Marc Noel , Lechich Anthony , Brickner Philip W. , Greenbaum Dennis , Kellogg F. Russell , Scharer Linda K. , Starita Laura , Daniel Beverly L.
Published: May 2008

There exists a deficiency of accurate information regarding standard nutritional parameters in people of greatly advanced age. In order to begin obtaining appropriate data, we assessed nutritional status in 45 elderly homebound individuals with a mean age of 84 yr, using anthropometric methods, skin testing, and blood analysis. We compared our data with those from the HANES survey, a reasonable approach to the testing of new possible standards for nutritional assessment. Our results suggest that standard measures in common use are inappropriate for people of greatly advanced age. (Journal of Parenteral and Enteral Nutrition 7:378–380, 1983)
The Use of Sterile and Low Microbial Diets in Ultraisolation Environments
Authors: Aker Saundra N. , Cheney Carrie L.
Published: May 2008

The evidence for the use of sterile and low microbial diets in ultraisolation environments is reviewed. Studies have suggested that sterile food is not required for gut sterilization when oral nonabsorbable antibiotics are used, but if a low microbial food contains an antibiotic‐resistant organism, colonization can occur. There may be a beneficial effect on the incidence of infection by serving pathogen‐free foods, either sterile or low microbial, to the immunosuppressed patient regardless of type of environment, yet the comparative effectiveness of sterile and low microbial diets in preventing introduction of new pathogens accessing the host via the mouth, oropharynx, and esophagus has not been systematically evaluated. (Journal of Parenteral and Enteral Nutrition 7:390–397, 1983)
Vitamin C Supplementation of Total Parenteral Nutrition Formulas
Authors: Abrahamian Vasken , Kaminski Mitchell V. , Cruz Santiago Gustavo
Published: May 2008

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. (Journal of Parenteral Nutrition 7:465–469, 1983)
Subclavian Venous Thrombosis Due to Indwelling Catheters: A Prospective Study on 52 Patients
Authors: Bozzetti Federico , Scarpa Daniela , Terno Giovanni , Scotti Adriana , Ammatuna Mario , Grazia Bonalumi Maria , Ceglia Enrico
Published: May 2008

Clinical occurrence of subclavian venous thrombosis due to indwelling catheters is rare, but there is some evidence that subclinical thrombosis frequently occurs. It is purpose of this study to report the results of a prospective investigation in patients with subclavian vein catheters. Fifty‐two patients admitted to the Istituto Nazionale Tumori of Milan and candidate to infraclavicular percutaneous catheterization of the subclavian vein were evaluated. There were 26 polyvinyl chloride and 26 rubber silicone catheters, which were correctly positioned in the superior vena cava‐atrium. Average duration of the intravenous stay was 12.8 days. Asymptomatic thrombosis was venographically demonstrated in 46.1% of the polyvinyl chloride catheters and in 11.5% of the silicone ones (p = 0.005). The average age of catheters with or without thrombosis was 10.8 and 13.8 days, respectively. Addition of heparin to the infusate (1 U/ml) did not reduce the thrombosis rate in polyvinyl chloride or in silicone catheters, but risk of thrombosis was significantly higher (p = 0.03) in polyvinyl chloride catheters without heparin in comparison to the silicone ones. Osmolarity of the infusional fluid, manipulation during the cannulation, colonization of the catheter tip, and duration of the intravenous stay of the catheter apparently did not influence the rate of thrombosis. Since the natural history of the thrombotic subclavian veins is not known, some caution must be paid to repeat the percutaneous cannulation of the same vein and the change the catheter over a guidewire. (Journal of Parenteral and Enteral Nutrition 7:560–562, 1983)
Stability of Thiamin in Parenteral Nutrition Solutions
Authors: Bowman Barbara B. , Nguyen Phuong
Published: May 2008

Since the vitamin thiamin is sensitive to degradation in the presence of stoichiometric concentrations of sulfite ions, the stability of thiamin in parenteral nutrition solutions containing sulfite as an antioxidant and preservative has been questioned. The usual clinical practice of mixing amino acids, dextrose, and other solutions for administration in total parenteral nutrition significantly dilutes the concentration of sulfite. We have measured the thiamin concentration in total parenteral nutrition solutions sampled from containers after administration to patients. We have also determined the time course of thiamin degradation in solutions containing two concentrations of sulfite. Thiamin content exceeded labeled amounts in total parenteral nutrition bags containing amino acid, dextrose, and multivitamin solutions. However, when multivitamins were added directly to amino acid solutions containing 0.1% (9.6 mM) sulfite, significant degradation occurred by 5 hr. Thiamin was stable for at least 22 hr when added to total parenteral nutrition solutions containing <0.05% (4.8 mM) sulfite. (Journal of Parenteral and Enteral Nutrition 7: 567–568, 1983)
Folic Acid and Total Parenteral Nutrition
Authors: Barker A. , Hebron B.S. , Beck P.R. , Ellis B.
Published: May 2008

The stability of folic acid in a variety of solutions used for parenteral nutrition has been determined over a 2‐wk period. Provided that the acidity of the solution remains above pH 5.0 the folate, in the concentrations usually used for parenteral nutrition, will remain stable in solution, and all of the folate added to the solution will be delivered to the patient. The applicability of this in vitro work to a group of patients requiring parenteral nutrition was assessed, in order to determine a suitable dose. A dose of 0.2 mg of folic acid daily was inadequate to meet the requirements of these patients. In contrast a dose of 1.2 mg daily for 7 days was sufficient to cause an increase in the serum folate concentration. (Journal of Parenteral and Enteral Nutrition 8:3–13, 1984)
Deep Brachial Vein Catheterization for Total Parenteral Nutrition—An Alternate Approach: Review of 154 Cases
Authors: Gillette J.F. , Susini J.
Published: May 2008

The relative safety of silicon rubber catheters allows us to use deep brachial vein catheterization when other vascular accesses are hazardous or impossible. The vein is isolated from nerve and artery after a small incision is made across the inner edge of the brachial biceps. From January 1980 until April 1982, 154 catheters were inserted and remained in place from 14–167 days. In four instances the catheter had to be replaced because the tip was not in the superior vena cava. Twice bleeding had to be controlled with an occlusive bandage. We had no incidence of clinical thrombosis. The surgical access to the deep brachial vein provides a simple and safe method for difficult and even long‐term vascular access. (Journal of Parenteral and Enteral Nutrition 8:49–50, 1984)
Preventing Hypophosphatemia during Total Parenteral Nutrition
Authors: Thompson Jon S. , Hodges Robert E.
Published: May 2008

Phosphate supplementation during total parenteral nutrition (TPN) is essential to prevent hypophosphatemia but individual phosphate requirements vary. We reviewed 68 courses of TPN in 61 patients to determine the incidence of hypophosphatemia and to identify factors which indicate a need for additional phosphate supplementation. Eight (12%) patients were hypophosphatemic before initiation of TPN. Sixty (88%) patients were normophosphatemic when TPN was initiated and 25 (42%) became hypophosphatemic. Of these 60 patients, 20 (38%) of 52 patients became hypophosphatemic when supplemented with 13.6 mM phosphate/ liter or more, whereas five (63%) of eight patients became hypophosphatemic when supplemented with only 6.8 mM phosphate/liter TPN fluid. More hypophosphatemic patients required insulin during TPN (48 υs 26%), were initially hyperglycemic (24 vs 9%), were alcoholic by history (24 vs 11%), had evidence of chronic weight loss (64 vs 46%), and had a history of recent diuretic (40 vs 23%) or antacid therapy (56 vs 43%). Hypophosphatemia occurs frequently after initiation of TPN therapy despite phosphate supplementation. Provision of 13.6 mEq phosphate/liter prevents hypophosphatemia in most patients. However, patients who are hyperglycemic, require insulin during TPN, or have a history of alcoholism, chronic weight loss, or chronic antacid or diuretic therapy may require greater supplementation to prevent the development of hypophosphatemia. Chronically malnourished patients require a slower initial rate of infusion as well. (Journal of Parenteral and Enteral Nutrition 8:137–139, 1984)
Care of the Central Venous Catheterization Site: The Use of a Transparent Polyurethane Film
Authors: Vazquez Richard M. , Jarrard Marilyn M.
Published: May 2008

Studies of care of patients with central venous catheters report a 3–7% incidence of catheter‐induced sepsis when sterile gauze and tape are used as an occlusive dressing. The technique requires that the dressing be changed three times each week for catheterization site inspection. From June 1979 to September 1980, a noncomparative evaluation of a transparent, self‐adhesive, polyurethane dressing which is permeable to water vapor but not bacteria was performed. This dressing was used for the care of 100 consecutive patients with central venous catheters. Dressing life averaged 5.3 days with silicone rubber catheters and 4.3 days for polyvinyl chloride catheters. One patient developed catheter induced sepsis (incidence 1%). This dressing material: (1) is acceptable for use as a dressing of central venous catheters; (2) continuously permits inspection of the insertion sites; (3) decreases nursing hours; (4) provides a comfortable dressing which secures the catheter to the patient; and (5) is durable even when exposed to high humidity therapy devices, or when possible permits the patient to take showers. (Journal of Parenteral and Enteral Nutrition 8:181–186, 1984)
The Choice to Treat All, Some, or No Patients Undergoing Gastrointestinal Surgery with Nutritional Support: A Decision Analysis Approach
Authors: Detsky Allan S. , Mendelson Rena A. , Baker Jeffrey P. , Jeejeebhoy Khursheed N.
Published: May 2008

We used decision analysis to compare three strategies for reducing the incidence of nutrition‐associated complications in patients undergoing gastrointestinal surgery: treat all patients with nutritional support, treat no patients, or perform a test which categorizes patients as high or low risk (treating only the high risk patients). We use the model to make management recommendations based on current knowledge and to set priorities for future research. The “test strategy” is optimal in the majority of cases which we believe are clinically encountered when the test involves subjective global assessment of nutritional status on admission (sensitivity 0.82, specificity 0.72) and nutritional support must be delivered by a central venous catheter. However, the result is particularly sensitive to the predictive properties associated with the test and is less sensitive to the effectiveness rate of nutritional support in reducing the incidence of postoperative complications. We conclude that in future research priority should be given to studying and improving the predictive properties of nutritional assessment techniques. (Journal of Parenteral and Enteral Nutrition 8:245–253, 1984)
Manganese Content of Large‐Volume Parenteral Solutions and of Nutrient Additives
Authors: Kurkus Jan , Alcock Nancy W. , Shils Maurice E.
Published: May 2008

Manganese (Mn) was analyzed by flameless atomic absorption spectrophotometry in a variety of commercially produced solutions and additives commonly used in total parenteral nutrition (TPN). The amount of Mn in preparations tested varied among manufacturers and among lots. It was generally present in very small amounts with amino acid preparations supplying the major portion in the TPN formulas. Among amino acid solutions, Aminosyn 10% had the highest Mn content (5.2–17.0 μg/liter) with Veinamine 8%, FreAmine II, 8.5%, Travasol 10%, and Nephramine having less than 6.7 μg/liter. Other large volume parenterals contained appreciably less Mn, eg, Dextrose 50% had 0.64–2.5 μg/liter. Some of the additives were high in Mn, eg, potassium phosphate—280 μg/ liter, magnesium sulfate 50%—up to 225 μg/liter, and Berocca C—245.8 μg/liter but their actual contributions to daily TPN intake was no more than 3.3 μg. The calculated Mn content in TPN formulas with varying source materials ranged from 8.07–21.75 μg per total daily volume. These values agreed with those obtained from analysis of actual TPN solutions. The values for 10% Intralipid and 20% Liposyn were 0.5 and 3.0 μg/liter, respectively. (Journal of Parenteral and Enteral Nutrition 8:254–257, 1984)
Selenium Status in Patients Receiving Home Parenteral Nutrition
Authors: Fleming C. Richard , Mccall John T. , O'Brien John F. , Forsman R.W. , Ilstrup Duane M. , Petz Jan
Published: May 2008

Selenium (Se) status was evaluated in patients with intestinal failure requiring home parenteral nutrition (HPN). Ninety‐two percent of patients (11 of 12) studied just prior to starting HPN had low serum Se values, and the mean value was 42 ng/ml, significantly less than mean values in disease controls with Crohn's disease not on HPN (76 ng/ml) and healthy controls (88 ng/ml). Eighty‐five percent of patients (22 of 26) already on HPN for 2 to 109 months when studied had low serum Se levels (mean 38.4 ng/ml). The mean 24‐hr urinary Se values were 3.7 μg in patients on HPN who did not have Crohn's disease, 10.9 μg in HPN patients with Crohn's, and 17.9 μg in healthy controls. In patients with Crohn's disease on HPN, a significant direct correlation existed between serum Se and the activity of whole blood glutathione peroxidase, a selenoprotein; and a significant inverse correlation was found between serum Se and months of HPN. This study confirms that Se deficiency is very common in patients before starting and during HPN. These data and recent reports of cardiomyopathies associated with Se deficiencies in patients on HPN increase the importance of proper Se replacement and maintenance. (Journal of Parenteral and Enteral Nutrition 8:258–262, 1984)
The Effect of Intravenous Fat and Total Parenteral Nutrition on Biliary Physiology
Authors: Doty Jeffrey E. , Pirr Henry A. , Porter‐Fink Vicki , Denbesten Lawrence
Published: May 2008

Patients on long‐term total parenteral nutrition (TPN) have an increased incidence of gallstones. To determine the pathophysiologic mechanisms responsible for gallstone formation in these patients, we fed three groups of prairie dogs intravenously for 10 days with continuous infusions of isocaloric, isovolemic, and isonitrogenous solutions with either 0, 25, or 50% of nonprotein calories provided as Intralipid. A fourth group of prairie dogs was hyperalimented with the 25% solution for 28 days. Control animals were fed Purina rat Chow ad libitum. Each animal's bile salt pool was labeled with iv 3H‐cholic acid 16 hr prior to collecting gallbladder and hepatic bile specimens. The ratio of gallbladder to hepatic bile 3H‐cholic acid specific activity (dpm/mol of bile acid), an index of gallbladder stasis, was significantly (p <0.05) lower in TPN animals (<0.65 ± 0.19) compared to controls (1.07 ± 0.11).This finding indicates that gallbladder stasis developed in all animals fed by TPN. TPN did not alter gallbladder or hepatic bile lithogenic index. Two of five 28‐day TPN animals developed biliary sludge, and one of these animals formed pigment gallstones. TPN without lipid decreased serum cholesterol concentration. As the lipid concentration of the TPN solution was increased, serum cholesterol increased. These data indicate that TPN induces gallbladder stasis regardless of caloric source but does not increase bile lithogenic index despite a dose‐related rise in serum cholesterol as the percent of calories provided as lipid is increased. We conclude that TPN‐induced gallbladder disease results from gallbladder stasis and not from increased bile cholesterol saturation. (Journal of Parenteral and Enteral Nutrition 8:263–268, 1984)
Tocopherol Isomers in Intravenous Lipid Emulsions and Resultant Plasma Concentrations
Authors: Gutcher Gary R. , Lax Anita A. , Farrell Philip M.
Published: May 2008

Conflicting reports exist regarding the relative tocopherol isomer content of Intralipid ranging from 99% as α‐tocopherol to as much as 90% as γ‐tocopherol. Our direct assay of Intralipid as well as plasma levels measured in premature infants receiving Intralipid confirm the existence of a low α, high γ‐tocopherol content and imply the need for α‐tocopherol supplementation in patients receiving Intralipid, particularly the relatively tocopherol‐deficient premature infant. Furthermore, the observation of abnormal erythrocyte hemolysis test values despite “normal” total tocopherol plasma concentrations may be explained by high plasma levels of non‐α, biologically less active isomers. The quantitation of tocopherol isomers helps explain this discrepancy and suggests the need for future studies of vitamin E status to employ measurements of tocopherol isomers in reporting results. (Journal of Parenteral and Enteral Nutrition 8:269–273, 1984)
Optimal Levels of Arginine in Maintenance Intravenous Hyperalimentation
Authors: Barbul Adrian , Wasserkrug Hannah L. , Penberthy Lynn T. , Yoshimura Norman N. , Tao Robert C. , Efron Gershon
Published: May 2008

The optimal levels of arginine (Arg) for growth and immunity were studied in mildly depleted, noninjured rats maintained on intravenous hyperalimentation. Three groups of S‐D rats (eight/group, weighing 275–300 g) underwent catheter insertion, 1 day of fasting, and then 7 days of intravenous hyperalimentation consisting of 20% dextrose, adequate minerals and vitamins, and three amino acid regimens: (1) FreAmine II (1.55 g Arg/liter); (2) FreAmine III (4.05 g Arg/liter); (3) experimental (7.5 g Arg/liter). The increase in arginine levels was achieved by lowering the glycine levels. There were no differences among the groups in terms of body weight gain (6.9 us 8.3 us 10.0 g) or in cumulative N balance (574 us 660 us 642 mg). Liver, spleen, and adrenal weights did not differ. Thymus weight was greater in groups B and C: (A) 345 ± 27 mg us (B) 445 ± 34 mg, p < 0.05, us (C) 438 ± 26 mg, p < 0.05) as were the total number of lymphocytes/thymus (×10−9) (A) 0.93 ± 0.12 vs (B) 1.37 ± 0.18, p < 0.05, vs (C) 1.46 ± 0.15, p < 0.05). Mitogen‐induced thymocyte blastogenesis (cpm) was greatest in group C in response to phytohemagglutinin: (A) 9.558 ± 3,799 υ s (B) 20,088 ± 5,890, NS, vs (C) 37,234 ± 6,209, p < 0.01 us A and p < 0.05 vs B) and Concanavalin A: (A) 71,035 ± 15,228 us (B) 111,734 ± 15,021, NS, us (C) 172,967 ± 19,861, p < 0.01 us A and p < 0.05 us B). In the intravenous hyperalimentation‐maintained noninjured rat ARG concentrations more than 1.55 g/liter do not enhance N retention or growth. Larger doses of ARG have strong thymic immunostimulatory effects without any toxicity or growth reduction. (Journal of Parenteral and Enteral Nutrition 8:281–284, 1984)
Effect of Fat Emulsions Containing Medium‐Chain Triglycerides and Glucose on Ketone Body Production and Excretion
Authors: Kolb S. , Sailer D.
Published: May 2008

The parenteral application of fat emulsions containing medium‐chain triglycerides results in an increase of ketone bodies as expression of the rapid metabolism of medium‐chain triglycerides. Although ketoacidosis could not be watched, it should be of advantage to reduce the ketonemia. This might be reached by application of carbohydrates. The simultaneous infusion of glucose—given to 10 healthy persons—together with a 10% fat emulsion containing 75% medium‐chain triglycerides almost completely inhibited the increase of ketone bodies in serum and its urinary excretion. Other prosperous metabolic effects, eg, the rapid clearance of the triglycerides from the serum were not affected by this regimen. (Journal of Parenteral and Enteral Nutrition 8:285–289, 1983)
Nutritional Support as an Adjunct to Radiation Therapy
Authors: Donaldson Sarah S.
Published: May 2008

Patients with malignancies which are treated with therapeutic radiation are at risk for nutritional problems, both from their underlying malignancy as well as from their treatment. These effects may be acute or chronic and relate to the site of the tumor and regions irradiated. There is a large experience with nutritional intervention in irradiated patients, including oral feedings and enteral and parenteral nutritional support. The indications for the specific administration of nutritional support during radiotherapy depend on the nutritional status of the patient and the area irradiated, as well as the individual prognosis. Patients who are malnourished at the time of treatment are most likely to profit from nutritional intervention. To date, prospective randomized trials of nutritional support in patients undergoing radiotherapy fail to show a benefit of routine adjuvant nutritional intervention in terms of improved response and tolerance to treatment, improved local control or survival rates, or reduction of complications from therapy. (Journal of Parenteral and Enteral Nutrition8:302–310, 1984)
Effect of Total Parenteral Nutrition on Free Fatty Acid Metabolism in Burned Patients
Authors: Goodenough Richard D. , Wolfe Robert R.
Published: May 2008

Free fatty acid (FFA) and energy metabolism were studied in six severely burned humans after an 8‐hr fast, after 1 hr of total parenteral nutrition, and after 72 hr of uninterrupted total parenteral nutrition. Caloric intake was twice the predicted basal metabolic rate, with 5 mg kg−1 min−1 of glucose, 2.5 g kg−1 day−1 of amino acid and the remainder of calories supplied as a fat emulsion. 1,2‐13C‐palmitate bound to albumin was continuously infused in order to quantitate FFA turnover and oxidation. Endogenous FFA turnover and oxidation were markedly suppressed by parenteral feeding, presumably due to increased insulin release. A modest recovery occurred in the initial suppression of FFA oxidation after 72 hr, but not in FFA turnover. Fat oxidation provided about one‐quarter of the energy released during parenteral feeding, with endogenous FFA oxidation as the major component. This was roughly equivalent to the percentage of calories supplied as fat. This work indicates that the direct oxidation of a lipid emulsion contributes only a small amount of the energy released in the setting of the severely traumatized human receiving total parenteral nutrition but serves mainly to preserve endogenous fat stores. (Journal of Parenteral and Enteral Nutrition 8:357–360, 1984)
Active Metabolic Expenditure of Gastroenterological Surgical Patients Receiving Intravenous Nutrition
Authors: Macfie John
Published: May 2008

The active metabolic expenditure of 30 gastroenterological surgical patients was measured by performing an energy balance study over 14 days of intravenous nutrition. The mean value of active metabolic expenditure in preoperative patients (559 ± 384 kcal/day) was significantly higher (p < 0.02) than postoperative patients (245 ± 325 kcal/day) but there was wide individual variation within both groups. Combinations of these results with values of resting metabolic expenditure obtained in the same patients suggest that very few uncomplicated surgical patients will ever require more than 2000 kcal/day to achieve a positive energy balance. (Journal of Parenteral and Enteral Nutrition 8:371–376, 1984)
Changes in Plasma Somatomedin‐C in Response to Ingestion of Diets with Variable Protein and Energy Content
Authors: Isley William L. , Underwood Louis E. , Clemmons David R.
Published: May 2008

We have attempted to determine the relative importance of dietary intake of protein and energy in restoring plasma immunoreactive somatomedin‐C (Sm‐C) concentrations after fasting. Ten healthy human volunteers were fasted for 5 days, then divided into two refeeding groups. One group (variable energy) was refed 1.0 g protein/kg ideal body weight, and in 9‐day sequences, 11, 18 and 25 kcal of energy/kg. The other group (variable protein) was given 35 kcal energy/kg, and in 9‐day sequences, 0.2, 0.4, and 1.0 g protein/kg. When subjects were refed the variable energy diets there was no significant increase in Sm‐C at 11 kcal/kg (0.47 ± 0.13 to 0.45 ± 0.12 U/ ml), suggesting that there is a threshold energy requirement below which optimal protein intake is not sufficient to raise the Sm‐C. When subjects were refed 18 and 25 kcal/kg, it became apparent that the more energy added to the diet, the greater the absolute concentration of Sm‐C attained (0.66 U/ ml on 18 kcal/kg and 0.97 U/ml on 25 kcal/kg). Sm‐C correlated with nitrogen balance (r = 0.58) during refeeding with the variable energy diets and was a good indicator of acute directional change in nitrogen balance. However, Sm‐C was not a reliable indicator of nitrogen repletion, since it rose almost to control levels on the 25 kcal/kg diet while nitrogen balance remained slightly negative. During refeeding of the variable protein‐adequate energy diets, there was a significant increase in Sm‐C at the lowest protein intake (at 0.2 g protein/kg, Sm‐C increased from 0.49 ± 0.22 to 0.80 ± 0.34 U/ml; p < 0.01), suggesting that the ingested energy facilitates the efficient utilization of small quantities of dietary protein. As more protein was ingested, the Sm‐C exceeded basal, prefast values in some subjects. Nitrogen balance correlated well with plasma Sm‐C (r = 0.71) on the variable protein diets and appeared to be a good indicator of acute changes in nitrogen accretion. These studies suggest that both energy and protein are important for restoration of Sm‐C after fasting. At extremely low levels of intake, however, it appears that energy restriction causes more impairment of the postfast recovery in plasma Sm‐C than does an equivalent restriction in protein intake. (Journal of Parenteral and Enteral Nutrition 8:407–411, 1984)
Amniotic Fluid Endocrine Changes During Maternal Hyperalimentation
Authors: Legge M. , Benny P.S. , Parker A.J. , Aickin D.R.
Published: May 2008

Ten women with low estriol excretion received hyperalimentation prior to induction of labor. Six received an amino acid mixture (5% Aminofusin) and 25% dextrose, two received the amino acid mixture, and two received 25% dextrose. Amniotic fluid obtained before and after hyperalimentation was assayed for fetal surfactant production, thyroid, pituitary, and carbohydrate regulating hormones. In the combined amino acid/dextrose infusion group the amniotic fluid palmitic acid levels increased significantly post infusion; rT3 also increased significantly but T3 and T4 showed no significant change. The pituitary hormones growth hormone, prolactin, and ACTH showed no significant change, but β‐endorphin‐like activity was significantly elevated. No thyroid‐stimulating hormone was detected in any of the samples. All the carbohydrate regulating hormones, insulin, cortisol, and cAMP, showed significant increases but cGMP showed a significant decrease. The amino acid and dextrose only groups gave similar results. Seven of the infants showed some degree of intrauterine growth retardation but no neonatal complications attributable to the hyperalimentation. (Journal of Parenteral and Enteral Nutrition 8:433–437, 1983)
Clearance Rate of Intravenously Administered Lipid Emulsion in Canine Endotoxemia
Authors: Iriyama Keiji , Mori Hiroshi , Teranishi Tadashi , Nishiwaki Hiroshi , Kusaka Noriko
Published: May 2008

The effect of endotoxemia on the initial catabolism of intravenously given lipid emulsion was investigated in dogs. Two types of endotoxemia were prepared. One was produced by peritonitis which was established by ligation of the artery and vein of an isolated intestine (group 1, n = 6). The other was made by an intravenous injection of Escherichia coli lipopolysaccharide in a dose of 1.5 mg/kg of body weight (group 2, n = 6). Group 1 showed evident peritonitis with a positive limulus test 48 hr after the procedure, but no significant changes of blood sugar level and lactate/pyruvate ratio, while group 2 demonstrated profound hypoglycemia, significant elevation of lactate/pyruvate ratio, and low arterial pressure 3 to 5 hr after the injection of lipopolysaccharide. The clearance rate of intravenously administered lipid emulsion (K value) of group 1 before the peritonitis was 0.0105 ± 0.0017 and after the peritonitis it was 0.0105 ± 0.0019. The difference was not significant, while the K value of group 2 which was 0.0133 ± 0.0056 before the injection of lipopolysaccharide decreased significantly to 0.0069 ± 0.0024 after the injection of lipopolysaccharide. These results suggest that, in case of endotoxemia with normally maintained oxidation‐reduction potential, the initial catabolism of intravenously given lipid emulsion is kept in a normal level, while oxidation‐reduction potential is impaired, it is inhibited. (Journal of Parenteral and Enteral Nutrition 8:440–442, 1984)
Pneumothorax following Attempted Nasogastric Intubation for Nutritional Support
Authors: Eldar Samuel , Meguid Michael M.
Published: May 2008

Nasogastric intubation is a routine procedure, performed daily by both medical and nursing staff. It is a simple procedure, but not without complications which can be life threatening. We present an unusual, life threatening complication which occurred when nasogastric intubation using a no. 8 polyurethane tube with its metal stilet resulted in a pneumothorax after intubation of the endotracheal tree in the presence of a cuffed endotracheal tube. We emphasize that the presence of a cuffed endotracheal tube should not be considered a safeguard against pulmonary intubation during nasogastric placement of a feeding catheter. (Journal of Parenteral and Enteral Nutrition 8:450–452, 1984)
Influence of Total Parenteral Nutrition on Plasma Fibronectin in Malnourished Subjects with or without Inflammatory Response
Authors: Sandstedt Stefan , Cederblad Gitten , Larsson Jörgen , Schildt Bo , Symreng Tommy
Published: May 2008

Plasma fibronectin, which is an α2‐glycoprotein of importance for the immunodefence, has been reported to decrease after starvation and in severely ill patients with cancer. To evaluate the usefulness of fibronectin as an indicator of nutritional repletion, 18 patients with gastrointestinal disorders were studied over a 2‐wk period of total parenteral nutrition (TPN). According to nutritional assessment on admission the patients were divided into well nourished (n = 6) and malnourished (n = 12). For comparison nine patients with anorexia nervosa were also studied over a 3‐wk period of TPN. Before and after TPN fibronectin, albumin, prealbumin, transferrin, and two acute‐phase reactants, haptoglobin and orosomucoid were measured in plasma. The majority of the malnourished patients had an inflammatory reaction in contrast to only a few of the well‐nourished and anorexia nervosa patients. Of the proteins measured, only fibronectin rose significantly in the malnourished patients (malnourished and anorexia nervosa), but not in the well nourished patients during TPN. Our results may indicate the usefulness of fibronectin as an indicator of short‐term TPN in malnourished subjects, irrespective of the presence or absence of inflammatory response. (Journal of Parenteral and Enteral Nutrition 8:000–000, 1984)