bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in Body Protein, Body Potassium, and Lean Body Mass During Total Parenteral Nutrition
Authors: McNeill Kenneth G. , Harrison Joan E. , Mernagh John R. , Stewart Sandra , Jeejeebhoy Khursheed N.
Published: May 2008

Lean body mass by anthropometry (AMLBM), total body potassium (TBK), and total body nitrogen (TBN) by prompt gamma analysis, are reported in 38 malnourished patients during total parenteral nutrition. Over long periods (>2 months) TBN increased 32% while AMLBM and TBK rose only by 9.2 and 9.5%, respectively. Changes in AMLBM and in K were significantly correlated, but changes in nitrogen were not correlated with either. From short‐term studies, the same conclusions can be obtained; although there are changes in lean body mass and in potassium, there is no correlation with such changes in nitrogen.

With repletion, changes in body protein are not necessarily related to changes in AMLBM or to TBK: the latter two reflecting total and intracellular water, respectively, but not protein content.
Prognostic Nutrition Factors in Lung Cancer Patients
Authors: Freeman Maxine , Frankmann Carol , Beck Jeanne , Valdivieso Manuel
Published: May 2008

To examine the effect of nutritional support via intravenous hyperalimentation (IVH) on tolerance, response, and survival, a prospective study of patients with adenocarcinoma of the lung receiving chemotherapy with or without IVH was undertaken. Results indicated a more favorable survival in patients with a >74% initial triceps skinfold and a <4% initial weight loss. The effect of IVH was reflected by greater weight gain in those patients receiving nutritional support 10 days prior to chemotherapy or simultaneous with chemotherapy; however, IVH had no significant advantage to improved survival or response.
Energy Intake and the Appearance of 5,8,11‐Eicosatrienoic Acid in Serum Lipids During Parenteral Nutrition Without Fat
Authors: Nubé M. , Bos L.P. , Boomgaard D.M.V.D. , Hekkens W.T.J.M.
Published: May 2008

During parenteral nutrition without fat, biochemical changes in fatty acid composition of serum lipids may occur, such as a decrease in the concentration of linoleic and arachidonic acid and an increase of 5,8,11‐eicosatrienoic acid. In various reports on essential fatty acid deficiency in parenteral nutrition, the rates and degrees of these changes in fatty acid composition of serum lipids are different. We have tested the hypothesis that a relationship exists between the energy intake and the increase in 5,8,11‐eicosatrienoic acid in parenteral nutrition without fat. The hypothesis is based on the assumption that mobilization of lipids from body fat, and thus of stored essential fatty acids, only takes place when energy intake is below requirements. Seventeen patients with gastrointestinal diseases were fed parenterally without fat during 1 to 5 weeks (mean 3.5 week). The energy supply to the patients varied from 88 to 222 kilo Joules per kilogram per day. In all patients, the fatty acid pattern of the serum phospholipid fraction was determined weekly. It appeared that those patients with the highest energy intake per kilogram body weight showed the lowest increase in 5,8,11‐eicosatrienoic acid. In ten patients, energy was given as glucose and fructose, in seven patients as sorbitol. The type of carbohydrate investigated did not influence the changes in the fatty acid pattern. Results show further that the individual values of the concentrations of 5,8,11‐eicosatrienoic acid and of arachidonic acid provide more information concerning the essential fatty acid status of a patient than the commonly used ratio of these two fatty acids.
Role of Total Parenteral Nutrition in the Treatment of Complications Following Surgery for Morbid Obesity
Authors: Ferrara John , Fabri Peter J. , Carey Larry C.
Published: May 2008

Although morbidly obese patients are assumed to be overnourished, they require the same intake of nitrogen postoperatively as other patients to achieve anabolism and to spare endogenous protein. Total parenteral nutrition was employed in six morbidly obese patients with complications following gastric partitioning that precluded oral intake and was considered essential to their recovery.
Rapidly Declining Serum Albumin Values in Newly Hospitalized Patients: Prevalence, Severity, and Contributory Factors
Authors: Courtney Mary E. , Greene Harry L. , Folk Cathy C. , Helinek Gerard L. , Dmitruk Andrea
Published: May 2008

We had noted that a number of hospitalized patients showed abnormally low serum albumin levels within a few days of admission, although the albumin had been normal at admission. Since this rapid decline in albumin could not be accounted for on the basis of starvation, we hypothesized that the changes were due to the increase in intravascular fluid volume which normally occurs with assumption of the recumbent position. Since albumin is often a nutritional screening parameter in hospitalized patients, it is important to ascertain the incidence of such profound changes in albumin as well as to identify possible causes for this change.

A survey of 34 concurrent hospital admissions showed that 28 out of 34 (82%) patients had a decline in serum albumin within 5 days of hospitalization. These 28 patients had a decrease of 0.5 ± 0.09 g/dl. Twenty‐five additional patients were studied in order to elucidate causative factors. Twenty out of the 25 showed a decrease in serum albumin within 5 days of admission (mean decrease 0.5 ± 0.05 g/dl). Hemoglobins in these patients decreased by a mean of 1.1 ± 0.34 g/dl (p < 0.01), but BUN and uric acid levels did not change significantly. The one factor common to all patients with declining albumin values was change in posture. All patients were ambulatory at the time of the initial albumin determination but were on bedrest for at least 6 1/2 hours before the second determination.

The findings indicate that most hospitalized patients have significant changes in serum albumin levels which occur with change in posture. If the albumin level is to be used as a nutritional indicator, the patient's position at the time of phlebotomy is essential for accurate interpretation of results.
Use of Op Site as an Occlusive Dressing for Total Parenteral Nutrition Catheters
Authors: Palidar Paula J. , Simonowitz David A. , Oreskovich Michael R. , Patchen Dellinger E. , Edwards William A. , Adams Susan , Karkeck Joan
Published: May 2008

Op Site dressings for total parenteral nutrition catheters on one general surgical ward were compared with the immediate prior experience with conventional occlusive gauze dressings on the same ward. Twenty‐one patients were followed for 319 patient days using Op Site and 11 patients (196 patient days) with gauze dressings. The infectious complication rate remained acceptably low (less than one infection/100 patient days). Savings in nursing time used for total parenteral nutrition catheter care occurred with Op Site (10 minutes versus 30 minutes per patient). This resulted in a savings of $25 per average patient, despite the slight additional cost of a single dressing.
Successful Diagnosis and Treatment of Cardiac Perforation Due to Subclavian Catheter During Total Parenteral Nutrition
Authors: Jaurietta‐Más E. , Rafecas A. , Pallarés R. , Sitges‐Serra A. , Sitges‐Creus A.
Published: May 2008

A case of atrial perforation by a subclavian vein catheter, which was inserted for total parenteral nutrition (TPN) is reported. Acute thoracic symptoms developed 3 days after the infusion was started. The diagnosis was correctly made by demonstrating contrast medium within the pericardial sac. The catheter was withdrawn and the patient recovered satisfactorily. The clinical picture and the differential diagnosis of this complication are discussed.
Compatibility of 5‐Fluorouracil and Total Parenteral Nutrition Solutions
Authors: Hardin Thomas C. , Clibon Unamarie , Page Carey P. , Cruz A.B.
Published: May 2008

The physicochemical stability and availability of 0.1% 5‐fluorouracil solutions in D5W and a typical total parenteral nutrition solution (hypertonic dextrose and crystalline amino acids) were studied in both glass and Viaflex delivery systems. Serial samples collected over a 48‐hour period were assayed for 5‐fluorouracil concentration using a high performance liquid chromatographic technique. Changes in the pH as well as precipitate formation were also investigated. There was no reduction in the amount of 5‐fluorouracil at 48 hours in either the glass or plastic system, regardless of whether the drug was added to D5W or to the total parenteral nutrition solution. No pH changes or precipitates were observed. These findings indicate that 5‐fluorouracil is compatible with and available from total parenteral solutions of hypertonic dextrose and amino acid in both plastic and glass containers. Use of such a system would allow for (1) a reduction in vascular access in patients receiving both treatments and (2) continued administration of nutritional support without the requirement for additional fluid volume.
Experience with Double Lumen Right Atrial Catheters
Authors: Sanders Jean E. , Hickman Robert O. , Aker Saundr , Hersman John , Buckner C. Dean , Thomas E. Donnall
Published: May 2008

A double lumen right atrial catheter was placed in 57 allogeneic marrow transplant recipients, and its use was compared to a concurrent series of 63 patients receiving the large‐bore single lumen catheter. Ten double lumen catheter recipients developed septicemia, while neutropenic with granulocyte counts less than 100 per cubic centimeter, and three had their catheters removed for persistent septicemia. Seventeen single lumen catheter recipients developed septicemia while granulocytopenic, and one had the catheter removed for persistent septicemia. Hyperalimentation was more effectively delivered with the double lumen catheter which provides a route for infusion of hyperalimentation solutions at a constant rate during infusions of blood products, antibiotics, and other fluids.
Continuous Elemental Enteral Alimentation in the Treatment of Children and Adolescents with Crohn's Disease
Authors: Morin Claude L. , Roulet Michel , Roy Claude C. , Weber Andrée , Lapointe Normand
Published: May 2008

Ten pediatric patients, aged 8.5–19 years, with active symptomatic Crohn's disease, received a three‐week period of continuous elemental enteral alimentation with no other form of treatment. All patients in this study were selected according to the following criteria, which were applied consecutively : (1) newly diagnosed patients with no previous treatment for Crohn's disease, (2) disease activity index over 200, and (3) no complication requiring surgery.

All patients experienced a clinical remission and improved their immunologic and nutritional status during the elemental enteral alimentation. The mean disease activity index for the whole group was 307.0 ± 23.6 (range: 203 to 413) before and 69.2 ± 11.4 (range: 15 to 114) after the feeding period. Significant increases in body weight, triceps skinfold, mid‐arm circumference, serum transferrin and mean percentage of T lymphocytes were also observed. Following cessation of enteral alimentation, a small declining dose of prednisone was used during a one‐year follow‐up period. Eight of the ten patients were still in clinical remission three months after the feeding period and their nutritional status had continued to improve during that period of time.
Serum Concentrations and Urinary Excretion of Amino Acids During Total Parenteral Nutrition After Abdominal Surgery
Authors: Jacobson Stefan
Published: May 2008

The effects of five days of postoperative total parenteral nutrition (TPN)—no oral intake—including a fat emulsion, Intralipid 20%, and varying amounts of amino acids and carbohydrates, on the fasting serum concentrations of amino acids, the nitrogen balance and the rate of urinary excretion of free amino acids were studied in three groups of patients, A, B and C, undergoing abdominal surgery. Group A was given 9.4 grams of nitrogen every 24 hours as 18 L‐amino acids in proportions corresponding to the amino acid composition of egg protein; groups B and C were given 9.3 and 13.9 grams of nitrogen every 24 hours, respectively, including the same 18 L‐amino acids in proportions corresponding to those present in human milk protein. During the first seven postoperative days, the changes in the serum concentrations of amino acids conformed largely to five patterns in all the groups. On day five, the serum concentration of methionine was higher in group B than in group C, whereas there was no difference in the urinary excretion rate for 3‐methylhistidine; this suggests that an increased supply of an amino acid may be reflected in a decrease in the fasting serum concentration of this amino acid administered. During the five days of TPN, the rate of urinary excretion of glycine and histidine decreased in all the groups. The 24‐hour urinary excretion of most of the amino acids administered was numerically greater in group C than in group B on all days studied with significant difference for methionine and valine on day five, whereas the excretion rate for amino acids expressed as a percentage of the total amount on a molar basis was similar for these groups. This suggests that an increase in the intravenous supply of amino acids in proportions corresponding to the amino acid composition of human milk protein is reflected in an increased rate of urinary excretion of the amino acids administered. The rate of urinary excretion of total nitrogen was similar in groups A and B. The nitrogen balance values showed efficient utilization of the two amino acids solutions studied, but no difference between them in this respect.
Arm Length Measurement as an Alternative to Height in Nutritional Assessment of the Elderly
Authors: Mitchell C.O. , Lipschitz David A.
Published: May 2008

The use of long bone measurements as an alternative to height in nutritional assessment of the elderly was investigated in 100 young and 63 aged individuals. Highly significant correlations between height and total arm length, humerus length, forearm length, and proximal phalanx length were found. Compared to young subjects, values for the elderly were shifted significantly, demonstrating a reduction in height not paralleled by decreases in arm length measurements. In subsequent studies, lean body mass was evaluated by creatinine excretion in groups of young and elderly male and female volunteers. In both males and females, when creatinine excretion was related to height, ideal body weight, or total arm length, significantly lower values were found in the elderly as compared to the young. In all groups highly significant correlations between the use of arm length and the other two methods of expressing creatinine excretion were found. This validates the use of arm length measurement as an alternative to height for nutritional assessment. Since arm length is less affected than height by the aging process and more easily obtained in the bedfast patient, it should provide a more accurate reflection of stature when performing nutritional assessments of the elderly. These preliminary data emphasize the need for appropriate standards for subjects of different ages when evaluating lean body mass.
Prealbumin: A Parameter of Visceral Protein Levels During Albumin Infusion
Authors: Vanlandingham Sam , Spiekerman A. Michael , Newmark Stephen R.
Published: May 2008

Prealbumin estimations were obtained to determine nutritional states in a group of patients supported with total parenteral nutrition and exogenous albumin infusions. Patients who were in positive nitrogen balance demonstrated an increase in prealbumin levels (11.0 ± 1.6 milligram percent versus 20.3 ± 3.3 milligram percent), whereas patients who were in negative nitrogen balance demonstrated a decrease in prealbumin levels (13.1 ± 5.3 milligram percent versus 9.8 ± 2.2 milligram percent).

Prealbumin can be utilized as a test to reflect visceral protein states in patients receiving exogenous albumin infusions.
Free Amino Acids in Plasma and Muscle in Fulminant Hepatic Coma During an Extracorporeal Liver Perfusion
Authors: Roth E. , Muhlbacher F. , Rauhs R. , Huk I. , Soderland K. , Funovics J.
Published: May 2008

A 21‐year‐old female patient suffering from fulminant hepatic failure was treated with extracorporeal normothermic baboon's liver perfusion for 60 hours. The amino acids (AA) uptake of the extracorporeal organ and the ratio of plasma and muscle AA at the end of the perfusion were measured.

The AA uptake of the extracorporeal liver was 414 millimoles per 60 hours and even greater during hemodialysis treatment.

In spite of this AA uptake, the plasma AA pattern was not normalized. At the end of the perfusion, the free AA concentration in muscle tissue was 86.25 millimoles per liter of intracellular water, an increase of 62% compared to healthy volunteers. In the patient, the ratio of glutamine to glutamine in muscle tissue was 20 to 1 compared to 5 to 1 in normals.

It is concluded that (1) the extracorporeal baboon liver cannot extract the quantities of AA released by endogenous protein catabolism in hepatic failure, and (2) the muscular ammonia detoxification system gets overloaded as indicated by the increase ratio of glutamine to glutamate.
Safety of Intravenous Hyperalimentation in Children with Malignancies: A Cooperative Group Trial
Authors: Van Eys Jan , Wesley Margaret N. , Cangir Ayten , Copeland Edward M. , Donaldson Sarah S. , Ghavimi F. , Shils Maurice , Suskind Robert , Jaffe Norman , Filler Robert
Published: May 2008

A prospective randomized cooperative trial of intravenous hyperalimentation (IVH) was executed in children with malignancies in two segments: those patients who are newly diagnosed and who would undergo abdominal irradiation, and patients with tumors that were metastatic to or from bone. The combined experience was pooled to evaluate the safety of IVH in these children with cancer. Patients who were not malnourished were randomized to receive IVH or regular diets. Malnutrition was defined by a weight for height below the 80th percentile of the median for age and sex and/or serum albumin below 3.0 grams per 100 milliliter. Patients falling below such standards were given IVH as nonrandomized entries in the study. Twenty‐three were randomized to IVH, 25 randomized to control, and 18 entered on IVH without randomization, for a total patient entry of 66. No incidence of pneumothorax or local infections at the catheter insertion site were seen. Among the patients randomized to IVH, no local infections were found at the catheter insertion site. One hemothorax occurred and one hematoma was seen. In patients who were malnourished, one insertion site infection occurred and two hematomas were seen. Volume overload was compared between the randomized patients. Among randomized patients, ascites occurred once on IVH and none in controls, whereas congestive heart failure did not occur on IVH but twice in controls. Abnormal blood ammonia was seen in two randomized IVH patients and in none of the control, altered electrolyte balance was seen once in both control and IVH groups as was symptomatic hyperglycemia. The infectious complications in patients who got abdominal irradiation showed more fever in patients randomized to IVH, but no documented infections. In the sicker children who had metastatic disease, there were three infections in controls and five in patients on IVH. These results showed that IVH is safe and acceptable in children with cancer, and that complications, which might readily have been attributable to IVH, were seen in both controls and IVH patients when compared in a randomized prospective fashion.
Serum Protein Response to Surgery and Starvation
Authors: Smale Brian F. , Hobbs Charles L. , Mullen James L. , Rosato Ernest F.
Published: May 2008

To investigate the effect of stress on the dynamics of serum protein response during starvation, serum albumin, prealbumin, and transferrin changes were studied in six chair‐adapted macaques during two separate 7‐day test periods: (1) Starvation—NPO + IV D5/W (100 cc/kg/day), and (2) Surgery/starvation—laparotomy and gastrostomy + NPO + IV D5/W (100 cc/kg/day). During the starvation period, transferrin was the only protein that decreased from baseline values and did so at day 7 of the study period. In contrast, during the period of starvation following surgery, both prealbumin and transferrin were significantly decreased at both day 4 and day 7 of the study period, whereas albumin was only decreased at day 7 of this period. These findings indicate that the addition of a surgical stress to starvation results in a depression of serum protein levels that is not only of greater magnitude, but also more rapid in onset than observed with starvation alone. In addition, the differential response of prealbumin and transferrin to starvation and stress may provide a useful indicator of the presence and/or degree of stress in certain situations. The clinical utility of this finding remains to be ascertained.
Perforation of Right Ventricle and Pericard by a Central Venous Catheter During Total Parenteral Nutrition
Authors: Halevy Ariel , Adam Yehuda , Reif Renate , Eshchar Jerachmiel
Published: May 2008

Fatal perforation of the right ventricular wall and pericardiac sac without presence of pericardiac tamponade by a central venous catheter is reported. The various events leading eventually to this catastrophic complication, such as malpositioning of the catheter tip, and its migration with the patient movements, are discussed. More frequent radiologic checks of the catheter tip, the use of silicon rubber catheters, and restriction of the patient's movements are recommended to avoid this fatal complication.
Selenium and Vitamin E Sufficiency in Premature Infants Requiring Total Parenteral Nutrition
Authors: Huston Robert K. , Benda Gerda I. , Carlson Christina V. , Shearer Thomas R. , Reynolds John W. , Neerhout Robert C.
Published: May 2008

A randomized prospective study of LBW infants was undertaken to evaluate the effect of parenteral lipid infusions upon their antioxidant systems. Ten babies received a parenteral nutrition regimen with lipid emulsion, and ten received a regimen without lipid. Although the addition of lipid emulsion to the total parenteral nutrition regimen led to a rise in vitamin E levels, the selenium levels fell in both groups. Neither group showed evidence of deficient antioxidant systems by the peroxide hemolysis test or thiobarbituric acid test. There did not seem to be any adverse effect of the lipid infusion upon the clinical course of the infants except for hyperlipidemia. There was a better weight gain in infants receiving lipid.
Unique Effects of Infectious or Inflammatory Stress on Fat Metabolism in Rats
Authors: Neufeld Harold A. , Pace Judith G. , Kaminski Mitchell V. , Sobocinski Philip , Crawford Daniel J.
Published: May 2008

Infectious or inflammatory stress in the rat causes very typical functional and metabolic alterations. Among the most typical are elevation in body temperature, insulin, and glucagon and depression in the concentrations of plasma ketones and free fatty acids. These changes occur only with infectious or inflammatory stress and not with noninflammatory stresses such as femoral fracture, screen restraint, or exercise. It appears that the depression in plasma ketone bodies during infection or inflammation is closely related to the rise in plasma insulin. During infection imposed on experimentally induced diabetes, inhibition of plasma ketones is not apparent. In a similar fashion, infection in hypophysectomized rats causes no elevation in plasma insulin and no depression in plasma ketones. Discussion concerning the implications of these observations in the rat and primate is included.
Perforation of Intrathoracic Great Veins by Parenteral Nutrition Catheters
Authors: Jebson Peter J. , Rempe Lynn E.
Published: May 2008

Perforation of intrathoracic great veins by parenteral nutrition catheters has been previously reported as an unusual complication. The following three case reports illustrate the varied clinical picture that may appear following perforation. The differential diagnosis may be difficult to clarify so early recognition is essential if rapid deterioration in the patient's condition is to be avoided.

Each patient in this report provides a useful example for diagnosing this complication. Included are some basic suggestions to help the clinician in early detection.
Nine Year's Survival with Short Bowel Syndrome after Occlusion of the Superior Mesenteric Artery in an Elderly Man: A Study of Periods of Parenteral Nutrition
Authors: Jacobson Stefan
Published: May 2008

A 70‐year‐old man with severe short bowel syndrome after acute occlusion of the superior mesenteric artery and massive intestinal gangrene was given total and supplementary parenteral nutrition for six periods of 14 to 28 days; he survived for more than 9 years and died from the effects of nutritional depletion. Studies of the blood chemistry and the urinary excretion of nitrogen and electrolytes during the six periods of intravenous nutrition showed that nutritional repletion of nitrogen and electrolytes was achieved without adverse effects on the liver function. The results suggest that intermittent total and supplementary parenteral nutrition may allow nutritional repletion and thereby prolong the survival time in the elderly patient in whom massive intestinal resection has been performed.
Validity of a Two‐variable Nutritional Index for Use in Selecting Candidates for Nutritional Support
Authors: Gay Rainey‐MacDonald C. , Holliday Ronald L. , Wells George A. , Donner Allan P.
Published: May 2008

The relationship of baseline nutritional test values to clinical outcome was prospectively studied in 55 consecutive surgical and critically ill patients referred for nutritional support. Eight nutritional tests were evaluated with respect to their ability to discriminate between patients who had major septic complications (MSC) and/or died, and patients who survived (without MSC). Our results show that a value of serum albumin (SA) less than 3.0 grams per deciliter had the best predictive accuracy for outcome (PPA) of the single tests (PPA = 76%, s = 0.86, f = 0.82), correctly separating 84% of the patients into the outcome groups. The combination of SA less than 3.0 grams per dl and serum transferrin (ST) less than 175 milligrams per deciliter had excellent ability to predict risk in patients deficient in both proteins (PPA = 77%, s = 1.0, f = 0.88, % correctly classified = 91%). The delayed cutaneous hypersensitivity (DCH) test was not useful for identifying high‐risk patients (s = 0.44, f = 0.88). The four‐variable discriminant function which described our data (1.17 SA + 0.012 ST — 0.061 triceps skinfold (TSF) — 0.75 DCH — 4.33) was compared with a two‐variable function (1.20 SA + 0.013 ST — 6.43) generated from the same data. Either function correctly classified 88% of the patients (PPA = 79%, s = 0.94, f = 0.85). Multiple regression analysis showed that the four‐variable and two‐variable functions contributed 54 and 51%, respectively, to the outcome, indicating that, in the presence of SA and ST, TSF and DCH were, for practical purposes, redundant. Our results suggest that, of the commonly employed nutritional tests, only SA and ST, used in the context of the weighted index, have sufficient discriminating ability to justify their use in nutritional evaluation.
Metabolic Study during Cyclic Total Parenteral Nutrition in Adult Patients with and without Corticosteroid‐induced Hypercatabolism: Comparison with Standard Total Parenteral Nutrition
Authors: Messing B. , Pontal P.J. , Bernier J.J.
Published: May 2008

In order to assess the metabolic efficacy of cyclic nocturnal parenteral nutrition (C‐TPN) in hospitalized patients, a prospective study was carried out with 14 patients having a protein calorie malnutrition due to severe gastrointestinal diseases. Patients population was divided into two groups: one group received 1 milligram per kilogram per day of prednisolone with induced hypercatabolism (n = 4); the second group was not under corticosteroid therapy (n = 10). Patients selected for the study were unaffected by cardiac, hepatic, renal or pulmonary failure, diabetes or bacteriemia. C‐TPN was compared to standard or continuous TPN (S‐TPN) and each type of TPN was 1 week with 24 hours between change over. During C‐TPN, parenteral perfusion was discontinued for 9.1 ± 0.4 hours per day (mean ± SEM). Intravenous regimens were strictly the same during C‐TPN and S‐TPN and provided 192 ± 10 milligram nitrogen per kilogram per day plus mixed energy‐sources equivalent to 50 ± 2 kilocalories per kilogram per day with a glucose‐fat emulsion ratio of 50 ± 5%. Metabolic data for each period included weight, serum albumin and transferrin changes, protein breakdown as estimated by measurement of urea production rate and lean body mass gain estimated from determination of total nitrogen balance. In corticosteroid‐induced hypercatabolic patients, C‐TPN provides visceral protein gain equal to S‐TPN and halves the water‐energy deposits observed during S‐TPN, but is less effective than S‐TPN for decreasing protein breakdown and achieving lean body mass gain. Inversely, in mildly catabolic patients, C‐TPN provides visceral protein and lean body mass gains which are similar to those achieved with S‐TPN; C‐TPN, however, halves the water‐energy deposits when compared to S‐TPN. From these data, C‐TPN can be proposed as an optimal therapy in mildly or uncatabolic patients who do not have severe energy depletion.
Effect of Heparin on Lipoprotein Profile During Parenteral Fat Infusions
Authors: Benderly A. , Rosenthal E. , Levi J. , Brook G.
Published: May 2008

Long‐term administration of Intralipid to infants raises the potential risk of cumulative hyperlipemia. The elimination of lipoproteins from the blood during 3 hours of Intralipid infusion (0.33 grams per kilogram per hour) was investigated in five term infants during two infusion periods without and with heparin. A single intravenous injection of heparin (100 micron per kilogram) preceded the period of Intralipid infusion. During the nonheparin periods levels of triglycerides (L‐particles) rose progressively to 1320±133 milligrams per 100 milliliters plasma, whereas during the heparin periods levels rose more moderately and peaked at 636±107 milligrams per 100 milliliter plasma (p <0.001–0.05). The study suggests that the heparin effect is still apparent for a period of 6 hours and repeated bolus injections may keep triglyceride levels at approximately normal concentrations during constant Intralipid infusion (0.166 grams per kilograms per hour).
Percutaneous and Surgical Placement of Fine Silicone Elastomer Central Catheters in High‐Risk Newborns
Authors: Sherman Michael P. , Vitale Dennis E. , McLaughlin Gary W. , Goetzman Boyd W.
Published: May 2008

Percutaneous insertion of fine silicone elastomer catheters (0.6 millimeters outside diameter) have been used for central parenteral nutrition of very low birth weight and other high risk infants. Because peripheral venous access can be limited in the newborn, we report the previously undescribed surgical cannulation of the superficial arm veins with this catheter, and compare our experience with this technique and the percutaneous method in neonates. A central catheter position was attained in 88% of surgical (38 of 43) and 74% of percutaneous (17 of 23) cannulations. The two groups did not differ in birth weight or gestational age. The mean duration of catheterization was similar in the two groups (combined X = 21.8 ± 2.3 days SEM). There was no difference in weight gain (combined X = 16.9 ± 1.0 grams SEM per day) or head growth (combined X = 1.1 ± 0.1 millimeters per day) between the groups and these rates approximated known fetal growth rates for our mean gestational age. Disseminated candidiasis, in a 770‐gram infant with thymic hypoplasia, caused the only systemic infection and death among our 49 patients. The most commonly encountered problem was catheter occlusion secondary to a blood clot at the tip of these fine catheters (8 of 55). No thromboembolic events were recognized, and minor complications were not different with the two techniques. Surgical cannulation of the superficial arm veins offers a safe alternative to percutaneous central silicone elastomer catheter placement if superficial venous access is not available. Both methods provided early, adequate parenteral nutrition without excessive fluid intake in our high‐risk infants, and undoubtedly contributed to a favorable neonatal outcome.
Tumor Effects on Gluconeogenesis in the Isolated Perfused Rat Liver
Authors: Shearer Jeffry , Caldwell Michael , Crosby Lon O. , Miller Elizabeth , Buzby Gordon P. , Mullen James L.
Published: May 2008

Alterations in metabolism in the tumor‐bearing host can be explained by: 1) alterations of metabolic processes in the tumor itself, and/or 2) tumor effects on host metabolism. Tumor effects on host liver metabolism were studied using an isolated perfused rat liver preparation. The livers of fasted female Lewis Wistar rats with and without transplanted subcutaneous mammary tumors were perfused for 1 hr with medium containing 5 mM glucose and physiological levels of amino acids. The rate of gluconeogenesis, as measured by conversion of 14C‐lactate to 14C‐glucose, showed a significant increase in the rate of glucose production from lactate in tumor‐bearing rats (2.40 vs 2.00 μmol/min/100 gm). Hepatic glycogen and 14C‐glycogen content were not significantly different between the two groups. In order to evaluate whether this tumor model exhibits characteristic changes in metabolism previously reported in other animal tumor models, serum lactate, triglyceride, glucose, and blood urea nitrogen were measured in non‐perfused animals. The serum concentration of lactate and triglycerides were significantly higher in tumor‐bearing rats (0.9 mM vs 2.7 mM lactate; 244 mg % vs 365.5 mg % triglycerides). Serum glucose and blood urea nitrogen were not significantly different in the two groups. An effect of tumor on host energy metabolism and serum metabolite levels is demonstrated. A method for the study of host‐tumor metabolic interactions is described.
Total Plasma Clearance of Intravenous Essential Amino Acids: Evidence of Abnormal Metabolism of Amino Acids in Chronic Renal Failure
Authors: Takala Jukka
Published: May 2008

The total plasma clearance of essential amino acids was studied in 9 non‐dialyzed patients with stabile chronic renal failure and 20 healthy young adult volunteers after a bolus infusion of 0.28 g amino acids per kg of body weight in a solution containing essential L‐amino acids in the proportions suggested by Rose and supplemented by L‐histidine. After the infusion, the plasma concentrations of amino acids were observed for 6 hr. The pharmacokinetic analysis was performed by a polyexponential parameter estimate computer program, capable of analyzing up to five‐compartment models. Wide individual variation in the capability to clear the given amino acid load from the plasma was observed. Expressed as a fraction of the sum of the total plasma clearances of the infused amino acids, the total plasma clearance of valine and phenylalanine had decreased in renal failure while that of histidine had increased. These alterations reflect the complex disorder of the protein metabolism and the observations may be of help in designing optimal nutritional regimens in renal failure.
Use of Thyroxine‐binding Prealbumin in the Nutritional Assessment of Children with Cancer
Authors: Coody Deborah , Carr Diane , Van Eys Jan , Carter Patricia , Ramirez Irma , Taylor Grant
Published: May 2008

The level of thyroxine‐binding prealbumin was evaluated in 87 pediatric cancer patients ages 1 through 16 years whose cancer was newly diagnosed but untreated, and 39 children with benign disease or no disease. There was no difference in levels of thyroxine‐binding prealbumin between the patients with either malignant or benign disease, nor was there a difference between diagnostic categories. Prealbumin values did correlate with age. When the data were compared, there was a correlation between nutritional status and prealbumin level when the total population (N = 126) was age corrected, but not within the malignant disease group by itself. This confirms data that suggest malnutrition in children with cancer is not a result of protein depletion.
Procainamide Absorption in Short Bowel Syndrome
Authors: Felser James , Ka Kit Hui
Published: May 2008

Oral procainamide was administered to a 68‐year‐old male with short bowel syndrome resulting from small bowel infarction. Therapeutic procainamide levels were achieved in this patient with a markedly reduced absorptive surface. The limited data regarding absorption of other drugs in short bowel syndrome are also reviewed.
Peripheral Vein Complications in Patients Receiving Amino Acid/ Dextrose Solutions
Authors: Massar Ellen L. , Daly John M. , Copeland Edward M. , Johnson Douglas E. , Voneshenbach Andrew C. , Johnston Dennis , Rundell Ben , Dudrick Stanley J.
Published: May 2008

, The incidence and severity of peripheral vein phlebitis was evaluated in patients receiving infusions of amino acids alone (1.4 g/kg/day)(group I), amino acids (1.4 g/kg/day) plus 5% dextrose (Group II) and 5% dextrose alone (Group III). Ninety‐three patients with carcinoma of the bladder were randomized to receive one of three peripheral parenteral nutrition solutions which were infused predominantly via scalp‐vein needles. Peripheral parenteral nutrition solutions contained sodium and potassium chloride as necessary to maintain normal serum electrolyte levels. The osmolality of each solution was calculated. Peripheral intravenous sites were evaluated every 8 hr and at the time of each intravenous site change. The incidence of infiltration, phlebitis and its' severity was recorded and graded zero (no complications) to 4 (severe complications). An intravenous cannula was discontinued if infiltration or a grade 2 or greater phlebitis occurred. The mean osmolality of the solutions were (group I) 450 to 500 mosm/liter, (group II) 713 to 763 mosm/liter and (group III) 369 mosm/liter. The mean duration of infusion was 9.0 + 0.4, 9.1 + 0.4, and 8.7 + 0.5 days, respectively, and the mean number of intravenous site changes were 6.1 + 0.3, 5.8 + 0.3, and 5.6 + 0.3. respectively. Infiltration preceded 57, 56, and 58%, of all intravenous site changes and the incidence and severity of peripheral vein phlebitis was similar for all three groups. Sixty patients who received their infusions via plastic indwelling catheters for a mean duration of 2.6 + 1.0, 2.3 + 1.0, and 2.8 + 1.0 days had an 86, 71, and 76% incidence of grade two or greater phlebitis, respectively. There was no significant difference in the incidence of infiltration and phlebitis in patients receiving peripheral parenteral infusions of amino acids alone, amino acids plus dextrose, and 5% dextrose alone.
Massive Pneumatosis Intestinalis and Subcutaneous Emphysema: Complication of Needle Catheter Jejunostomy
Authors: Cogbill Thomas H. , Wolfson Robert H. , Moore Ernest E. , Vanway Charles W. , Jones Todd N. , Strain John D. , Rudikoff Jeffrey C.
Published: May 2008

The safety and efficacy of enteral feeding by needle catheter jejunostomy has prompted its use after many major gastrointestinal operations. Indeed, the technical complications of this procedure are infrequent. This report details the development of massive pneumatosis intestinalis associated with elemental feeding via jejunostomy. The proposed etiology includes excessive gas accumulation within the small intestine secondary to 1) inadequate nasogastric suction, 2) post‐traumatic intestinal ileus, and 3) disaccharide fermentation combined with a mucosal defect created by the catheter jejunostomy. Successful management consists of nasogastric suction and immediate termination of the enteral feeding.
Biotin‐responsive Depression during Hyperalimentation
Authors: Levenson James L.
Published: May 2008

A patient with multiple enteric fistulae, after months of parenteral hyperalimentation, developed severe depression accompanied by delirium, dermatitis, pallor, paresthesias, nausea, vomiting, anorexia, and headaches. His symptoms improved after treatment with parenteral biotin. Biotin‐deficiency should be suspected in patients on hyperalimentation (without biotin supplementation) who develop similar symptoms.
Compatibility of Enteral Products with Commonly Employed Drug Additives
Authors: Cutie Anthony J. , Altman Esther , Lenkel Laurie
Published: May 2008

Although drugs are routinely administered through gavage feedings set along with enteral products, there is little scientific data available to the physician, pharmacist, nurse, and dietician concerning the physical and chemical compatibility of drugs with enteral formulations. This study assesses the compatibility of Ensure (Ross Laboratories, Columbus, OH), Ensure Plus (Ross Laboratories, Columbus, OH), Osmolite (Ross Laboratories, Columbus, OH) with antibiotics, gastrointestinal agents, antipsychotic agents, urinary antiseptics, cough and cold medications, and other commonly used additives. All enteral formulations were examined immediately after mixing for phase changes, creaming, and particle growth using a contrast light and a rotation viscometer. Results are presented in a tabular format. Guidelines and recommendations concerning how the addition of troublesome drug additives can be added are also presented.
Effects of an Anabolic Steroid on Plasma Amino Acids, Proteins, and Body Composition in Patients Receiving Intravenous Hyperalimentation
Authors: Young Gerald A. , Yule Alastair G. , Hill Graham L.
Published: May 2008

In this controlled trial we have studied the effect of anabolic steroid on ill surgical patients receiving intravenous hyperalimentation. Body composition, plasma proteins, and amino acids were compared in each of two groups of 12 patients before and after 14 days of intravenous feeding. The patients in one group were given 100 mg of nandrolone decanoate at the commencement of study and again one week later. Body weight, muscle (AMC), plasma transferrin, prealbumin, and retinolbinding protein were increased comparably in both groups. An apparent gain in total body nitrogen was not significant. However, anabolic steroid caused greater gain of water requiring a more liberal use of diuretics, but prevented the gains of fat, triglyceride and insulin that occurred in the control group. Most plasma amino acids increased due to intravenous hyperalimentation but decreased in patients given anabolic steroid. It is concluded that in patients who may be in the catabolic phase of recovery anabolic steroid probably enhances amino acid and water uptake by tissues and increases the utilization of fat but, does not promote any greater increase in “visceral” proteins than during intravenous hyperalimentation alone.
Respiratory Quotient and Patterns of Substrate Utilization in Human Sepsis and Trauma
Authors: Giovannini Ivo , Boldrini Giuseppe , Castagneto Marco , Sganga Gabriele , Nanni Giuseppe , Pittiruti Mauro , Castiglioni Giancarlo
Published: May 2008

Three hundred measurements of indirect calorimetric and hemodynamic variables were performed in 99 critically ill septic and nonseptic surgical patients. Septics manifested, with respect to nonseptics, higher O2 consumption, metabolic rate and cardiac index, and lower respiratory quotient in the presence of higher glucose infusion rates and glucose infusion rate/metabolic rate ratios. Among septics there was a group of more severely ill patients with signs of multiple organ failure who manifested a dissociated pattern characterized by a tendency to decreased O2 consumption in the presence of increasing cardiac index and central venous O2 partial pressure: they had higher respiratory quotients, with respect to the other septics, for a given glucose infusion rate/metabolic rate ratio. The lower mean respiratory quotient of septics indicates that they depend generally more than nonseptic trauma patients on fat as an energy substrate and confirms a previously obtained evidence of limited hepatic lipogenesis in sepsis. At the same time, however, it is suggested that fat utilization becomes impaired (and hepatic lipogenesis becomes prominent) in sepsis at a stage in which signs of impaired oxidative metabolism and major metabolic abnormalities also develop.
Effect of Intravenous Fat Emulsion on Experimental Acute Pancreatitis
Authors: Raasch Ralph H. , Hak Lawrence J. , Benaim Vivianne , Brower Lee , Levinson Sidney L. , Heizer William D.
Published: May 2008

The known relationship of hyperlipidemia and pancreatitis raises the question whether intravenous fat emulsion is detrimental in acute pancreatitis. Pancreatitis was induced in 52 male Sprague‐Dawley rats followed by placement of a jugular catheter which was anchored to the back with a Teflon button. The animals were placed NPO in metabolic cages and continuously infused, initially with normal saline. The 37 animals surviving 24 hr were randomly assigned to group I (mean iv intake: glucose 222 kcal/kg/day; amino acids 13.1 g/kg/day) or group II (glucose 191 kcal/kg/day; intravenous fat emulsion 10% 47 kcal/kg/day; amino acids 12.9 g/kg/day). Nine animals were eliminated from the study because of mechanical problems leaving 14 in each group for analysis. Per cent survival on days 3, 5, and 7 was 64, 50 and 36 in group I, and 50, 36 and 36 in group II. Mean urinary amylase excretion was 244 ± 185 units/day in group I and 262 ± 127 units/day in group II. There was no significant difference in survival or urine amylase excretion nor in pancreatic histology or gross appearance of the animals between the two groups. In this model of acute pancreatitis, intravenous fat emulsion was not detrimental as measured by survival, urinary amylase excretion, and pancreatic histology.
Estimation of Fecal Nitrogen in Patients with Liver Disease
Authors: Mueller Karen J. , Crosby Lon O. , Oberlander June L. , Mullen James L.
Published: May 2008

The use of a fecal nitrogen (FN) predictive equation (Am J Clin Nutr 1978; 31:12–22, Cheng) based on dietary nitrogen intake (Nm) [FN (mg/kg/day) = 10.817 + 0.03 Nm(mg/kg/day)] was evaluated in patients with liver disease with and without concomitant lactulose therapy. Ten male cirrhotics were studied in 27 3‐day nitrogen balance studies including measured daily total urinary nitrogen, total FN, and Nin calculated from weighed food records. The Cheng formula accurately predicted FN in cirrhotics not receiving lactulose who demonstrated normal digestion and absorption of dietary protein. However, the formula did not accurately reflect FN excretion in patients receiving lactulose who showed impaired protein digestibility and significantly increased fecal weight. The Cheng predictive equation is a useful index of FN excretion in patients with liver disease whose digestive and absorptive capacities are not compromised by exogenous factors.
Enteral Nutrition Support: Formula Preparation from Modular Ingredients
Authors: Smith Janet L. , Heymsfield Steven B.
Published: May 2008

Many hospitalized patients are undernourished, and often this condition can be corrected by feeding one of a variety of commercial enteral formulas through a thin nasoenteral cannula. In a subset of tube feeding patients, nutritional requirements are unique, and needs cannot be met by a fixed composition formula. Modification, or de novo fabrication of the enteral formula is therefore required. Few reviews have adequately addressed some of the complexities of designing, mixing, and feeding these specialized diets. This report provides some of this information, and shows that considerably more education and research in this area is needed.