bluuebunny/crossref_metadata_2025 huggingface dataset:
The Stability of Amikacin, Gentamicin, and Tobramycin in Total Nutrient Admixtures
Authors: Bullock L. , Clark J.H. , Fitzgerald J.F. , Glick M.R. , Hancock B.G. , Baenziger J.C. , Black C.D.
Published: May 2008

Amikacin (A), gentamicin (G), and tobramycin (T) were added to eight different total nutrient admixtures (TNA) with varying concentrations of dextrose, amino acid, and fat emulsion to determine drug and emulsion stability. All TNA were prepared aseptically and stored at room temperature under normal room lighting for 12 hr before drug addition. One volume of each drug was added to an equal volume of each of the eight TNAs to simulate 1:1 piggyback contact volumes. Samples were left at room temperature for 6 hr. Drug concentrations were analyzed by fluorescence polarization immunoassay. TNA/drug admixtures were pH tested and visually inspected before and after centrifugation in microhematocrit tubes, noting signs of emulsion stability at 1 and 6 hr. Emulsion particle size was determined at 1 and 6 hr using interference contrast microscopy. All three drugs retained their immunoreactivity in all TNAs for at least 6 hr. G and T were stable in all eight TNAs for at least 6 hr with no significant effect on emulsion particle size or stability after centrifugation. A was incompatible with all eight TNAs, resulting in visual breaking of all emulsions within 1 hr. Therefore, G and T, but not A, can be administered via piggyback method with the eight TNAs tested if the infusion is completed within 6 hr. (Journal of Parenteral and Enteral Nutrition 13:505–509, 1989)
Response of Preterm Infants to Aluminum in Parenteral Nutrition
Authors: Koo Winston W.K. , Kaplan Lawrence A. , Krug‐Wispe Susan K. , Succop Paul , Bendon Robert
Published: May 2008

Twenty‐five preterm infants with birth weights (BW) 540 to 2280 g (20 with birth weight < 1500 g) and gestational ages 24 to 37 weeks, were studied to determine the response to 2 levels of aluminum (Al) loading from currently unavoidable contamination of various components of parenteral nutrition (PN) solution. High Al loading group (H) received solutions with measured Al content of 306 ± 16 μg/liter and low A1 loading group (L) received solutions with 144 ± 16 μg A1/liter. Urine Al:Creatinine (Al:Cr) ratios (μg:mg) became elevated and significantly higher in H (1.6 ± 0.38 us 0.5 ± 0.1, p < 0.05) at the third sampling point (mean 19 days). Serum Al concentrations were highest at onset in both groups and stabilized with study but remained consistently higher than the normal median of 18 μg/liter. Calculated urine Al excretion were consistently low and were 34 ± 6% us 28 ± 5% in the H and L groups, respectively. One infant in the L group who died 39 days after termination of above study showed the presence of A1 in bone trabeculae and the presence of excessive unmineralized osteoid along the trabeculae. We conclude that small preterm infants are able to increase urine Al excretion with increased Al load. However urine Al excretion is incomplete with bone deposition of Al and persistently elevated serum Al concentrations. (Journal of Parenteral and Enteral Nutrition 13:516–519, 1989)
Necrotizing Enterocolitis: Feeding in Endemic and Epidemic Periods
Authors: Zabielski Paul B. , Groh‐Wargo Sharon L. , Moore John J.
Published: May 2008

Aggressive feeding practices are thought to increase the incidence of necrotizing enterocolitis (NEC). Detailed feeding histories of the 39 cases occurring between January 1, 1984 and May 31, 1985 were compared with matched controls. The study period included a cluster (epidemic) of 11 cases diagnosed within 1 month. Data were analyzed collectively and separately for endemic and epidemic cases. Collectively, cases had greater average daily intake volume, maximum daily intake volume, intake volume on the day prior to diagnosis, and maximum daily caloric intake (all p < 0.05) than controls. The only recorded parameter that differed in endemic cases vs controls was intake the day prior to diagnosis. In contrast, epidemic cases were fed significantly more volume, more calories, and faster than controls: average intake volume (62.5 ± 27.2 us 37.4 ± 18.0 ml/kg/day); maximum intake volume (118.5 ± 33.5 us 76.4 ± 38.8 ml/kg/day); intake day prior to diagnosis (109.8 ± 30.9 us 63.8 ± 43.1 ml/kg/day); maximum daily increment (42.6 ± 16.7 us 26.7 ± 16.4 ml/kg); maximum caloric intake (126.1 ± 44.6 us 77.3 ± 50.0) (all p < 0.01). Five of the feeding parameters were significantly less for the epidemic controls than the endemic controls, suggesting a general slowing of feeding during the NEC epidemic. In summary, the data suggest feeding patterns may have an impact on NEC especially during epidemic periods. (Journal of Parenteral and Enteral Nutrition 13:520–524, 1989)
Internal Fracture of a Pediatric Broviac Catheter
Authors: Wagman Lawrence D. , Konrad Patricia , Schmit Paul
Published: May 2008

Indwelling central venous catheters have become an integral part of the care of bone marrow transplant patients. Current technology provides the physician with repeated, reliable accesses to the central venous system via centrally placed silastic (Broviac) catheters. This report describes an unusual mechanical complication and a method for catheter salvage. (Journal of Parenteral and Enteral Nutrition 13:560–561, 1989)
Prevention of Yeast Translocation across the Gut by a Single Enteral Feeding after Burn Injury
Authors: Inoue Sumio , Epstein Mark D. , Alexander J. Wesley , Trocki Orrawin , Jacobs Paul , Gura Patricia
Published: May 2008

Recently, burn injury has been shown to facilitate the ability of enteric Candida albicans (CA) to penetrate the gut epithelium and translocate to the mesenteric lymph nodes (MLN) during the first 24 hr after injury. Guinea pigs were given 3 x 1010 CA intragastrically before inflicting a 50% burn to determine if a single enteral feeding could affect CA translocation to the MLN. A bolus infusion (20 kcal/kg, 12 ml in volume) of liquid meal, consisting of 68% carbohydrate, 20% protein, and 12% lipid, was administered either at 3‐hr or 12‐hr postburn. Control groups received no food or a similar amount of saline by bolus infusion. All animals were allowed water ad libitum until 24‐hr postburn when their MLN and intestinal segments were harvested for enumeration of viable CA. Blood was also collected for determination of serum IgG, C3, cortisol, and albumin. Compared to nonfeed animals, those with a single enteral feeding at 12‐hr postburn had reduced numbers of CA translocating to the MLN (970 ± 220 vs 7,120 ± 2,130 CFU/g, p < 0.02) and colonizing in the ileum (27,000 ± 6,770 vs 104,000 ± 23,550 CFU/g, p < 0.01). Bolus feeding at 12 hr was associated with a lower cortisol level (237 ± 55% of normal controls) than bolus feeding at 3 hr (310 ± 58, p < 0.02) or the nonfed group (326 ± 66, p < 0.01). Regardless of dietary treatment, serum cortisol levels correlated positively with the extent to which CA translocated to the MLN and negatively with C3 levels. (Journal of Parenteral Enteral Nutrition 13:565–571, 1989)
An Analysis of Factors Contributing to the Development of Total Parenteral Nutrition‐Induced Cholestasis
Authors: Drongowski Robert A. , Coran Arnold G.
Published: May 2008

The risk of developmental of total parenteral nutrition (TPN)‐associated cholestatic jaundice in neonates receiving intravenous hyperalimentation is high. Numerous factors have been cited as contributing to TPN cholestasis; however, the exact etiology remains obscure. This retrospective study was undertaken in order to identify any factors which might contribute to this syndrome.

The hospital records of 172 neonates requiring TPN for a minimum of 1 week were reviewed. In addition, a subgroup of 32 infants requiring TPN for a minimum of 7 weeks was also examined. Cholestasis was defined as a direct serum bilirubin greater than 2.0 mg/dl during the course of TPN therapy.

Significant factors for the development of cholestasis in both groups (n = 172, n = 32) included: number of operations (2.56 vs. 1.08, p = 0.0000), the number of days the patients received antibiotics (40.3 vs 12.9, p = 0.0000), and delayed start of enteral feedings (33.8 vs 14.1, p = 0.0000).

Fifteen of the 32 patients who received TPN for at least 7 weeks did not develop cholestasis. In this subgroup (n = 32), there were no differences in birth weight, gestational age, days from birth to the start of TPN, or respiratory distress between those who developed cholestasis and those who remained anicteric. In contrast, there were significant differences between the cholestasis and noncholestasis groups in number of operations (13 vs 6, p = 0.0407), and days until enteral feedings were started (33.1 vs 18.9, p = 0.0289).

This study suggests that the factor(s) contributing to the development of TPN‐associated cholestasis are likely multifactorial. There appears to be a direct correlation between increasing severity of cholestatic jaundice and duration of TPN. This review does add a new parameter to the various causative factors suggested, namely the number of operative procedures. This new variable could be related to the stress of surgery itself or to the repeated administration of anesthetic agents. (Journal of Parenteral and Enteral Nutrition 13:586–589, 1989)
Intravenous Fat Emulsion Acutely Suppresses Neutrophil Chemiluminescence
Authors: Robin Arnold P. , Arain Imtiaz , Phuangsab Anan , Holian Oksana , Roccaforte Peter , Barrett John A.
Published: May 2008

The immediate effect of intravenous fat emulsion on neutrophil oxidant release was studied. Opsonized nonencapsulated S. aureus was used to stimulate neutrophil activity. Luminol enhanced chemiluminescence was followed over 15 min and recorded as peak output (P; mV), integral under the curve (I; V·sec) and rate of increase (R; mV/sec). Eighteen chronically ill patients receiving glucose based total parenteral nutrition were studied before and after a 4‐ to 6‐hr test infusion of 500 ml of 10% fat emulsion. P decreased from 719 ± 46 to 461 ± 42 mV (p < 0.001), I decreased from 169 ± 17 to 111 ± 12 V·sec (p < 0.001) and R decreased from 6.9 ± 1.0 to 4.0 ± 0.6 mV/sec (p < 0.001). Preincubation of normal whole blood with fat emulsion in vitro did not adversely affect chemiluminescence (11 studies), nor did incubation of normal neutrophils with patient postinfusion plasma (10 studies). We conclude that fat emulsion infusion acutely suppresses neutrophil chemiluminescence. The suppression is not a direct effect of the fat emulsion per se and is not due to inhibitory substances in the plasma following infusion. (Journal of Parenteral and Enteral Nutrition 13:608–613, 1989)
Effect of the Continuous Administration of Fat Emulsion on the Infiltration of Intravenous Lines in Infants Receiving Peripheral Parenteral Nutrition Solutions
Authors: Phelps Stephanie J. , Cochran Emily B.
Published: May 2008

Animal data and anecdotal human experience suggest that vascular damage induced by the infusion of dextrose/amino acid solutions may be ameliorated by the concomitant administration of fat emulsion. We prospectively evaluated the effect of the continuous infusion of peripheral nutrition solutions with and without fat emulsion on the incidence of, probability of, and time to infiltration of peripheral venous lines in infants (median age: 1.0 month; range 1 day‐11.9 months). Ninety‐seven peripheral venous lines were studied in 53 infants who received 10% dextrose (n = 34), 10% dextrose/ 2% amino acids (n = 30), or 10% dextrose/2% amino acids/fat emulsion (n = 33). Solutions were administered by positive pressure infusion devices through Teflon catheters with similar gauge. Dextrose, amino acid, electrolyte, and mineral content was standardized for the dextrose/amino acid and dextrose/ amino acid/fat emulsion groups. The three groups were similar with respect to age, race, gender, weight, administration of intravenous medications, and catheter site (p > 0.05). Patients receiving dextrose/amino acid or dextrose/amino acid/fat emulsion had greater rates of solution administration than those receiving dextrose alone (p < 0.002). Infiltration occurred in 71% of dextrose, 66% of dextrose/amino acid, and 67% of dextrose/amino acid/fat emulsion solutions (p > 0.05). The probability of infiltration was greater for infants receiving dextrose/amino acid than for those receiving either dextrose or dextrose/amino acid/fat emulsion (p = 0.01). The mean ± SEM length of time the intravenous sites were viable was significantly shorter for the dextrose/amino acid solutions (26.3 ± 3.3 hr) compared to the dextrose (54.9 ± 7.8 hr) and dextrose/ amino acid/fat emulsion (43.6 ± 4.2 hr) groups. No site complications were associated with the infiltration of any solution. We conclude that the incidence of infiltration among the three solution groups studied is not different. However, the time to infiltration is prolonged and the probability of infiltration is decreased following the infusion of either dextrose alone or dextrose/amino acid/fat emulsion solutions when compared to the administration of dextrose/amino acid solutions without concomitant fat emulsion infusion. (Journal of Parenteral and Enteral Nutrition 13:628–632, 1989)
Hyperalimentation‐Associated Neonatal Cholestasis: Effect of Oral Gentamicin
Authors: Spurr Stephen G. , Grylack Lawrence J. , Mehta Niten R.
Published: May 2008

The effect of oral gentamicin on the incidence of parenteral nutrition‐associated cholestasis in preterm infants less than 1500 g birth weight was assessed retrospectively. Of 24 patients on parenteral nutrition for more than 10 days, 12 infants who received oral gentamicin (group I) for prophylaxis against neonatal necrotizing enterocolitis were compared to 12 infants who did not (group II). Both mean and peak direct bilirubin levels were significantly higher in group II. The increase in both mean and peak direct bilirubin levels after initiation of total parenteral nutrition (TPN) was significant in group II only. The incidence of cholestasis was significantly higher in group II than in group I. These results suggest that oral gentamicin may have a protective effect against parenteral nutrition‐associated cholestasis in the newborn preterm infant. (Journal of Parenteral Enteral Nutrition 13:633–636, 1989)
Catheter Obstruction: Analysis of Filter Content of Total Nutrient Admixture
Authors: Rubin Moshe , Bilik Ron , Aserin Abraham , Ziv Yechiel , Sinai Yehezkel , Dintsman Moshe
Published: May 2008

Catheter blockage in patients receiving long‐term parenteral nutrition with fat‐containing total nutrient admixture (TNA) is a relatively common complication. A study was carried out to characterize the material which is filtered out of the TNA and is a potential cause of catheter blockage. A total of 45 bags containing the same TNA solution were stored for 7 days at 4°C. The stability of the solution in all the bags was then confirmed by light microscope and Coulter Counter, to determine the particle‐size distribution, following which the solution was filtered through a 5‐μm filter. Chemical analysis was then made to determine the amount of solid particles, fat and precipitates of Mg, Zn, Ca, Na, and K in the filter contents. Each bag was found to contain 7326 ± 2681 solid particles as plasticizers and the main component of the filter contents was fat (99.4%) whereas electrolytes as precipitates constituted less than 0.5%. The amount of fat and electrolytes lost on the filter from the solution was negligible. Our analysis of the material trapped on the filter, which may block the catheter during long‐term therapy, suggests the importance of filtration and of finding a means for dissolving the fat, the main component of the filter material. (Journal of Parenteral and Enteral Nutrition 13:641–643, 1989)
Reduced Cardiac Selenium Content in the Acquired Immunodeficiency Syndrome
Authors: Dworkin Brad M. , Antonecchia Paul P. , Smith Fred , Weiss Lisa , Davidian Marianna , Rubin Dave , Rosenthal William S.
Published: May 2008

Selenium deficiency has been implicated in the pathogenesis of a dilated congestive cardiomyopathy in areas of China (Keshan disease) and in several patients on long‐term total parenteral nutrition. Recently a clinically and pathologically similar cardiomyopathy has been described in AIDS. Since blood selenium levels are low in AIDS, we assayed cardiac selenium status by a spectrofluorometric method in eight AIDS patients at autopsy compared to nine age‐matched, non‐AIDS autopsy controls with histologically normal hearts. We found (mean ± SD) a cardiac selenium level of 0.327 ± 0.082 μg/g dry weight in AIDS vs 0.534 ± 0.184 μg/g dry weight in controls (p<0.01; Student's t test). There were no significant differences between the groups for heart weight, serum CPK, or other laboratory parameters. No specific chest x‐ray or electrocardiographic abnormalities were present. Histologically, all AIDS hearts were abnormal; mostly with mild degrees of muscle hypertrophy or fibrosis. Foci of myocytolysis and myocyte necrosis and fibrous replacement of myocytes and monocytic infiltration were present in two AIDS cases.

We conclude that heart tissue in AIDS demonstrates a significant selenium deficit. These data provide a potential link between selenium deficiency and cardiomyopathy in AIDS. (Journal of Parenteral and Enteral Nutrition 13:644–647,1989)
Skin‐Level Gastrostomies and Jejunostomies for Long‐Term Enteral Feeding
Authors: Shike Moshe , Wallach Carl , Gerdes Hans , Hermann‐Zaidins Mindy
Published: May 2008

Skin level gastrostomies and jejunostomies were used in 17 patients for long‐term enteral feeding. These devices offer greater comfort to the patient and less potential complications and dysfunction compared to tube gastrostomies and jejunostomies. Placement of the skin level devices requires “mature” gastrocutaneous and jejunocutaneous fistulas. These fistulas can be created by initial placement of percutaneous endoscopic gastrostomies and jejunostomies. (Journal of Parenteral and Enteral Nutrition 13:648–650, 1989)
Review: The Basics of Immunological Tests
Authors: Ogle Cora K. , Ogle James D. , Alexander J. Wesley
Published: May 2008

This review article describes the cells and the humoral factors of the immune system. It also explains what tests are available to assess the immune functions of patients. Each test listed states the amount of blood needed and the time required to perform the assays. (Journal of Parenteral and Enteral Nutrition 13:651–657, 1989)
Multiorgan Failure from the Inadvertent Intravenous Administration of Enteral Feeding
Authors: Ulicny Karl S. , Korelitz Joel L.
Published: May 2008

Nasogastric tube‐feeding was inadvertently administered parenterally to a 65‐year‐old woman with chronic lymphocytic leukemia. Administration was discontinued after approximately 8 hr of infusion. The patient manifested acute renal failure, respiratory failure, hepatic insufficiency, and high‐output septic shock requiring invasive hemodynamic monitoring, peritoneal dialysis, mechanical ventilation, and broad spectrum intravenous antibiotics. Blood cultures were positive for alpha‐hemolytic Streptococcus, Staphylcoccus epidermidis, and Enterobacter cloacae while cultures of the enteral solution grew alpha‐hemolytic Streptococcus, S. epidermidis, Pseudomonas vesiculare and unidentifiable coliforms. Aggressive management resulted in hospital discharge, although she eventually died of recurrent pneumonia and septicemia 111 days after the infusion. It is of paramount importance to be cognizant of this potential complication in any patient receiving enteral feeding who presents with the clinical picture of high‐output septic shock. We discuss clinical features as well as treatment modalities necessary for a positive outcome. (Journal of Parenteral and Enteral Nutrition 13:658–660, 1989)
A technique for intravenous nutrition in the newborn rabbit
Authors: Rivera A , Roberts RJ , Wispe
Published: May 2008

A technique and nutritional regimen for intravenous feeding of neonatal rabbits is described. Central venous nutrition of 40‐ to 60‐g newborn rabbits was accomplished in a modified infant incubator using a specially constructed catheter and light‐weight harness to provide nutrients by central vein for periods up to 7 days. Throughout the infusion period the newborn rabbits appeared healthy and evidenced increasing activity with age. The pups grew an average of 6.3 g/day, while receiving an intake of 150 to 200 kcal/kg/day. This model appears capable of being utilized to provide information on neonatal growth and metabolism in response to parenteral nutrition.
A prospective study of complications in Hickman right‐atrial catheters in marrow transplant patients
Authors: Ulz L , Petersen FB , Ford R , Blakely W , Bennett C , Grimm M , Hickman RO
Published: May 2008

One hundred forty‐three large bore right‐atrial catheters (RACs) in 111 bone marrow transplant recipients were prospectively analyzed for the incidence of complications interfering with catheter function. Of the 143 RACs, 108 (76%) were patent on departure from Seattle or death. Infectious complications occurred in 63 (44%) of the catheters, resulting in 18 (13%) removals. Noninfectious complications occurred with 54 (38%) of the catheters, resulting in 17 (12%) removals. Successful interventions included catheter repair, dissolving precipitates with ammonium chloride solution, and declotting catheter lumens with heparin and/or urokinase. We conclude that RACs continue to be reliable and safe devices to use in marrow transplant patients. Complications interfering with catheter function are frequent; however, most can be resolved without the need to remove the catheter.
Effects of formula composition on hepatic and intestinal drug metabolism during enteral nutrition
Authors: Knodell RG
Published: May 2008

Significant compositional differences in protein and lipid content are present in currently available enteral nutrition preparations. Since variations in dietary protein and/or lipid have previously been shown to produce alterations in liver and gut drug metabolism, effects of five commonly used enteral nutrition regimens on several drug metabolic parameters were assessed in rats. Study formulations included: 1) Vivonex: low protein ‐no lipid; 2) High Protein Vivonex: normal protein ‐no lipid; 3) Vital: normal protein ‐normal lipid; 4) Sustacal: high protein ‐high lipid; 5) Isocal: normal protein ‐high lipid. Hepatic and intestinal microsomes were prepared after a continuous 7‐day intragastric infusion of one of the formulations, and measurements of cytochrome P‐450 content and assays of drug metabolizing activity were performed. No differences in intestinal microsomal cytochrome P‐450 content or meperidine demethylase activity were seen among the various alimentation groups. However, significantly decreased amounts of cytochrome P‐450 and reduced meperidine demethylase and pentobarbital hydroxylase activity were present in hepatic microsomes of animals receiving the lipid‐poor Vivonex and High Nitrogen Vivonex preparations compared to the other alimentation groups. These data suggest that the composition of enteral nutrition formulations may significantly impact on hepatic function and specifically that the presence of lipid in such preparations may be important for maintaining normal levels of hepatic drug metabolism.
Comparison of low, medium, and high carbohydrate formulas for nighttime enteral feedings in cystic fibrosis patients
Authors: Kane RE , Hobbs PJ , Black PG
Published: May 2008

This study examined whether the increase in CO2 production (VCO2) and ventilatory demands by carbohydrate loading with different formulas during nighttime enteral feedings could be detrimental in young adult cystic fibrosis patients with moderate to advanced lung disease. Ten patients age 17 to 24 (mean 21.4 years) received 1000 kcal/M2 of a low (Pulmocare), medium (Ensure Plus), and high (Vivonex HN) carbohydrate formula in random order. Eight patients had severe, and two moderate obstructive pulmonary disease; nine used nighttime oxygen therapy. Basal energy expenditure (BEE) without feedings averaged 120% of that predicted by the Harris‐Benedict equation. The metabolic expenditure by indirect calorimetry during nighttime feedings was 25 to 36% greater than the BEE. Oxygen consumption (VO2) increased 21 to 27% during nighttime feedings with no difference between formulas. VCO2 increased 29% for Pulmocare, 46% with Ensure Plus, and 53% with Vivonex HN. The increase in VCO2 with Pulmocare was significantly less than Ensure Plus (p less than 0.05) and Vivonex HN (p less than 0.005). The respiratory quotient (RQ) (VCO2‐/VO2) for Pulmocare (0.88) was the same as the BEE, but increased with Ensure Plus (1.00), and Vivonex HN (1.08). The 41% increase in minute ventilation with Vivonex HN was greater than the 25 to 28% increase observed for Pulmocare and Ensure Plus (p less than 0.05). Transcutaneous oxygen saturation fell no more than 2% with all formulas. PCO2 changed +/‐ 5 torr during enteral feedings with similar changes in any patient with all formulas.(ABSTRACT TRUNCATED AT 250 WORDS)
Evaluation of the endotoxin retention capabilities of inline intravenous filters
Authors: Horibe K , Mashima Y , Tashiro T , Yamamori H , Okui K
Published: May 2008

The capabilities of inline filters to retain bacteria and endotoxin were examined during simulated extended infusions for up to 168 hr. The tested inline filters were the ELD96 (Pall Biomedical Corp) and the IVEX 2 (Millipore Corp). Approximately 1 x 10(8) total cells of Escherichia coli B. were challenged to the upstream site of the filter. The test solution of 5% dextrose in water, 0.9% saline, Paremental A (A basic solution for total parenteral nutrition (TPN), a TPN solution in use in our clinic were infused continuously up to 168 hr and flow rate was maintained at 83 ml/hr. The effluents were analyzed using the Limulus Amebocyte Lysate (LAL) test to detect endotoxin and also passage of the challenged bacteria was tested at 24‐hr intervals over 168 hr. The results were as follows: (1) The viability control culture showed the presence of viable bacteria throughout the 168‐hr period of the experiment. (2) During the experiments, all filters produced sterile effluents. (3) LAL assay indicated that only the effluents from the ELD96 contained no detectable endotoxin for 168 hr.
Small bowel resection‐associated urinary calcium loss in rats on long‐term total parenteral nutrition
Authors: Chu RC , Barkowski SM , Buhac J
Published: May 2008

This study was designed to study the effects of small bowel resection on daily urinary excretion patterns, plasma and bone levels of magnesium, phosphorus and calcium in rats on long‐term total parenteral nutrition (TPN). Male Sprague‐Dawley rats weighing 300 to 350 g were randomly divided into two groups with six rats in each group. Control consists of rats whose small intestines were transected but anastomosed. Resected rats had 70% of their small intestine removed. After intestinal resection and transection, rats were infused with a balanced TPN solution for 17 days. Resected rats excreted significantly more calcium than transected rats during the first 10 days of TPN infusion. Peak excretion occurred between day 3 and 4 followed by a trend toward a slightly higher than normal level of calcium excretion between days 10 and 17. Urinary losses of phosphorus and magnesium were not influenced by bowel resection. Plasma and tibia calcium, phosphorus and magnesium levels were not altered. The effects of small bowel resection on urinary calcium loss is specific and our data demonstrate the involvement of gut in regulating urinary calcium excretion and suggest that gut may play a significant role in TPN induced metabolic bone disease.
Effect of heat processing and storage on protein quality and lysine bioavailability of a commercial enteral product
Authors: Lowry KR , Fly AD , Izquierdo OA , Baker DH
Published: May 2008

Several rat bioassays were conducted to evaluate protein quality and lysine (LYS) bioavailability (BIO) of Osmolite HN, a commercial enteral product, as affected by the severity of heat processing during sterilization and by storage of the products for 1 year. Without amino acid supplementation, the protein quality of Osmolite HN, as determined by protein efficiency ratio (PER), was lower than that of casein, regardless of heat treatment. With addition of the limiting amino acid, cystine, the PER of Osmolite HN was equivalent to that of cystine‐fortified casein. Storage of the product for 1 year had no effect (p greater than 0.05) on PER, even though the products had darkened in color. Slope‐ratio regression analysis (weight gain regressed on supplemental LYS intake) yielded a LYS BIO estimate of 94.4% for the Osmolite HN control relative to crystalline LYS. Partitioning weight gain into that resulting from LYS consumed in the basal diet and that resulting from the LYS supplement per se provided more accurate estimates of LYS BIO. This method estimated LYS BIO at 100% for the Osmolite HN products, regardless of heat treatment. With storage, LYS BIO decreased 11–12% in all of the Osmolite HN products. The decreased LYS BIO is of minimal nutritional significance in that overall protein quality of the products was not affected by storage. This is likely due to the fact that there is a plethora of lysine in Osmolite HN such that LYS is not a protein‐quality limiting factor.
The refeeding syndrome: a review
Authors: Solomon SM , Kirby DF
Published: May 2008

Refeeding syndrome has been used to describe those phenomena, such as severe hypophosphatemia and other metabolic complications, seen in malnourished patients receiving concentrated calories via total parenteral nutrition. The purpose of this review is to clarify and broaden this definition, as well as to make recommendations for its recognition and, more importantly, prevention.
Validation of a new formula for calculating the energy requirements of burn patients
Authors: Allard JP , Pichard C , Hoshino E , Stechison S , Fareholm L , Peters WJ , Jeejeebhoy KN
Published: May 2008

In a previous study, we analyzed the roles of the estimated basal energy expenditure (EBEE) calculated by the Harris‐Benedict equation, caloric intake (CI), total burn surface area (TBSA), body temperature (Temp) and number of post‐burn days (PBD) in order to estimate the resting energy expenditure (EE) of burn patients. By multiple regression analysis we found that the measured EE (MEE) is best approximated by the following formula: ‐4343 + (10.5 x %TBSA) + (0.23 x CI) + (0.84 x EBEE) + (114 x Temp (degree C)) ‐ (4.5 x PBD), r = 0.82, p less than 0.001, (Toronto formula (TF)). To validate this, 10 patients with a mean TBSA of 49.1 +/‐ 5.5% had their resting MEE done by indirect calorimetry when fed either by the TF or by 2 x EBEE. The caloric intake when on 2 x EBEE was 3260 +/‐ 45 kcal/day which significantly exceeded the MEE (2765 +/‐ 101 kcal/day, p less than 0.001). The caloric intake when on the TF was 2542 +/‐ 52 kcal/day and matches the MEE which was 2537 +/‐ 86 kcal/day (NS). These results show that the TF matches the MEE very closely. With the addition of a factor of activity for the 24‐hr EE, it can be used to accurately feed individual burn patients.
Resting metabolic rate of esophageal carcinoma patients: a model for energy expenditure measurement in a homogenous cancer population
Authors: Thomson SR , Hirshberg A , Haffejee AA , Huizinga WK
Published: May 2008

In cancer patients controversy exists as to the nature of changes in resting metabolic rate (RMR) and their contribution to cachexia. This study describes the fasting indirect calorimetry, and nutritional measurements made on a homogeneous group of Black patients with carcinoma of the esophagus. It compares them with a reference group. All cancer patients had localized disease and were markedly malnourished. They were on average 20 to 25% lighter than reference subjects. In the cancer patients, the triceps skinfold thickness (TSF) in mm and the hand grip strength in kg/m2, mean and SD, were, respectively, 7.3 +/‐ 2.8 and 28 +/‐ 6 for men and 12 +/‐ 5 and 22 +/‐ 3.5 for women, and were significantly lower than those of the reference subjects. Fat‐free mass was calculated from the TSF measurements. In men with cancer RMR (6.06 MJ/day +/‐ 0.56) was significantly lower than the reference subjects values (7.07 MJ/day +/‐ 0.64) p = 0.002. In women with cancer RMR was on average 2 MJ/day less than in controls but this difference failed to reach significance. However, when expressed per kg fat free mass, or per kg body weight this difference is no longer apparent the RMR being 0.14 MJ/kg/fat free mass in both groups. Our interpretation is that there is no direct effect of the tumour on RMR and that energy expenditure changes are secondary to body composition changes.
Response of tumor and host to hyperalimentation and antiglutamine treatments
Authors: Chance WT , Cao LQ , Fischer JE
Published: May 2008

In two experiments, treatment of tumor‐bearing (TB) rats with the glutamine antimetabolite, acivicin, reduced tumor growth during 14 days of total parenteral nutrition (TPN) that supplied 120% and 130% of the nutritional intake of non‐TB control rats. The acivicin treatment or combination of acivicin with TPN produced increased carcass weights and decreased tumor/carcass ratios. Significant muscle saving was observed in TB rats receiving TPN or TPN and acivicin as compared to acivicin‐treated TB rats maintained on rat chow. Tumor growth was not stimulated by TPN at 130% of ad libitum. intake with a calorie/nitrogen ratio of 102:1. However, when the calorie/nitrogen ratio was increased to 143:1, tumor growth was increased by TPN at 120% of ad libitum. intake. These results suggest that acivicin may prove useful in the stabilization of tumors in situations where tumor growth may be stimulated, such as during TPN.
Effects of nonglucose substrates (xylitol, medium‐chain triglycerides, long‐chain triglycerides) and carnitine on nitrogen metabolism in stressed rats
Authors: Fried RC , Mullen JL , Blackburn GL , Buzby GP , Georgieff M , Stein TP
Published: May 2008

To evaluate the efficacy of nonglucose energy substrates in promoting nitrogen retention and survival in stressed states, two series of studies were done. In study 1, 50 rats underwent cecal ligation/perforation and subsequent infusion for 24 hr with one of four isocaloric (220 kcal/kg/day), isonitrogenous (1.4 g/N/kg/day), isovolemic regimens which differed in caloric source: Glucose (GLU) + long‐chain triglycerides (LCT) (50%:50%), GLU + LCT + medium‐chain triglycerides (MCT) (50%:32%:18%), GLU + LCT/Carnitine (10 mg/dl) or GLU + LCT + Xylitol (XYL) (33%:33%:33%). The nitrogen‐sparing effect of GLU + LCT was not enhanced by the addition of carnitine to facilitate LCT mitochondrial uptake or by MCT to bypass carnitine‐dependent transport. In contrast, relative to GLU + LCT GLU + LCT + XYL decreased urinary 3‐methylhistidine (3MH) excretion (p less than 0.01), and enhanced nitrogen retention (p less than 0.01 vs GLU + LCT). For study 2, 24 male rats were anesthetized, cannulated for TPN, and given a 25% burn. They were then randomized into three dietary groups. The diets were isocaloric (103 kcal/kg/day) and isonitrogenous (2.0 g N/kg/day) but differed in nonprotein calorie source: GLU + LCT (51%:49%), GLU + Glycerol (51%:49%) and XYL + LCT (51%:49%). As in the septic animals, N balance was best with the xylitol regimen (p less than 0.01). The polyol, xylitol, appears to have a significant nitrogen sparing effect in stressed animals.
Antibiotic therapy of catheter infections in patients receiving home parenteral nutrition
Authors: Miller SJ , Dickerson RN , Graziani AA , Muscari EA , Mullen JL
Published: May 2008

Fifty‐eight episodes of catheter‐related sepsis in 21 patients receiving home parenteral nutrition were retrospectively studied. Of 81 organisms isolated from the blood, 59% were Gram‐positive cocci, 25% were Gram‐negative bacilli, and 16% were yeast. Attempts to treat bacterial infections at home with antibiotic therapy while the catheter remained in place were made; fungal isolation resulted in immediate hospitalization and catheter removal. Gram‐negative infections more often resulted in eventual hospitalization (92%) and catheter removal (50%) than Gram‐positive infections (57% hospitalization and 23% catheter removal). Empiric therapy with 1 g of cefazolin intravenously every 12 hr was successful in only 33% of episodes caused by coagulase‐negative staphylococci, whereas vancomycin was successful in 62%. Sensitivity testing was not a reliable guide for antibiotic choice for treatment of these infections. Cefazolin, 1 g, intravenously every 12 hr was successful in only 25% of Gram‐negative episodes treated empirically with this regimen. We conclude that our home parenteral nutrition patients should be hospitalized for a few days upon presentation with a catheter infection for clinical evaluation and aggressive antibiotic therapy. Vancomycin is the preferred drug for treatment of catheter‐related infections caused by coagulase‐negative staphylococcus.
Home enteral nutrition system: one patient, one daily ration of an “all‐in‐one” sterile and modular formula in a single container
Authors: Sami H , Saint‐Aubert B , Szawlowski AW , Astre C , Joyeux H
Published: May 2008

A home enteral nutrition (HEN) system was introduced to deliver a day's ration of an “all‐in‐one” sterile and modular formula from a large container. The nutrient formula consisted of carbohydrate, protein, and lipid modules sterilized separately, in an autoclave at 120 degrees C, then mixed and supplemented with minerals and trace elements. Vitamins were given the patients through a feeding tube before connecting the nutrient container. The system was used to feed 12 malnourished patients (10 men and two women) with cancer (carcinoma of esophagus or tongue) or without cancer (esophageal perforation). All patients had normal gastrointestinal function but could not take in more than 500 kcal/day orally, because of their primary disease or the treatment for it (surgery in four patients; and radiotherapy, associated in some cases with chemotherapy, in eight). HEN duration ranged from 30 to 435 days at a daily cost of approximately US $15 to $20. Statistical analysis (Student's t‐test for paired data) showed significant body weight gain (p less than 0.05) and significant increases in serum levels of albumin, transthyretin (p less than 0.05, respectively), and transferrin (p less than 0.01). Increases of serum total protein level were not statistically significant (p less than 0.09). The nutrient formula was well tolerated and there were no HEN‐related rehospitalizations. Seventy‐five % (nine of the patients) considered that HEN had improved their quality of life. The daily savings per patient, compared to the cost of treatment in a hospital, was about $260/day.(ABSTRACT TRUNCATED AT 250 WORDS)
Availability of cysteine and of L‐2‐oxo‐thiazolidine‐4‐carboxylic acid as a source of cysteine in intravenous nutrition
Authors: Bjelton L , Fransson GB
Published: May 2008

Cysteine is usually not included in amino acid solutions for intravenous nutrition for two reasons: it is not considered to be an essential amino acid, and it causes stability problems in solutions. The cysteine content of a solution decreases markedly in the presence of oxygen and/or glucose due to formation of various derivatives, such as cystine and D‐glucocysteine. It is not clear if the formed derivatives are available for metabolic processes. A cysteine analogue, L‐2‐oxothiazolidine‐4‐carboxylic acid (OTCA), is stable in solutions and can be metabolized in the body‐yielding cysteine. The metabolic availability of cysteine and OTCA from an all‐in‐one total parenteral nutrition (TPN) mixture was evaluated in the rat and compared to a regimen with cysteine infused from a separate container. A cysteine‐free TPN mixture served as a control. All mixtures contained a suboptimal amount of methionine, which can normally be metabolized to cysteine, to enhance the nutritional effect of cysteine or OTCA supplement. The cysteine content in the admixture decreased approximately 40% during 30 hr after mixing. Nevertheless the utilization of this admixture was identical to the regimen supplying cysteine separately. The admixture containing OTCA showed similar results as the two cysteine regimens. All three regimens promoted growth significantly better than the cysteine‐free‐mixture. The results suggest that 1) cysteine is available for metabolic processes from its derivatives formed in an all‐in‐one TPN mixture, and 2) OTCA acts as a precursor of cysteine to the rat when supplied as a part of TPN.
The taurine content of common foodstuffs
Authors: Laidlaw SA , Grosvenor M , Kopple JD
Published: May 2008

There is growing evidence that taurine is a biologically valuable nutrient. However, there are few published data concerning the taurine content of different foods. We measured the taurine content of 29 meats, including both cooked and uncooked samples, nine dairy products, 17 infant or adult‐feeding solutions and 48 plant foods (including vegetables, nuts or seeds, fruits and legumes. Taurine was detected in meats, dairy products, and infant feeding solutions but not in plant products or adult feeding solutions. Using these data, we compared calculated and measured daily taurine intakes in six defined diets. We present sample daily diets for omnivores, lacto‐ovovegetarians and vegans (strict vegetarians), together with calculated taurine intakes.
Fat emulsion effects on prothrombin time in warfarin anticoagulated patients: an in vitro study
Authors: Cotto MA , Lutomski DM , Palascak JE , Fant WK , LaFrance RJ
Published: May 2008

The effect of lipid emulsions on prothrombin time in blood from anticoagulated patients was determined. Blood samples were obtained from 23 patients therapeutically anticoagulated with warfarin (prothrombin time 1.3–2.0 x control). Varying amounts of an intravenous lipid emulsion (Intra‐lipid) were added to the blood to simulate concentrations seen in vivo with a constant lipid infusion. The prothrombin time was measured on the plasma from these samples and compared to the prothrombin time of the plasma samples without lipid. The mean decrease in prothrombin times were: 0.29 sec at 50 micrograms/ml, 0.23 sec at 100 micrograms/ml, and 0.29 sec at 200 micrograms/ml. All concentrations showed a statistically significant decrease (p less than 0.05) when compared to the control by the Scheffe test. Lipid emulsions appear to decrease the prothrombin times in anti‐coagulated patients. The differences however, were small and not of clinical significance at the concentrations tested.
Parenteral nutrition hypersensitivity
Authors: Levy M , Dupuis LL
Published: May 2008

Total parenteral nutrition (TPN) is widely used. Although mechanical, septic, and metabolic complications are well known, hypersensitivity skin reactions are rare. We describe a 16‐year‐old boy with Burkitt's lymphoma who developed a urticarial skin rash when treated with TPN and vitamins. The adverse skin reaction was probably caused by the inactive component of excipient, polysorbate.
In vitro evaluation of a compact metabolic measurement instrument
Authors: Weissman C , Sardar A , Kemper M
Published: May 2008

The ability of the Datex Deltatrac (Sensor‐Medics, Anaheim, CA) to accurately measure oxygen consumption (VO2v) and carbon dioxide production (VCO2) was examined in vitro using the carbon dioxide addition and nitrogen dilution methods. The accuracy of respiratory quotient (RQ = VCO2/VO2) measurements was assessed using methanol combustion (RQ = 0.67). Both in the canopy (blow‐by) and respirator (FiO2: 0.21–0.6, PEEP: 0–12 cm H2O) modes the Deltatrac's measurements of VO2 and VCO2 were within +/‐ 7% of values predicted from CO2 and N2 simulations. Similar results were obtained with methanol combustion. In vitro testing revealed that the Deltatrac accurately measures VO2 and VCO2 under a variety of simulated clinical conditions.
Arginine Supplementation and Its Effect on Established Peritonitis in Guinea Pigs
Authors: Gonce Sara J. , Peck Michael D. , Alexander J. Wesley , Miskell Phillip W.
Published: May 2008

To evaluate the efficacy of supplemental arginine with nutritional support in the presence of sepsis, eighty‐eight gastrostomized female Hartley guinea pigs were implanted with osmotic pumps effusing an Eschericia coli/Staphylococcus aureus mixture. Animals were randomized and infused for two weeks with isocaloric and isovolumetric diets containing 0%, 2%, 4%, or 6% supplemental arginine as arginine hydrochloride. Survival was 12/22 (54%) in 0%, 9/22 (41%) in 2% and 4%, and 2/22 (9%) in 6%. Analysis by chi‐square test of independence was significant (p = 0.0141) with 6% survival lower than the others. Median survival was 11 days in 0%, 8 days in 2% and 6%, and 9 days in 4%. Median survival was longer in 0% than in 2% or 6% (Kruskal‐Wallis ANOVA: p = 0.02). Nitrogen balance was significantly lower in 6% compared to 0% on days 2 through 10, and lower than 2% and 4% on days 6 and 9. Nitrogen balance was higher in 0% than in 2% on days 4, 6, 10, and 13. Serum albumin and C3 were lower in all experimental groups than normal controls (ANOVA: p = 0.01). Comparison of liver, spleen, adrenals, gastrocnemius, and carcass weights, cell‐mediated immunity as determined by contact sensitivity to DNFB, and transferrin showed no significant differences. There was a positive dose‐response effect seen amongst the experimental groups for the amino acids arginine, ornithine, and citrulline in relation to the amount of supplemental arginine. This study suggests that dietary arginine supplementation does not enhance survival in a guinea pig model of established peritonitis. (Journal of Parenteral and Enteral Nutrition 14:237–244, 1990)
Low Plasma Carnitine in Patients on Prolonged Total Parenteral Nutrition: Association with Low Plasma Lysine
Authors: Berner Yitshal N. , Larchian William A. , Lowry Stephen F. , Nicora Robert R. , Brennan Murray F. , Shike Moshe
Published: May 2008

Plasma carnitine levels were determined in 17 patients maintained on long‐term total parenteral nutrition (TPN) for a mean (±SEM) period of 69 ± 11 months (range 12–196). All had severe malabsorption and were dependent on intravenous feeding. Plasma carnitine was determined by a modified Cederblad enzymatic method. Mean plasma carnitine was significantly below the mean normal for females (p < 0.02) and borderline low for males (p = 0.07). In six patients the levels were below the low normal range, and in five others they were at the lowest levels of normal. Of the six patients with normal levels, three had elevated serum creatinine, indicating renal dysfunction which may by itself elevate plasma carnitine. In 10 patients the plasma levels of lysine (a carnitine precursor) were determined and found to be lower than normal (p < 0.05). Plasma carnitine levels correlated positively with serum albumin (r = 0.62, p < 0.05), and negatively with serum alkaline phosphatase (r = ‐0.64, p < 0.05). Thus, patients maintained on long‐term TPN may have low plasma carnitine, which could represent carnitine deficiency. The low plasma carinitine may be related to a deficiency of the carnitine precursor lysine. Further studies are required to determine the significance of the low plasma carnitine and whether carnitine supplementation should be required in long‐term TPN. (Journal of Parenteral and Enteral Nutrition 14:255–258, 1990)
A Validation and Comparison Study of Two Metabolic Monitors
Authors: Phang P. Terry , Rich Tom , Ronco Juan
Published: May 2008

Two portable metabolic cart systems of indirect calorimetry (Deltatrac Metabolic Monitor, 2900 MMC System) were validated. CO2 and N2 were delivered at precise rates into a constructed lung model to simulate CO2 production (VCO2) and O2 consumption (VO2). VCO2 (200–400 ml/min) and VO2 (250–750 ml/min) were measured at varying combinations of minute ventilation (VE) (6, 10, 20 liter/min) and FiO2 (0.21, 0.30, 0.60, 0.80). VCO2 was measured with overall errors of 1.5% and 2.4% for the Deltatrac and 2900 monitors, respectively. VO2 was measured with overall errors of 1.9% and 3.2% by the Deltatrac and 2900 monitors, respectively. Both monitors performed equally well for measurement of VO2 at FiO2 up to 0.6, but the Deltatrac had less error for measurements of VO2 at FiO2 of 0.8. (Journal of Parenteral and Enteral Nutrition 14:259–261, 1990)