bluuebunny/crossref_metadata_2025 huggingface dataset:
Nasopulmonary Intubation with Feeding Tubes: Case Reports and Review of the Literature
Authors: Lipman Timothy O. , Kessler Thomas , Arabian Aram
Published: May 2008

Pulmonary aspiration of regurgitated feeding material is a recognized complication of enteral nutrition by feeding tube. Nasopulmonary intubation with feeding tubes has been reported infrequently. We present two patients with such complications. In one, nasopulmonary intubation resulted in a pneumothorax. In the other unrecognized misplacement resulted in pneumonia and hydrothorax. Similar cases in the literature are discussed. Common features of this complication are: (1) patients who are obtunded, debilitated, or without gag reflex; (2) previous successful insertion of a tube; (3) successful passage past endotracheal tubes and tracheostomies; and (4) positive auscultation of insufflated air over the left upper quadrant. Complete prevention of this complication probably is not possible, but health care personnel should be aware of this potential problem in the patient at risk. (Journal of Parenteral and Enteral Nutrition 9:618–620, 1985)
Nutrition in Patients Undergoing Orthotopic Liver Transplant
Authors: Hehir Dermot J. , Jenkins Roger L. , Bistrian Bruce R. , Blackburn George L.
Published: May 2008

Thirteen patients with severe liver disease had nutritional assessment in the weeks prior to orthotopic liver transplantation. Parameters measured included height and weight, upper arm anthropometry, delayed cutaneous hypersensitivity, total lymphocyte count, serum levels of albumin and transferrin, and plasma amino acids. Weight, when expressed as a percentage of ideal body weight, was greater than 85%, considered the normal lower limit, in all but two patients. However, mean triceps skinfold and arm muscle circumference were 49 ± 25 and 78 ± 9% standard, respectively. Mean serum albumin was 2.7 ± 0.6 g/dl and although mean serum transferrin level was 184 ± 86, eight patients had levels less than normal. Seven patients were anergic to Multitest CMI (58%) and 12 patients had depressed total lymphocyte count. All these later measurements in the aggregate support a diagnosis of protein‐calorie malnutrition. High preoperative levels of amino acids, especially aspartate, phenylalanine, tyrosine, and methionine, were returned to normal by transplantation. We conclude that protein‐calorie malnutrition is common in the group of patients likely to require liver transplant, although individual nutritional assessment parameters may lack sensitivity and specificity in determining nutritional status. (Journal of Parenteral and Enteral Nutrition 9: 695–700, 1985)
Utilization of Prealbumin as a Nutritional Parameter
Authors: Tuten Mikel B. , Wogt Stephen , Dasse Frank , Leider Z.
Published: May 2008

The response of prealbumin was compared to that of albumin and transferrin in 16 patients following 7 days of metabolic/nutritional support. Baseline values were compared to day 7 results to assess the degree of change. Prealbumin demonstrated a significant increase in the mean serum concentration (13.0 us 19.6 mg/100 ml) in the presence of a positive nitrogen balance. Transferrin exhibited a similar significant response (168.8 us 223.7 mg/100 ml). Albumin, body weight, and serum iron concentration did not change significantly during the 7‐day period. Prealbumin effectively demonstrated an anabolic response in the study sample and could possibly be used as an early indicator of visceral protein anabolism in patients receiving metabolic/nutritional support. (Journal of Parenteral and Enteral Nutrition 9:709–711, 1985)
A New Intravenous Emulsion Containing Medium‐Chain Triglyceride: Studies of its Metabolic Effects in the Perioperative Period Compared with a Conventional Long‐Chain Triglyceride Emulsion
Authors: Crowe P.J. , Dennison A.R. , Royle G.T.
Published: May 2008

The effects of carbohydrate, lipid, and nitrogen metabolism of recently available lipid emulsions containing either 50% medium‐chain triglyceride (MCT) and 50% long‐chain triglyceride (LCT) or 100% LCT were compared in elective surgical patients. Postoperative urinary urea excretion was similar during isocaloric MCT/LCT and LCT infusions (1.9 mg/kg/min) and was decreased compared with a standard infusion of 5% glucose (1 mg/kg/min). Plasma glucose and insulin concentrations were similar during both lipid and low dose glucose infusions. However, plasma triglyceride and nonesterified fatty acid concentrations were decreased during the MCT/LCT infusion compared with the LCT infusion, suggesting that the MCT/LCT emulsion was cleared from the circulation faster than pure LCT. Ketone body concentrations were similar during all three infusions. MCT/LCT emulsion can be safely infused perioperatively and has similar nitrogen conserving properties to LCT in these circumstances (Journal of Parenteral and Enteral Nutrition 9:720–724, 1985)
Endoscopic Placement of Enteral Feeding Tubes
Authors: Gallo Santiago , Ramirez Alfonso , Elizondo Javier , Molina Gaston , Ramirez‐Acosta Javier
Published: May 2008

The techniques for placement of feeding tubes using fiberscopes are described and an evaluation of the results obtained in the last 12 months is made. The techniques are discussed and compared with other methods of enteral feeding known at present. It is concluded that placement of feeding tubes by endoscopy can be achieved easily, that it is possible to choose the site of enteric liberation of nutrients under conditions which previously represented contraindications, and that this procedure is free of complications even during long periods of time. (Journal of Enteral and Parenteral Nutrition 9: 747–749, 1985)
Bioavailability of Warfarin in a Patient with Severe Short Bowel Syndrome
Authors: Kearns Patrick J. , O'Reilly Robert A.
Published: May 2008

Acquired warfarin resistance has resulted from altered drug metabolism and excessive vitamin K. A third possible mechanism, decreased gastrointestinal absorption of the drug, was examined in a patient with short bowel syndrome and severe malabsorption who demonstrated transient warfarin resistance. Despite the resistance, bioavailability studies demonstrated normal drug absorption and a prolonged half‐life. The parenteral administration of vitamin K proved to be the cause of the prolonged warfarin resistance. (Journal of Parenteral and Enteral Nutrition 10:100–101, 1986)
Bedside Enteral Feeding Tube Placement into Duodenum and Jejunum
Authors: Thurlow Peter M.
Published: May 2008

A bedside method for placement of nasoenteric feeding tubes is described utilizing gravity and corkscrewing of the feeding tube to pass the pylorus and then air injection to verify position of the tube from the location and character of transmitted sounds to the stethoscope. Twenty‐eight of 31 consecutive patients requiring enteral feeding had tubes successfully placed past the pylorus using this method, 25 on the first attempt and three on the second. This method is an effective and inexpensive alternative to endoscopic or fluoroscopic feeding tube placement. (Journal of Parenteral and Enteral Nutrition 10:104–105, 1986)
Tumor Immunogenicity—The Prime Determinant of the Nutritional Influence on the Host‐Tumor Relationship
Authors: Mccarrick James W. , Ikeda Craig B. , Ziegler Moritz M.
Published: May 2008

The influence which malnutrition plays on the host‐tumor relationship is controversial because of the disparity of human and rodent tumors, a critical difference being the minimal immuogenicity of human tumors and the variable antigenicity of rodent tumors. The hypothesis we tested is that the influence of malnutrition on tumor growth is a result of the immunogenicity of the host's tumor. C‐1300 neuroblastoma (NB) is an immunogenic tumor by in vivo and in vitro assessment while the histologically identical TBJ‐NB clone is non‐immunizing. Isogeneic A/J mice were malnourished with 2.5% protein chow and were inoculated with C‐1300‐NB or TBJ‐NB; either serial tumor volumes were assessed by three‐dimensional measurement or animals were serially killed and tumor weight/carcass weight ratios (TW/CW) were calculated. Non‐immunogenic TBJ‐NB grew more rapidly than C‐1300‐NB in both control and malnourished groups, but there was no difference in either tumor size or TW/CW ratios between the two TBJ‐NB nutritional groups. Contrasting with these data were immunogenic C‐1300‐NB in that the tumor grew significantly better in malnourished mice (tumor volume p < 0.05 day 12 and 14; TW/CW p < 0.026 by day 21). Prior whole‐body irradiation abrogated this difference. These data demonstrate that for tumors differing only in antigenicity the influence of malnutrition is on that tumor which induces an immunologic antitumor response. (Journal of Parenteral and Enteral Nutrition 10:21–28, 1986)
The Malfunctioning Silastic Catheter—Radiologic Assessment and Treatment
Authors: Schneider Thomas C. , Krzywda Elizabeth , Andris Deborah , Quebbeman Edward J.
Published: May 2008

Occlusion of silastic catheters is attributed to several documented causes. One factor not yet adequately documented is fibrin sleeve formation. In this instance, the catheter functions for infusion purposes, but blood withdrawal is no longer feasible. This is a troublesome occurrence when encountered in the clinical setting. This report reviews the assessment of fibrin sleeve formation, the use of catheter phlebography and treatment with low‐dose streptokinase. Seventeen instances of the inability to aspirate blood from silastic catheters are evaluated with restoration of full catheter function in all cases after streptokinase administration. (Journal of Parenteral and Enteral Nutrition 10:70–73, 1986)
Prevention of Duodenal Ulcer Formation in the Rat by Dietary Vitamin A Supplementation
Authors: Mahmood Tariq , Tenenbaum Steven , Niu X.T. , Levenson Stanley M. , Seifter Eli , Demetriou Achilles A.
Published: May 2008

We have shown previously that supplemental vitamin A (Vit. A) increases the early inflammatory response to wounding and enhances the collagen content of the intestine of normal and injured rats. We now report the effect of dietary supplementation with Vit. A on the prevention of duodenal ulcer (DU) in rats caused by intragastric administration of cysteamine‐HCl. A major way cysteamine‐HCl induces DU formation is by enhancing gastric acid secretion. Adult male rats were divided into two groups: (1) rats fed a standard rat Chow (Purina) (15 IU Vit. A/g diet) containing two to three times the National Research Council recommended daily allowance for Vit. A for normal rats; (2) rats fed the same supplemented with 150 IU of Vit. A palmitate per/g Chow. One week later, all rats were given 1 ml of cysteamine‐HCl (135 mg) intragastrically. The rats were maintained on their respective diets. Two days later, all rats were killed with ether, the stomach and duodenum excised, and examined for the presence of ulcers. No gastric ulcers were found in either group. There was a statistically significant decrease in the incidence of DUs in the Vit. A‐supplemented group when compared to the control group (p < 0.01) 48 hr following cysteamine‐HCl administration; 32% of the Vit. A‐supplemented rats developed a DU whereas 74% of rats fed standard Chow had DUs. Most rats had a single DU in the first part of the duodenum, occasionally a second ulcer was noted in the same area. Dietary supplementation with Vit. A had no effect on gastric acid production. In conclusion, our data show that Vit. A dietary supplementation is effective in preventing formation of DUs caused by cysteamine‐HCl administration to rats. This effect does not appear to be due to reduction of gastric acid output. (Journal of Parenteral and Enteral Nutrition 10:74–77, 1986)
Treatment of Esophageal Anastomotic Leakages after Cancer Resection. The Role of Total Parenteral Nutrition
Authors: Riboli E. Berti , Bertoglio S. , Arnulfo G. , Terrizzi A.
Published: May 2008

A series of 16 cases of esophageal anastomotic leakages after cancer resection observed from 1978 to 1982 is analyzed in a retrospective manner. Eight patients related to the period 1978 to 1980 (series A) were treated with emergency surgery while the remaining eight patients observed from 1980 to 1982 (series B) were treated conservatively with total parenteral nutrition (TPN) and complete fasting.

Seven patients from series A eventually died postoperatively and one patient had a good recovery after emergency reintervention. In the series B six patients left the hospital with complete healing of the anastomotic leaks after 27.2 ± 13.5 days of TPN and complete fasting, while failure of the treatment was observed in two patients who died from septic mediastinitis and acute respiratory failure. Different incidence of positive clinical results in Series A and B was statistically significant (p < 0.01).

The role of TPN and complete fasting will be discussed as the primary approach for the management of this severe complication, taking in consideration the suture line drainage and the control of infection. (Journal of Parenteral and Enteral Nutrition 10:82–85, 1986)
Aluminum Does Not Accumulate in Teenagers and Adults on Prolonged Parenteral Nutrition Containing Free Amino Acids
Authors: Heyman Melvin B. , Klein Gordon L. , Wong Alvin , Recker Robert R. , Tyrrell J. Blake , Alfrey Allen C. , Sherrard Donald J. , Hohn David C.
Published: May 2008

Prolonged total parenteral nutrition (TPN) with solutions containing hydrolyzed casein has been associated with aluminum accumulation in patients with bone disease. We investigated the effects of free amino acids in TPN solution on plasma, urine, and bone aluminum in six patients, five of whom had symptoms of bone disease or documented demineralization. No evidence of aluminum accumulation was found. TPN with free amino acids, containing 42 μg aluminum per liter or less, does not lead to aluminum loading in adolescents or adults. (Journal of Parenteral and Enteral Nutrition 10:86–87, 1986)
Nutritional Assessment of Pediatric Patients Admitted to an Acute‐Care Pediatric Service Utilizing Anthropometric Measurements
Authors: Leleiko Neal S. , Luder Elisabeth , Fridman Morton , Fersel Jordan , Benkov Keith
Published: May 2008

Two hundred consecutive pediatric patients were given a nutritional assessment at the time of their admission to the hospital. A weight‐for‐height below the 5th percentile was an indication of acute depletion and a height‐for‐age below the 5th percentile a sign of chronic depletion. Measurement of weight‐for‐height and/or height‐for‐age was below the 5th percentile in 32% of those assessed. Seventy‐five percent of the acutely depleted children and 60% of the acute and chronically depleted children had midarm circumferences below the 5th percentile. Midarm muscle circumference below the 5th percentile was significantly more prevalent in all the depleted children.

This paper reports the results of our study of the objective (quantitative) elements of our nutritional assessment. These measurements indicate that a significant number of patients are at nutritional risk at the time they are admitted to the hospital.

An adequate nutritional assessment cannot be limited to objective considerations, however. A complete medical evaluation of the patient is required, including objective and subjective considerations. (Journal of Parenteral and Enteral Nutrition 10:166–168, 1986)
Intravenous Nutrition and Hepatic Dysfunction
Authors: Robertson J.F.R. , Garden O.J. , Shenkin A.
Published: May 2008

Abnormalities in biochemical liver function tests in 127 general surgical patients who had a course of intravenous nutrition have been reviewed. Only 26 patients had liver function tests considered to be normal on commencing intravenous nutrition and they were included in this retrospective study. During intravenous nutrition the most sensitive biochemical test of liver dysfunction was γ‐glutamyl transpeptidase—all patients having an elevated γ‐glutamyl transpeptidase level by week 4. Most abnormalities were transient whereas the elevation of alkaline phosphatase was prolonged beyond week 9. Patients with major sepsis were found to have almost double the incidence of abnormal liver function test values compared with patients with no evidence of sepsis. Only patients who were transfused more than 8 units of blood showed a significant rise in bilirubin. Liver function tests in patients who received smaller transfusions showed no difference from patients who did not receive any blood. Patients with below normal anthropometric measurements on commencing intravenous nutrition were more likely to develop abnormalities in aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and γ‐glutamyl transpeptidase. (Journal of Parenteral and Enteral Nutrition 10:172–176, 1986)
Detection of Total Parenteral Nutrition‐Induced Fatty Liver Infiltration in the Rat by in Vitro Proton Nuclear Magnetic Resonance
Authors: Jacobs Danny O. , Settle R. Gregg , Trerotola Scott O. , Albina Jorge E. , Wolf Gerald L. , Rombeau John L.
Published: May 2008

In an effort to determine if NMR techniques might be used to detect TPN‐induced hepatic steatosis, the NMR spin‐lattice (T1) and spin‐spin (T2) relaxation times were measured on liver tissue from rats who received one of five dietary regimens: (1) 100% of nonprotein calories as lipid (Fat); (2) a mixture of 50% lipid and 50% glucose nonprotein calories (50/50); (3) 100% of nonprotein calories as glucose (CHO); (4) intravenous saline and standard laboratory rat chow (Saline); and (5) rat chow alone (Oral). The parenteral diets were isonitrogenous and isocaloric. Serum liver function tests were also measured. Animals in the Fat and 50/50 groups had the greatest amounts of liver fat and significantly longer T1 and T2 times (p < 0.01) than any other group. Furthermore, the correlation of T2 time with liver fat content (r = 0.82) was far superior (p < 0.001) to that of serum SGPT (r = 0.48) which was the only liver function test which correlated significantly with liver fat content. In a multiple linear regression analysis, T1 and T2 predicted liver fat content with an r value of 0.84 (p < 0.001). These data suggest that in vivo NMR imaging techniques might be used to detect TPN‐induced fatty infiltration of the liver noninvasively. (Journal of Parenteral and Enteral Nutrition 10:177–183, 1986)
Serum Levels of Vitamin D Metabolites in Children Receiving Total Parenteral Nutrition
Authors: Kimura Saburo , Nose Osamu , Harada Tokuzo , Maki Ichiro , Kanaya Shinobu , Tajiri Hitoshi , Shimizu Kazuo , Yamaoka Kanji , Seino Yoshiki , Yabuuchi Hyakuji , Itakura Takeo , Takagi Yoji , Okada Akira
Published: May 2008

Serum levels of 25‐hydroxyvitamin D (25‐OHD) and 1,25‐dihydroxyvitamin D (1,25‐(OH)2D) were measured on 19 occasions in seven children receiving total parenteral nutrition (TPN). The daily intakes of vitamin D3 ranged from 44 to 540 IU/day, and all serum samples were obtained after the same daily intake of vitamin D3 for more than 1 month. There was a significant positive correlation between serum 25‐OHD levels and parenteral vitamin D3 intakes (r = 0.90, p < 0.01). In this study, serum 25‐OHD levels in all cases taking 200 to 360 IU/day of vitamin D3 were within the normal range. On the other hand, no significant correlation was found between serum 1,25‐(OH)2D levels and vitamin D3 intakes, and serum 1,25‐(OH)2D levels were normal or elevated in all cases. (Journal of Parenteral and Enteral Nutrition 10:191–194, 1986)
Clinical Studies on Zinc Metabolism during Total Parenteral Nutrition as Related to Zinc Deficiency
Authors: Takagi Yoji , Okada Akira , Itakura Takeo , Kawashima Yasunaru
Published: May 2008

In 99 adult patients receiving controlled total parenteral nutrition (TPN), a study was made on the time course of concentrations of zinc in plasma, erythrocyte and urine in relation to the development of zinc deficiency. Zinc deficiency developed in 11 cases receiving TPN solutions not containing zinc. The plasma zinc level was significantly lower at the time of onset of zinc deficiency than in normal subjects, before the procedure of TPN, or at the time of symptomatic relief achieved by administration of zinc. The erythrocyte zinc level was slightly but not significantly lower at time of onset of zinc deficiency than in normal subjects, before TPN or at time of symptomatic relief. The urinary zinc level at time of onset of zinc deficiency was significantly lower than that in normal subjects or at the time of symptomatic relief but not significantly lower than that before TPN. A comparison between patients developing and those not developing zinc deficiency within 4 wk of the outset of TPN showed that only the plasma zinc level was significantly lower in the former than the latter group. The urinary zinc level also tended to be lower, although not significantly, in the former than the latter group but varied widely. No difference was present between the groups as to the erythrocyte zinc level. Zinc deficiency developed in none of those patients who had a plasma zinc level of 50 μg/dl or more but in five of 10 (50%) patients with less than 50 μg/dl and in all three with less than 30 μg/dl of zinc in plasma. Zinc deficiency was frequent in patients with benign gastrointestinal diseases, notably inflammatory bowel diseases. During the course of TPN with solutions not containing zinc a steady fall occurred only in plasma zinc level. Administration of in daily dose of 60 μmol (3.9 mg) was adequate to prevent plasma zinc level from falling and maintain it essentially within normal range. None of the patients receiving zinc in daily dose of 60 μmol (3.9 mg) developed sings or symptoms of zinc deficiency or showed an abnormally elevated plasma zinc level. (Journal of Parenteral and Enteral Nutrition 10:195–202, 1986)
A Technique for Optimization of Enteral Feeding Regimens: Implementation on a Microcomputer
Authors: Krasner Jay B.
Published: May 2008

Many clinical factors must be taken into account in choosing an appropriate enteral feeding regimen for a particular patient. In a patient with multiple medical problems, this decision process may become overwhelmingly complex. This paper discusses a mathematical adjunct to aid in this problem. Using patient‐specific weights for various clinical factors, an algorithmic determination is made of the degree of correspondence between the characteristics of available preparations and those weights. A microcomputer implementation rendering this method usable to the medical health care professional has been created, and is described. (Journal of Parenteral and Enteral Nutrition 10:208–212, 1986)
Selenium Content of Enteral Formulas
Authors: Martin Ramon F. , Young Vernon R. , Janghorbani Morteza
Published: May 2008

Selenium content of several complete enteral formulas and modular enteral components was determined by neutron activation analysis. Formulas based on egg albumin provided the highest content of selenium. Most of the remaining formulas had selenium contents that would provide an amount less than the proposed safe and adequate range of intake. Selenium supplementation should be considered for these latter formulas. (Journal of Parenteral and Enteral Nutrition 10:213–215, 1986)
Copper Deficiency in an Infant on Prolonged Total Parenteral Nutrition
Authors: Tokuda Yutaka , Yokoyama Seishichi , Tsuji Makoto , Sugita Teruji , Tajima Tomoo , Mitomi Toshio
Published: May 2008

An infant with the megacystis microcolon intestinal hypoperistalsis syndrome, required total parenteral nutrition due to ineffective gastrointestinal function, and developed copper deficiency after a prolonged course in total parenteral nutrition in conjunction with a chronic draining jejunostomy. She responded promptly to copper supplementation. (Journal of Parenteral and Enteral Nutrition 10:242–244, 1986)
Elemental Diet Administered Nasogastrically without Starter Regimens to Patients with Inflammatory Bowel Disease
Authors: Rees R.G.P. , Med B. , Keohane P.P. , Grimble G.K. , Frost P.G. , Attrill H. , Silk D.B.A.
Published: May 2008

The present study questions the concept of routinely using ‘starter regimens’ at the outset of enteral feeding with chemically defined elemental diets. A hypertonic elemental diet with an osmolality of 630 mOsm/kg was administered by 24‐hr nasogastric infusion to 12 patients with exacerbations of inflammatory bowel disease and to two patients with short bowel syndrome. Starter regimens were not used. Upper gastrointestinal symptoms of nausea, abdominal bloating, and colicky pain occurred transiently in only five of 14 patients. Stool frequency did not increase during full‐strength feeding, and daily stool weights decreased significantly (p < 0.01). These findings show that it is safe to administer undiluted hypertonic elemental diets by constant nasogastric infusion to patients with inflammatory bowel disease. Avoiding starter regimens leads to increased nutrient intake and improved nitrogen balance. (Journal of Parenteral and Enteral Nutrition 10:258–262, 1986)
Total Parenteral Nutrition in Very Low Birth Weight Infants with Travasol 10% Blend C
Authors: Pineault Marjolain , Chessex Philippe , Lepage Danielle , Dallaire Louis , Brisson Gilles , Qureshi Ijaz
Published: May 2008

Ten very low birth weight (VLBW) infants (birth weight: 994 ± 66 g, gestational age: 27 ± 0.5 wk) requiring total parenteral nutrition (TPN) were studied in order to evaluate their metabolic response to the amino acid solution Travasol 10% blend C. These patients received the solution at a constant rate, providing 2.61 ± 0.02 g/kg/day of amino acids and 76 ± 1 kcal/kg/day. Plasma amino acids analysis was performed after 4.6 ± 0.3 day of infusion and compared to values reported previously with Travasol blend B. The new solution (blend C) showed a significantly lower (p < 0.001) glycinemia (485 ± 24 vs 993 ± 69 μmol/liter), methioninemia (39 ± 2 vs 114 ± 12 μmol/liter) and phenylalaninemia (67 ± 3 vs 92 ± 5 μmol/liter) related to the lower intake of these amino acids. Despite the provision of 47.5 mmol/liter of serine with blend C no changes in plasma level (182 ± 15 vs 196 ± 41 μmol/ liter) were noted. The increased molar arginine/glycine ratio (blend C: 0.48 vs blend B 0.22) could have contributed to keep ammoniemia within normal levels (55.1 ± 4.2 μmol/liter). Wide variations in insulin response (9.9 to 26.4 μU/ml) allowed for a correlation between its plasma concentration and those of sensitive amino acids, underlining its role in protein metabolism. Despite the immaturity of the study population no short‐term metabolic imbalance has been encountered with the Travasol blend C solution. (Journal of Parenteral and Enteral Nutrition 10:296–299, 1986)
Recommendations of Nutrition Support Team Promote Cost Containment
Authors: O'Brien D.D. , Hodges R.E. , Day A.T. , Waxman K.S. , Rebello T.
Published: May 2008

Traditionally, Nutrition Support Teams (NST) have been employed in an advisory capacity to recommend the most beneficial type of total nutritional support. Frequently, this form of therapy is also the most economical, particularly when enteral nutrition can replace parenteral nutrition. In a retrospective study, we reviewed the files of 31 patients who had received total nutritional support and compared the nutritional therapy initiated by their attending physicians to the therapy recommended by the NST. Based on guidelines established by the NST, we evaluated patient records for appropriateness of therapy and potential monetary savings had the NST's recommendations been followed. In the majority of cases in which compliance with the NST's recommendations was not accepted, the NST had encouraged the use of enteral nutritional support rather than parenteral nutrition. In the 14 noncompliant cases (representing 280 days of nutritional support) the potential savings to these patients was estimated at $70,200 (more than $5,000 per patient). (Journal of Parenteral and Enteral Nutrition 10:300–302, 1986)
Vitamin E Status in Patients on Parenteral Nutrition Receiving Intralipid
Authors: Vandewoude Michel G. , Vandewoude Maurits F.J. , De Leeuw Ivo H.
Published: May 2008

Low vitamin E levels have been found to be a frequent side effect in patients on total parenteral nutrition (TPN). In the present study, the vitamin E content of fat emulsions (Intralipid) was measured and the influence of the intravenously administered lipid emulsion on plasma vitamin E levels was investigated. The majority of vitamin E was provided in the β + γ‐tocopherol fractions (68.7% of total tocopherol). Vitamin E levels in patients were significantly lower (p < 0.05) as compared to age‐ and sex‐matched normal controls. Although sufficient amounts of vitamin E (16.9 ± 0.8 IU daily) were infused, according to RDA requirements, E‐plasma levels decreased even further during the course of TPN. It was concluded that high amounts of biologically less active tocopherol isomers are not sufficient to maintain vitamin E plasma levels. Supplemental sources of αα‐tocopherol are needed and more attention should be paid to the different tocopherol isomers in the quantitation of the daily allowances of vitamin E. (Journal of Parenteral and Enteral Nutrition 10:303–305, 1986)
Total Parenteral Nutrition‐Associated Metabolic Acidosis
Authors: Kushner Robert F.
Published: May 2008

To prevent acid‐base disturbances, a patient receiving intravenous nutritional solutions must excrete the daily metabolic production of acid. These hydrogen ions are generated from external (infused) sources and internal metabolic processes. Patients with normal respiratory and renal organ function are capable of excreting these volatile and nonvolatile acids, respectively, and maintaining acid‐base balance. However, increased renal or gastrointestinal loss of bicarbonate, diminished renal excretion of acid, or increased acid production may all result in a metabolic acidosis. This article reviews the mechanisms of hydrogen ion production associated with total parenteral nutrition and the variety of disease states leading to development of a metabolic acidosis. (Journal of Parenteral and Enteral Nutrition 10:306–310, 1986)
Fibronectin Levels in Stressed and Septic Patients Fed with Total Parenteral Nutrition
Authors: Linden C.J.V.D. , Buurman W.A. , Spronken E.E.M. , Soeters P.B.
Published: May 2008

Plasma fibronectin concentrations were measured in healthy persons as well as in septic and stressed patients. A decrease in plasma fibronectin concentration was shown in volunteers receiving a low energy (600 kcal), amino acids‐ and lipid‐deficient diet. Increased fibronectin levels were measured in stressed and septic patients, not receiving enteral nutrition, after adequate total parenteral nutrition (TPN during 1 week). It is concluded that total parenteral nutrition facilitates improved fibronectin synthesis in stressed and septic patients. Total parenteral nutrition containing an amino acid mixture rich in branched amino acids (50.2% BCAA) is not superior to TPN containing a standard amino acid mixture (15.6% BCAA) in this respect. (Journal of Parenteral and Enteral Nutrition 10:360–363, 1986)
Comparison of Total Nutrient Admixture Stability Using Two Intravenous Fat Emulsions, Soyacal and Intralipid 20%
Authors: Harrie Kathleen R. , Jacob Mary , Mccormick David , Reid John S. , Mcintosh Norma L.
Published: May 2008

The safe clinical use and physical stability of a total nutrient admixture (TNA) system containing a soybean oil emulsion (Intralipid) has been reported. A study was conducted to compare the physical stability of four admixtures which were divided into two groups based upon the ratios (1:1:1 and 2:1:1) of amino acids (8.5%), dextrose (70%), and fat emulsion (20%). The fat component in each group contained either a new soy bean fat emulsion, Soyacal, or Intralipid. The quantities of all electrolytes, trace elements and vitamin additives were the same. All solutions were stored at 4°C for 28 days and then held at ambient temperature for 5 days for a total 33‐day study period. Each admixture was serially analyzed on days 0, 1, 2, 3, 5, 7, 14, 21, 28, 29, 30, 31, 32, and 33. Examination of gross visual appearance and determinations of pH were performed. Osmolality was measured by means of freezing point depression (Advanced Digimatic Osmometer, Advanced Instruments, Inc., Needham Heights, MA). A Brook‐haven particle analyzer was used to measure lipid particle size and particle size distribution. Electron and light microscopy were used to verify maximum particle size and distribution on days 0, 7, 14, 21, 28, and 29. The type of lipid emulsion used did not affect the pH or osmolality of the admixtures. Admixtures prepared with the 2:1:1 ratio had slightly higher pH (0.07) and lower osmolality (350 mOsm/kg). The range of mean diameters for the admixtures prepared with Soyacal and Intralipid were 0.283 to 0.310 μm and 0.314 to 0.351 μm, respectively. Based upon particle size distribution, 95% of all particles were less than 0.395 and 0.392 μm (Soyacal) and 0.444 and 0.439 μm (Intralipid). The largest particle observed in the admixture was 8.75 μm. Our data indicate that the physical stability of a TNA system prepared with Soyacal 20% or Intralipid 20% are similar. (Journal of Parenteral and Enteral Nutrition10:381–387, 1986)
Effects of Nutrition on Plasma, Liver and Muscle Amino Acids in Scalded Rats
Authors: Karner J. , Roth E. , Funovics J. , Hanusch J. , Walzer L.R. , Berger A. , Meissl G.
Published: May 2008

This study set out to investigate the effect of three different parenterally administered diets on the free amino acid (AA) levels in the plasma, muscle, and liver of scalded rats. Diet I consisted of AA (1.4 g/100 g weight) and a high glucose dose (6 g/100 g weight), diet II consisted of AA and a low glucose dose (1.4 g/100 g weight) and in diet III only a low glucose dose was infused. Parenteral nutrition was started on the 3rd day posttraumatically. Sampling was performed on the 7th day posttraumatically.

Nitrogen balances were significantly different in all three groups, being lowest in group III. Scalded rats fed isonitrogenously, but with different amounts of glucose showed only minor changes in AA concentrations. However scalded rats fed with a nitrogen‐free diet exhibited significantly reduced total muscle and liver AA levels. These decreased AA levels were due to a drop of glycine in the muscle tissue (74%) and liver (49%). Contrary to the clinical catabolic situation in scalded and starved rats, it was not intracellular glutamine but glycine which was considerably influenced by catabolism and starvation. (Journal of Parenteral and Enteral Nutrition 10:393–398, 1986)
Selenium Deficiency in the Acquired Immunodeficiency Syndrome
Authors: Dworkin Brad M. , Rosenthal William S. , Wormser Gary P. , Weiss Lisa
Published: May 2008

Severe protein‐calorie malnutrition is common in patients with AIDS (acquired immunodeficiency syndrome). These nutritional deficits are likely to further impair immune responses and other organ functions vital for recovery from serious infectious diseases. Since selenium deficiency is known to be associated with oral candidiasis and abnormal phagocytic function in animals and depressed helper T‐cell numbers in man, we evaluated both selenium status and other nutritional parameters in 12 patients with AIDS compared to 27 healthy controls. Selenium was measured by a spectrofluorometric method. The mean (±SD) plasma selenium level in AIDS was 0.043 ± 0.01 μg/ml vs 0.095 ± 0.016 μg/ml in controls (p < 0.001). Whole blood selenium and red blood cell selenium levels were also significantly reduced in AIDS (p < 0.005). The mean weight loss in AIDS patients was 35.5 ± 21.2 pounds. Serum albumin was significantly (p < 0.01) lower in AIDS patients compared to controls. A good correlation between serum albumin and plasma selenium was noted (r = 0.77; p < 0.001). We conclude that selenium deficiency is a common component of the malnutrition seen in AIDS patients. Therefore, aggressive nutritional support, including attention to selenium status, should be considered an integral part of the therapy of AIDS patients. (Journal of Parenteral and Enteral Nutrition 10: 405–407, 1986)
Branched‐Chain Amino Acid Interactions in Skeletal Muscle: Isoleucine and L‐Alloisoleucine
Authors: Downey R.S. , Karl I.E. , Bier D.M.
Published: May 2008

Parenteral administration of a mixture of branched‐chain amino acid (BCAA) solutions is known to alter plasma levels of the BCAA (ILE, LEU, VAL), their corresponding alpha‐ketoacids (KMV, KIC, KIV) and L‐alloisoleucine (ALLO), a stereoisomer of ILE. Although variously formulated mixtures of BCAA are administered, the metabolic implications of individual BCAA interactions have been only partially elucidated. Using the incubated, isolated, and intact rat epitrochlearis muscle, we measured the effect of graded increases (0.05, 0.10, 0.5, and 1.0 mM) in media concentrations of a single BCAA or ALLO on (1) the rate of decarboxylation of the other BCAA, and (2) the release of branched chain ketoacids from muscle. A graded increase of media ILE concentration to 1.0 mM changed the decarboxylation of LEU by —28%, and the release of KIC by +23%, but VAL decarboxylation increased by +25%, and the release of KIV declined by ‐56%. A graded increase of media LEU to 1.0 mM increased ILE decarboxylation by +146%, and its corresponding ketoacid (KMV) by +61%. Howevever, VAL decarboxylation changed by only +25% and KIV release declined by —65%. A graded increase in media VAL to 1.0 mM accelerated ILE decarboxylation by +37%, but KMV release was unchanged. Similarly, LEU decarboxylation fell by ‐26%, and the release of KIC by only +6%. ALLO 0.025 mM increased ILE release by +55% but had an inconsistent effect on ILE decarboxylation and did not alter protein synthesis or degradation (estimated by phenylalanine incorporation and tyrosine release, respectively). Increasing ILE did not affect ALLO release. This study provides further evidence for the unique role of individual BCAA and ALLO interactions at one of the major control points of BCAA degradation in skeletal muscle. Because the use of mixtures of BCAA as a therapeutic modality can result in specific alterations of individual plasma BCAA, the effects of variously formulated BCAA mixtures must be studied in detail before the full implications of their metabolic interactions are known. (Journal of Parenteral and Enteral Nutrition 10:456–462, 1986)
Energy Metabolism and Substrate Oxidation as Possible Factors for Net Protein Accretion in Growing Rats
Authors: Lindmark L. , Martins F. , Lundholm K.
Published: May 2008

This study describes an experimental model with growing rats in which we have measured energy expenditure and substrate oxidation as possible factors for regulation of net protein synthesis in intravenously fed growing rats. Orally fed rats were used as a reference group.

Rats were given intravenous nutrition for 10 days at a high (350 kcal/kg/day) and a low (270 kcal/kg/day) energy level with four different fat‐to‐carbohydrate compositions at each energy level: N (no fat), L (low fat, 6% nonprotein calories), M (medium fat, 30% nonprotein calories) and H (high fat, 60% nonprotein calories). Continuous O2‐consumption and CO2 production of the animals were measured. Whole body substrate oxidation was calculated from respiratory gas exchange and nitrogen excretion. Body composition was assessed in all animals at the end of infusions.

Energy balance with zero growth was reached at 240 kcal/ kg/day. Growth rate was normal in animals receiving 350 kcal/ kg/day compared with freely eating reference animals irrespective of the glucose‐to‐fat ratio of the intravenous solutions. Animals on 270 kcal/kg/day showed retarded growth rate, but the differences in growth rate among the groups were mainly explained by carcass fat. Net protein accretion did not differ among most of the groups irrespective of intravenous or oral intake at different levels. The whole body oxidation rate of glucose was directly proportional to the infusion rate of glucose, while the net fat oxidation was inversely correlated to the infusion rate of glucose. The oxidation rate of amino acids and proteins was not directly correlated to the oxidation of glucose or fat. Oxidation of proteins was quantitatively the same in animals on 350 kcal/kg/day and freely fed reference animals, but it was elevated in rats on 270 kcal/kg/day. The energy cost for net protein accretion was higher in rats receiving mainly fat (60 energy%) as nonprotein calories at 270 kcal/kg/day.

The results show that growth rate is determined by factors that are not directly related to the oxidation rate of carbohydrates and fat above energy balance. We suggest that normal growth is achieved only at a certain intake of amino acids. Below the level net protein synthesis starts to fall irrespective of the nonprotein intake. (Journal of Parenteral and Enteral Nutrition 10:463–469, 1986)
Clinical Experience with the Multiple Lumen Central Venous Catheter
Authors: Kaufman Jeffrey L. , Rodriguez Jorge L. , McFadden John A. , Brolin Robert E.
Published: May 2008

One hundred four multiple lumen central venous catheters (MLC) were evaluated in 74 seriously ill patients. Eighty percent of the catheters were placed in an intensive care unit. Each MLC served as access for a mean of 4.5 different functions, including infusions, central venous monitoring and phlebotomy. Complications occurred with 16 MLC (15.4%), including two aberrant placements, 10 mechanical problems, and four septic catheters (3.8%). Simultaneous administration of TPN and other infusions through MLC did not affect the rate of catheter sepsis.

MLC are well tolerated and cost effective. They increase the comfort of patients who require complex venous access or who lack peripheral veins. They allow safe concurrent administration of TPN, medications, and central venous monitoring. (Journal of Parenteral and Enteral Nutrition 10:487–489,1986)
Bacterial/Fungal Growth in a Combined Parenteral Nutrition Solution
Authors: Mershon John , Nogami Wallace , Williams Janice M. , Yoder Caryn , Eitzen Harold E. , Lemons James A.
Published: May 2008

Appropriately mixed, compatible solutions of glucose, amino acids and lipid have recently become available for clinical use. While a single hyperalimentation solution has several advantages over the conventional two‐bottle technique, its effect on infusion‐related septicemia is unknown. An in vitro, mock infusion system identical to that used in our newborn intensive care unit was set up to assess the relative growth rates of three microorganisms in several parenteral nutrition mixtures. Growth of Staphylococcus epidermidis, Escherichia coli and Candida albicans was measured in seven different alimentation solutions, including two combined solutions. Generally, microbial growth was the same or decreased in combined solutions as compared to fat alone although considerably greater than that observed in nonlipid containing solutions. In addition, the ability of these organisms to pass in‐line terminal filters of pore size 0.22 and 1.2 μm was assessed. (Journal of Parenteral and Enteral Nutrition 10:498–502, 1986)
Nutrition Education in Schools of Nursing in the United States. Part 1. The Evolution of Nutrition Education in Schools of Nursing
Authors: Englert Deann M. , Crocker Kathleen S. , Stotts Nancy A.
Published: May 2008

In 1981 the Nurses' Committee of the American Society for Parenteral and Enteral Nutrition appointed an Ad Hoc Committee to investigate the evolution of and the current status of nutrition education curriculum in schools of nursing accredited by the National League for Nursing. This investigation identified current trends in the teaching of nutrition content in baccalaureate and graduate schools of nursing. Part one explores the evolution of nutrition content in school of nursing curriculum; while part two (to be published in a later journal) presents the results of a descriptive survey of accredited schools of nursing in the United States. (Journal of Parenteral and Enteral Nutrition 10:522–527, 1986)
Cardiac Tamponade: A Complication of Central Venous Hyperalimentation
Authors: Suddleson Edwin A.
Published: May 2008

Complications from central venous catheterization for administration of parenteral feeding solutions are common and well documented. In a recent series, complications from catheter placement were reported as 4.8%.1 We report the case of a patient with cardiac tamponade while receiving parenteral hyperalimentation through a polyurethane central venous catheter. (Journal of Parenteral and Enteral Nutrition 10: 528–529, 1986)
Report on the 1986 A.S.P.E.N. Research Workshop on Selenium in Clinical Nutrition
Authors: Levander O.A. , Burk R.F.
Published: May 2008

Selenium in human nutrition was the theme of the 1986 Research Workshop of the American Society for Parenteral and Enteral Nutrition. At the workshop, evidence for the nutritional essentiality of selenium to humans was reviewed, and it was concluded that Keshan disease, the cardiomyopathy of children and young women described in China, is now firmly linked to selenium deficiency, although other factors may be involved. Selenium metabolism and techniques for assessing selenium status also received attention at the workshop. A measurement of blood selenium levels was accepted, in general, as a valid technique for assessing selenium status in individuals with relatively constant selenium intakes. Clinical practitioners at the workshop reported that some of their total parenteral nutrition patients not receiving selenium presented biochemical evidence of selenium deficiency, but no characteristic clinical syndrome due to selenium deficiency has yet been observed in such patients. The workshop attendees acknowledged the need for an official guideline for selenium use in total parenteral nutrition, but were unable to develop a consensus regarding such a guideline. However, the workshop agreed that any guideline established in the future should specify the type of patients to be supplemented, the dose of selenium to be administered, and the selenium compound to be used. Until that time, the physician supervising the therapy must assume responsibility both for determining the need for selenium supplementation, and for the administration of the supplemental selenium. (Journal of Parenteral and Enteral Nutrition 10:545–549, 1986)
Impaired Wound Healing in Surgical Patients with Varying Degrees of Malnutrition
Authors: Haydock David A. , Hill Graham L.
Published: May 2008

The relationship between nutritional state and wound healing was examined in 66 adult surgical patients. Wound‐healing response was assessed by measuring the collagen content (hydroxyproline) of fine tubes of Gore‐tex inserted subcutaneously along standardized needle track arm wounds. After a period of 7 days, the tubes were removed and it was found that there was a higher hydroxyproline content in the tubing of 36 normally nourished patients than there was in the tubing of 21 patients with mild protein energy malnutrition (p < 0.01) and 9 patients with moderate to severe protein energy malnutrition (p < 0.01). There was no difference in the wound‐healing response between the two latter groups of patients who had significantly different degrees of malnutrition. The results suggest that a definite abnormality in the wound‐healing response exists in malnourished surgical patients, but it occurs earlier in the course of the illness than previously supposed. (Journal of Parenteral and Enteral Nutrition 10:550–554, 1986)