bluuebunny/crossref_metadata_2025 huggingface dataset:
Metabolic and Neurologic Effects of an Intravenous Medium‐Chain Triglyceride Emulsion
Authors: Miles J.M. , Cattalini M. , Sharbrough F.W. , Wold L.E. , Wharen R.E. , Gerich J.E. , Haymond M.W.
Published: May 2008

These studies were undertaken to investigate the relationship between medium‐chain fatty acid availability, medium‐chain fatty acid oxidation, and central nervous system toxicity during infusion of medium‐chain triglycerides in dogs. Six dogs received a sequential, stepwise infusion of trioctanoin at three different rates for 80 min each, providing calories below and equal to resting energy expenditure in the species. Ketone body production rates (using a 14C β‐hydroxybutyrate tracer) and plasma concentrations of lactate and octanoate were monitored. Three animals were infused with saline to serve as controls. Blood‐brain barrier integrity was assessed with Evans blue dye, and brain samples were taken at the end of the study to quantify brain water. Three animals were studied under anesthesia to obtain good quality EEG and intracranial pressure measurements. Results were (1) plasma octanoate increased to 0.37 ± 0.13, 0.78 ± 0.2, and 1.44 ± 0.41 mmol/liter during the three infusion intervals; (2)emesis, somnolence, and coma were observed at the two highest trioctanoin rates; (3)ketone body concentrations and production increased from 102 ± 15 to 859 ± 54 μmol/liter and 3.6 ± 0.43 to 18.5 ± 1.7 μmol/kg/min, respectively, at the highest trioctanoin infusion rate; and (4)plasma lactate also increased from 1.3 ± 0.1 to 4.3 ± 0.9 mmol/liter at the highest infusion rate. EEG changes were also observed, consisting of high amplitude slowing and reduction in amplitude of faster components. There was no extravasation of Evans blue dye, nor change in brain water or intracranial pressure. The conclusion—medium—chain triglycerides have significant dose‐related central nervous system toxicity in dogs. Therefore, caution should be exercised in clinical studies with MCTs, including careful measurement of medium‐chain fatty acid concentrations. (Journal of Parenteral and Enteral Nutrition 15:37–41, 1991)
Effect of Enteral Diets on Whole Body and Gut Growth in Unstressed Rats
Authors: Zaloga Gary P. , Ward Kimberly A. , Prielipp Richard C.
Published: May 2008

The composition of enteral feeding formulas may have different effects on total body and gut growth. We studied the growth effects in rats of a complex solid fiber‐based diet (Prolab Rodent Diet) with that of three isocaloric and isonitrogenous commercially available liquid feeding formulas which differ in their type of protein (Osmolite HN, an intact protein formula; Reabilan HN, a peptide formula; and Vivonex‐TEN, an amino acid formula). Total body weight gain was greatest with the rodent diet (93 ± 2 g/10 days), followed by the peptide diet (72 ± 5 g/10 days) and intact protein diet (58 ± 8 g/10 days). Weight gain was significantly lower on the amino acid diet (43 ± 7 g/10 days). Proximal and mid gut mass was comparable with all four diets, but distal gut mass was significantly lower with the amino acid diet. Somatomedin C levels on the rodent diet (13.3 ± 1.8 nM), and the peptide diet (14.0 ± 3.3 nM) were significantly higher than somatomedin C levels on the amino acid diet (8.0 ± 1.0 nM). Somatomedin C levels on the intact protein diet (9.6 ± 1.4 nM) were intermediate between the rodent diet and amino acid diet. We conclude that growth effects vary with different enteral diets (unrelated to total calories and protein) and may result from differences in the generation of tissue growth factors. (Journal of Parenteral and Enteral Nutrition 15:42–47, 1991)
Liver Function Tests in Patients Receiving Parenteral Nutrition
Authors: Clarke P.J. , Ball M.J. , Kettlewell M.G.W.
Published: May 2008

A 5‐year prospective study was performed to monitor liver function tests (LFTs) in patients receiving total parenteral nutrition (TPN). A gradual and progressive rise was seen in the plasma concentration of bilirubin, aspartate transaminase, and alkaline phosphatase. The rate of rise was not increased in patients with LFT abnormalities before the start of TPN. Half of the patients had an episode of sepsis during TPN, but overall abnormal LFTs did not appear more common in these patients than in those without obvious sepsis. Patients with malignant disease, those requiring long‐term TPN, and those requiring a nonstandard TPN regimen were more likely to develop raised LFTs. (Journal of Parenteral and Enteral Nutrition 15:54–59, 1991)
Nonenzymatic Glycosylation of Immunoglobulin G Impairs Complement Fixation
Authors: Hennessey Patrick J. , Black C. Thomas , Andrassy Richard J.
Published: May 2008

Transient hyperglycemia in patients receiving total parenteral nutrition may be associated with impaired immune function. The effects of short‐term hyperglycemia on one aspect of antimicrobial immune function, ie, the ability of IgG to fix complement, were investigated. Aliquots of antihuman albumin, anti‐horse ferritin, and anti‐alkaline phosphatase were incubated for 0, 8, 16, 24, 48, and 96 hr with either 0 or 240 mg of glucose per deciliter of buffer. All samples were analyzed for the degree of glycation using a thiobarbituric acid assay, and for complement fixation ability using a microcomplement fixation assay. Significant increases in glycation over control samples were observed after only 16 hr (31 us 15 mmol 5‐hydroxymethylfurfural/mol IgG, p < 0.01). Complement fixation was significantly altered after 48 hr of incubation (76 ± 5% vs 90 ± 8% total serum complement fixed by albumin/antialbumin complex, p < 0.03) when four of the 84 (4.7%) IgG lysine residues were glycated. It is demonstrated that a significant reduction in complement fixation by immunoglobulin occurs with elevated glucose concentrations and that this may play a clinically significant role in transiently hyperglycemic patients. (Journal of Parenteral and Enteral Nutrition 15:60–64, 1991)
Use of a Ventilated Canopy for Assessment of [13C]Leucine Oxidation in Patients Receiving Total Parenteral Nutrition
Authors: Just Bernard , Darmaun Dominique , Koziet Joseph , Rongier Monique , Messing Bernard
Published: May 2008

Rates of oxidation of infused 13C‐labeled substrates are calculated from CO2 production and 13C enrichment in breath CO2. Breath sampling through a mouthpiece is not appropriate in severely ill patients; the authors therefore validated the use of direct air sampling from the ventilated canopy of an indirect calorimeter for measuring the oxidation of 13C‐labeled substrates. Infusions of H13CO3 Na or L‐[1‐13C]leucine were performed in four healthy postabsorptive adults and six malnourished patients receiving total parenteral nutrition (TPN). At each sampling point, air was collected from the canopy to compare with breath air sampled through a mouthpiece and 13CO2 enrichment determined by isotope ratio mass spectrometry. Despite five‐fold dilution of expired air by room air within the canopy (a dilution required to maintain safe CO2 levels in inspired air): (1) Breath 13CO2 enrichment was accurately predicted using samples from the canopy, with a correction taking into account the measured CO2 fractions in canopy and room air; (2) the precision in isotopic determination was similar with both methods (SD/mean of 12 determinations = 2.5 ± 1.0% us 3.0 ± 1.0%). These data demonstrate that the use of a ventilated canopy allows for combined assessment of energy expenditure and rates of oxidation of 13C‐labeled substrates even in sick, debilitated patients receiving total parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 15:65–70, 1991)
Infusion of Total Parenteral Nutrition via the Umbilical Artery
Authors: Kanarek Keith S. , Kuznicki Margaret B. , Blair R. Clifford
Published: May 2008

The administration of total parenteral nutrition through umbilical artery catheters in 48 neonates (birth weight 1.7 ± 0.58 kg) was compared with administration via central venous catheters in 26 infants (birth weight 2.05 ± 0.89 kg). There was no significant difference in the amount of calories delivered (72 ± 12 us 78 ± 18 cal/kg/day) or in the mean daily weight gain (16.6 ± 13.3 vs 18 ± 13.9 g/day). The incidence of sepsis was significantly lower in the umbilical artery catheter group (10.4% us 15.4%) but there was no significant difference in the rate of infection when adjustment was made for number of days of catheter life (1 per 224 days of catheter life in the umbilical artery group us 1 per 199 days in the central venous catheter group). Other major complications included transient hypertension in 2 (4%) of the 48 umbilical artery catheter infants and in 1 (3.8%) of the central venous catheter group, aortic thrombosis in 1 (2%) of the 48 umbilical artery catheter infants and a tricuspid vegetation in 1 (3.8%) of the central venous catheter group. Results suggest that the umbilical artery is a reasonable route for the infusion of total parenteral nutrition in low birth weight infants who require arterial access for blood gas analysis. Use of the umbilical artery catheter for parenteral alimentation may avoid the need for surgical placement of central venous lines and the risk of the attendant complications. Nevertheless, safer routes and improved methods of infusion of parenteral infusion must continue to be developed. (Journal of Parenteral and Enteral Nutrition 15:71–74, 1991)
Acute Effects of Continuous Nasogastric Tube Feeding on Gastric Function: Comparison of a Polymeric and a Nonpolymeric Formula
Authors: Kleibeuker Jan H. , Boersma‐Van Wietske
Published: May 2008

The acute effects of continuous intragastric administration of 1500 ml (4200 kJ/liter) of a polymeric and of a nonpolymeric formula on gastric function were studied in 15 healthy subjects. During 450 min 1500 ml, containing 6300 kJ (1500 kcal), was given through a nasogastric tube. At regular intervals the volume, the pH, the titratable acidity, and the pepsin activity of the gastric contents and the plasma gastrin concentration were determined. Maximal observed intragastric volumes occurred after 120 min (118 ± 16 ml during polymeric formula, 212 ± 37 ml during nonpolymeric one) and volumes subsequently halved (at 450 min 68 ± 13 and 104 ± 16 ml, respectively). During the administration of both polymeric and the nonpolymeric formula intragastric pH fell progressively to 3.15 and 2.67, respectively, at 450 min. Incremental plasma gastrin values increased between 120 and 450 min from 7 to 12 ng/liter during the polymeric formula. During the nonpolymeric one it stabilized after 120 min at 12 ng/liter. When the whole test periods were considered integrated, mean intragastric volumes tended to be larger during the nonpolymeric formula (153 ± 23 ml) than during the polymeric formula (107 ± 12 ml), but this difference was not statistically significant. Median integrated mean pH was lower during the nonpolymeric formula (2.89) compared with the polymeric one (3.26). Despite the limitation that the investigations were performed in healthy subjects only, it is concluded from this study that the risk of aspiration during continuous nasogastric tube feeding is probably greatest during the first few hours of administration because of the larger intragastric volumes. The findings further suggest that the risk of aspiration may be less with the polymeric formula because of the smaller intragastric volumes observed. However, studies in ill patients are necessary to confirm the clinical validity of our observations. (Journal of Parenteral and Enteral Nutrition 15:80–84, 1991)
Safety and Efficacy of a New Pediatric Enteral Product in the Young Child
Authors: Ramstack Mary , Listernick Robert
Published: May 2008

Children who are unable to maintain an intake of energy and nutrients adequate to meet their needs for growth and maintenance of nutritional status require modifications in feeding. A new pediatric enteral product (PediaSure) was formulated to meet the nutrient needs of children 1 to 6 years of age in a volume that can be tolerated. We designed a noncontrolled, nonrandomized study to evaluate the suitability of this product in young children with respect to growth, protein status, metabolic responses, and gastrointestinal tolerance. Fourteen chronically disabled children were fed the study formula for 12 weeks, receiving daily at least 90% of their estimated energy requirements. Anthropometric measurements and biochemical parameters were obtained throughout the study period. Weight, weight for age, length, weight index, triceps skin fold thickness, mid‐arm circumference, mid‐arm muscle circumference, and mid‐arm muscle area all increased over the study period. Gastrointestinal tolerance and acceptance of the study formula were excellent; there were no clinically significant changes in the biochemical measurements. This study demonstrates that PediaSure is both safe and efficacious in the maintenance of the nutritional status and the promotion of growth in chronically disabled children who require specialized nutritional support. (Journal of Parenteral and Enteral Nutrition 15:89–92, 1991)
Toward Rational Nutritional Support of the Human Immunodeficiency Virus‐Infected Patient
Authors: Aron Jeffrey M.
Published: May 2008

The acquired immunodeficiency syndrome and (human immunodeficiency virus) infection loom as our major public health priorities for at least the next two decades. Despite the recent exciting early development of vaccines1 and newer drug therapies,2 we are all faced with a reservoir of almost one‐quarter million cases in the United States and several times that worldwide.3 Since the vast majority of HIV‐infected patients develop AIDS, which is a chronic progressive disease that produces gastrointestinal dysfunction and wasting, development of rational strategies for nutritional support of these patients should also be a high priority. (Journal of Parenteral and Enteral Nutrition 15:121–122, 1991)
Comparative Effects of Thermal and Surgical Trauma on Rat Muscle Protein Metabolism
Authors: Lee Mermel Virginia , Wolfe Bruce M. , Hansen Robert J. , Clifford Andrew J.
Published: May 2008

A modified intraperitoneal pool flooding technique, employing L‐3 H‐tyrosine, was developed for measuring muscle protein synthetic rates following traumatic injury. Sufficient radiolabeled tyrosine was injected intraperitoneally to effect a six‐fold increase in plasma tyrosine concentration (124–800 μM) resulting in constant, sustained specific radioactivities in plasma‐ and intracellular‐free tyrosine pools. Localized vs systemic effects of thermal and surgical trauma on gastrocnemius muscle protein turnover were assessed 2 and 4 days postinjury. Thermal trauma increased total, myofibrillar, and sarcoplasmic muscle protein synthesis (44%) and protein degradation (300%). Conversely, surgical trauma decreased synthesis of total (24%), myofibrillar (14%), and sarcoplasmic (43%) muscle proteins without altering protein degradation. Short‐term restriction of pair‐fed controls did not affect either aspect of protein turnover. (Journal of Parenteral and Enteral Nutrition 15:128–136, 1991)
Effects of a Fish Oil Diet on Pigs' Cardiopulmonary Response to Bacteremia
Authors: Murray Michael J. , Svingen Bruce A. , Holman Ralph T. , Yaksh Tony L.
Published: May 2008

Since an ω3 fatty acid (FA) diet may have beneficial effects in inflammatory processes, we tested the hypothesis that the physiologic response to sepsis could be modified by altering the eicosanoid precursor pool via an ω3 FA diet. Two groups (n = 8) of pigs were prefed for 8 days either an ω3 FA or an w6 FA diet (Weaner Pig Feed with either menhaden or corn oil to produce a eucaloric feed with 15% fat) and then injected with live Escherichia coli. The w3 FA diet increased the concentration of eicosapentainoic acid (EPA, 20:5ω3) in plasma lipids, and increased the ratio of EPA to arachidonic acid (AA, 20:4ω6) in platelets from 1:20 to 1:1 over the 8 days. Following the injection of bacteria, there was a fall in PaO2 and blood pressure that was attenuated (p < 0.05) by the ω3 FA diet. The ω3 FA diet, compared to the ω6 FA diet, also attenuated the rise in thromboxane B2 (3.0 ± 1.1 vs 12.9 ± 5.7 ng/mL) and 6 keto‐PGF1α (0.8 ± 0.5 vs 1.7 ± 1.1 ng/mL) associated with bacteremia. We conclude that dietary ω3 FA attenuated the physiologic response to sepsis, possibly by modifying arachidonic acid metabolism. (Journal of Parenteral and Enteral Nutrition 15:152–158, 1991)
Tumor Regulation of Hepatic Glutamine Metabolism
Authors: Chen Mike K. , Salloum Rabih M. , Austgen Thomas R. , Bland Jonathan B. , Bland Kirby I. , Copeland Edward M. , Souba Wiley W.
Published: May 2008

Fast‐growing tumors are major glutamine consumers and may alter host glutamine metabolism to benefit the tumor. Previous studies from our laboratory have demonstrated that the liver switches from an organ of glutamine balance to one of glutamine release with progressive malignant growth. However, the regulation of this change is unclear. This study examined tumor modulation of hepatic glutamine metabolism by determining the activities of glutaminase, the principle enzyme of glutamine degradation, and glutamine synthetase, the principal enzyme of glutamine synthesis. Hepatic glutamine content was also determined. Rats with a fast‐growing subcutaneous fibrosarcoma (TBR) and pair‐fed controls were studied at 2 and 3 weeks after tumor or sham implantation, when the tumors comprised approximately 5% and 20% of total body weight. Arterial glutamine fell with progressive tumor growth (608 ± 26 μmol/L in controls vs 494 ± 15 in TBR, p < 0.005) and was not attributable to a diminished food intake. Hepatic glutamine content was increased 45% (p < 0.01) in tumor rats at 2 weeks due in part to a 35% fall in liver glutaminase activity. At 3 weeks, glutamine synthetase activity increased by 43% (0.58 ± 0.07 μmol/mg of protein/hr in controls vs 0.83 ± 0.04 in TBR, p < 0.01) whereas glutaminase remained depressed (2.68 ± 0.12 μmol/mg of protein/hr in controls vs 2.22 ± 0.15 in TBR, p < 0.05) and glutamine content fell compared to 2 week tumor‐bearing rats, consistent with accelerated hepatic glutamine release. Tumors may alter liver glutamine metabolism by modulating hepatic enzyme activity in order to provide circulating glutamine for the growing malignancy. (Journal of Parenteral and Enteral Nutrition 15:159–164, 1991)
Implication of a Distant Septic Focus in Parenteral Nutrition Catheter Colonization
Authors: Chuang Jn‐Haur , Chuang Suh‐Fen
Published: May 2008

During a 4‐year period, 244 surgical patients receiving total parenteral nutrition (TPN) were studied with emphasis on the relationship between TPN catheter colonization and a preexisting distant septic focus (DSF). A colonized catheter was defined as a catheter with a positive semiquantitative culture of the catheter tip (≥ 15 colonies on the plate). Catheter‐related sepsis (CRS) was defined as a catheter with either the same organisms cultured from the catheter tip and from blood or with defervescence following catheter removal. Two hundred sixty‐nine catheters were inserted for TPN for a total of 4433 patient days, with a mean length of stay of 16.5 days. Forty‐two of the 269 catheters (15.6%) were colonized and more than half (57.1%) of the organisms cultured were Gram‐negative bacilli or enterococci. Nineteen of the 42 colonized catheters were associated with CRS with a CRS rate of 7.1% among the 269 catheters. A DSF was present in 165 of the 244 patients or in 188 of the 269 catheters (69.9%). The colonization rate of 19.1% (36/188) in those catheters with DSF was significantly higher than that of 7.4% (6/81) in those without DSF (p < 0.05). Those patients with DSF or with a colonized catheter were associated with a high mortality (p < 0.001). Sepsis was responsible for 33 of the 48 patients (68.8%) who died. The data stress the important contribution of DSF to the colonization of TPN catheters and to the mortality of these critically ill surgical patients. (Journal of Parenteral and Enteral Nutrition 15:173–175, 1991)
Dry Beriberi: Unusual Complication of Prolonged Parenteral Nutrition
Authors: Zak J. , Burns D. , Lingenfelser T. , Steyn E. , Marks I.N.
Published: May 2008

An adult with Crohn's disease on home total parenteral nutrition (TPN) for 8 months presented with peripheral neuropathy and ataxia. The patient was found to be deficient of thiamine. A prompt symptomatic response to intravenous thiamine suggests that the patient had the chronic form of dry beriberi. To our knowledge, this variety of beriberi in a patient on TPN has not previously been reported. (Journal of Parenteral and Enteral Nutrition 15: 200–201, 1991)
Glutamine or Glutamic Acid Effects on Intestinal Growth and Disaccharidase Activity in Infant Piglets Receiving Total Parenteral Nutrition
Authors: Burrin Douglas G. , Shulman Robert J. , Storm Michael C. , Reeds Peter J.
Published: May 2008

This study was designed to measure the effect of free glutamine or glutamic acid supplementation on small intestinal growth and disaccharidase enzyme activity in 7‐day‐old miniature piglets. The piglets received one of three total parenteral nutrition solutions exclusively for 7 days. All three solutions were isonitrogenous and isocaloric, and glutamine or glutamic acid was included at physiological levels (5% of the total amino acid content) in two of the three solutions; the third (control) contained neither glutamine nor glutamic acid. No differences were seen between groups in plasma glutamine or glutamic acid concentrations. Similarly, no effect was observed on small intestinal protein or DNA content or on the specific activities of lactase, sucrase, or maltase. These data demonstrate that in the healthy miniature piglet, parenteral glutamine or glutamic acid supplemented at physiological doses does not influence small intestinal growth and development. (Journal of Parenteral and Enteral Nutrition 15:262–266, 1991)
A Single, Accurate Measurement of Resting Metabolic Expenditure
Authors: Stokes Maurice A. , Hill Graham L.
Published: May 2008

Indirect calorimetry is widely used in estimating nutritional requirements for severely ill patients. However, because the accuracy of a single measurement is dependent on many factors, the authors have sought to find the optimal single measurement. It is shown here that a more accurate resting metabolic expenditure (RME) can be obtained by studying a fasted, rested patient in relaxing surroundings after acclimatizing him or her to the calorimetric hood. Using this altered protocol, a significantly lower RME (by a mean of 125 kcal/d, p < 0.0001) is achieved. This RME compares well with most of the various predictive equations. A predictive equation, based on the normal patients in this study and relating the RME to TBK (a measure of the body cell mass), allows calculation of a predicted RME, and subsequently a Stress Index as a measure of metabolic stress, ie, Predicted RME = TBK x 0.34 + 4.94. Stress Index = Measured RME/Predicted RME (Journal of Parenteral and Enteral Nutrition 15:281–287, 1991)
Energy Expenditure and Substrate Utilization in the Course of Renutrition of Malnourished Children
Authors: Salas Jordi S. , Dozio Eugenia , Goulet Olivier J. , Marti‐Henneberg Carles , Moukarzel Eddy , Ricour Claude
Published: May 2008

Energy expenditure (EE) and substrate utilization in the course of renutrition of malnourished children is not well understood in children receiving total parenteral nutrition (TPN). The aim of this study was to evaluate, during protein‐glucose renutrition, EE and substrate utilization and the relationship between EE and growth and/or protein metabolism. Seven malnourished children were studied during the first 3 weeks of TPN. Weight‐for‐height = 81.4 ± 8.0%, with an initial weight of 4.5 ± 3.3 kg. Caloric support was progressively increased according to a preestablished protocol. Every 7 days the following were determined: (1) EE at 3 different 3‐hour intervals per day using an open circuit indirect calorimetric system, (2) anthropometrically defined fat free mass (FFM), and (3) 24‐hour urinary 3‐methylhistidine (3‐M‐His) and protein balance. Compared to initial values, EE increased 13% at day 7 and 36% at day 14. A negative relationship was found between the amount of perfused glucose and lipid utilization (r = ‐0.82; p < 0.0001). EE per kilogram of total body FFM changes during renutrition were more than EE changes per kilogram of total body weight. There was a relationship between EE and weight gain (r = 0.62; p < 0.005) and a positive relationship between EE and protein gain (r = 0.48; p = 0.012) and 3‐M‐His excretion (r = 0.51; p < 0.026). These results suggest that the increment of EE in the course of renutrition is accompanied by the conservation of lipid utilization at a glucose perfusion rate of 14.3 mg/kg per minute and which can be partially explained by the FFM accretion and partially by protein metabolism. (Journal of Parenteral and Enteral Nutrition 15:288–293, 1991)
Early Enteral Nutrition After Brain Injury by Percutaneous Endoscopic Gastrojejunostomy
Authors: Kirby Donald F. , Clifton Guy L. , Turner Hope , Marion Donald W. , Barrett Judy , Gruemer Hanns‐Dieter F.
Published: May 2008

Twenty‐seven patients in a series of 52 patients with severe brain injury (Glasgow Coma Scale score ≤8) underwent insertion of intestinal feeding tubes at the bedside. The technique required endoscopy with externalization of gastric and intestinal ports through the abdominal wall. Feedings were begun through the intestinal tube with Vital HN within 4 hours of its insertion with simultaneous gastric decompression via the gastric tube. Tubes were placed 2.3 (range 0–5) days after injury. Full caloric intake (3020 kcal/24 h) was achieved by 6.8 (range 2–8) days after injury to 4.2 (range 2–8) days after placement of the feeding tube. Only 1 patient failed to tolerate feedings immediately after tube insertion. Technical inability to insert the tubes occurred in 3 patients and the intestinal tube migrated into the stomach in 2 patients; diarrhea occurred in only 1 patient. With this technique, it was possible to deliver an average daily intake of 1.2 g/kg of protein in 8‐day balance periods beginning at the time of tube insertion. These data included 3‐ to 4‐day periods in which feedings were steadily increased. In 16 patients in whom nitrogen balance was measured for 8‐day balance periods, average nitrogen balance was ‐5.7 (range ‐11.3 to +3.5) g/24 h. The reduction in nitrogen loss by this technique appears equal to or superior to either gastric feeding or TPN. This technique provides the ability to enterally feed a high proportion of brain‐injured patients (except those in barbiturate coma) very early after injury using a bedside procedure. It is concluded that intestinal feeding is the procedure of choice for the nutritional management of the brain‐injured patient. (Journal of Parenteral and Enteral Nutrition 15:298–302, 1991)
Bile Acid Conjugation Pattern in the Isolated Perfused Rat Liver During Infusion of an Amino Acid Formulation
Authors: Sweeny David J. , Barnes Stephen , Diasio Robert B.
Published: May 2008

The influence of the taurine‐containing amino acid mixture Trophamine on the pattern of bile acid conjugation was examined in the isolated perfused rat liver using cholic acid as the bile acid substrate. In all experiments, greater than 97% of the cholic acid appearing in bile was conjugated with taurine or glycine. The pattern of taurine and glycine bile acid conjugation, however, was dependent on the availability of taurine in the perfusate medium. Thus, in the absence of Trophamine infusion, the percentage of cholic acid conjugated with taurine (ie, taurocholate) declined throughout the course of the cholic acid infusion. Trophamine infusion increased the ratio of biliary taurocholate/glycocholate by 4.5‐fold over that observed in the absence of the amino acid infusion. Increasing the amount of taurine in Trophamine by 2‐ or 5‐fold resulted in a 1.8‐ and 4.3‐fold increase, respectively, in the taurocholate/ glycocholate ratio over that observed during the Trophamine infusion. Infusion of taurine alone, at an equimolar concentration of taurine as that in Trophamine, resulted in a similar taurocholate/glycocholate ratio as that observed during the Trophamine infusion. These data indicate that taurine availability, even in the presence of high concentrations of glycine and other amino acids in Trophamine, appears to be the most important factor in determining the pattern of bile acid conjugation in the isolated perfused rat liver. (Journal of Parenteral and Enteral Nutrition 15:303–306, 1991)
Review: Nutrition and Alcoholic Liver Disease
Authors: Marsano Luis , Mcclain Craig J.
Published: May 2008

While the rate of malnutrition is relatively modest in alcoholic patients without alcoholic liver disease, the rate of malnutrition is virtually 100% in patients with alcoholic hepatitis and/or alcoholic cirrhosis. The reasons for malnutrition in the alcoholic hepatitis patient include various factors such as anorexia, poor diet, malabsorption, and altered metabolic state. When the patient is hospitalized, the malnutrition frequently worsens because of fasting for tests, continued anorexia, and complications such as gastrointestinal bleeding. Patients with severe acute hepatitis appear to be both hypermetabolic and hypercatabolic, whereas data are much more conflicting concerning patients with more stable liver disease. Most studies suggest that patients with alcoholic liver disease require at least 60 g of protein per day to maintain positive nitrogen balance. Consistent alterations in plasma amino acid profiles occur in alcoholic liver disease, and specialized nutritional formulations have been devised to correct this amino acid profile with the intent of improving overall nutritional status, hepatic encephalopathy, and mortality. The effects of nutritional support (including use of specialized products) on outcome, on acute hepatic encephalopathy, and on chronic or latent portal systemic encephalopathy are reviewed. (Journal of Parenteral and Enteral Nutrition 15:337–344, 1991)
Comparative Hypersensitivity in Intravenous Lipid Emulsions
Authors: Buchman Alan L. , Ament Marvin E.
Published: May 2008

We report a case of hypersensitivity to Intralipid but not to Liposyn II lipid emulsion. The patient had mild allergies to soybean protein, egg yolk, and egg whites by radioallergosorbent testing (RAST). Because protein contamination of the phospholipid binder during the emulsion manufacture may rarely occur, such contamination should be considered as a cause for urticarial eruptions associated with lipid emulsions. (Journal of Parenteral and Enteral Nutrition 15:345–346, 1991)
Selenium Deficiency and Cardiomyopathy in Acquired Immunodeficiency Syndrome
Authors: Kavanaugh‐Mchugh Ann L. , Ruff Andrea , Perlman Elizabeth , Hutton Nancy , Modlin John , Rowe Stuart
Published: May 2008

Selenium deficiency is common in patients with human immunodeficiency virus infection and may contribute to the development of cardiomyopathy. A 5‐year‐old boy with congenital human immunodeficiency virus infection developed cardiomyopathy. Evaluation for reversible causes of cardiomyopathy was notable for the diagnosis of selenium deficiency. Cardiac function improved on selenium supplementation. The role of selenium in cardiac dysfunction and the need for nutritional evaluation and supplementation of malnourished patients with acquired immunodeficiency syndrome is discussed. (Journal of Parenteral and Enteral Nutrition 15:347–349,1991)
Vitamin K Therapy in Severe Liver Disease
Authors: Mehta Rekha , Reilly James J. , Olson Robert E.
Published: May 2008

A middle‐aged man with parenchymatous liver disease and a decrease in vitamin K‐dependent factors was given large doses of intravenous phylloquinone (10 mg/d for 20 days) without improvement in the synthesis of vitamin K‐dependent factors. During subsequent liver transplantation, he exsanguinated. Although the exact role of over treatment with phylloquinone in this case is unclear, plasma levels of phylloquinone 300 times normal were attained after 5 days of treatment without effect on factors II, VII, IX, and X. Further therapy with vitamin K was unnecessary. (Journal of Parenteral and Enteral Nutrition 15:350–353, 1991)
Noncompartmental Analysis in Metabolism
Authors: Norwich Kenneth H.
Published: May 2008

A new type of model called a department is formulated to complement the compartment. While a compartment may be dominated by convective transport, a department is dominated by diffusive transport. Although exit from a compartment is limited by the rate of biophysical or biochemical removal (“kC”), exit from a department is limited by the rate of transport to the site of biophysical or biochemical removal. (Journal of Parenteral and Enteral Nutrition 15:59S‐64S, 1991)
Determination of Plasma‐Free Fatty Acid Kinetics with Tracers: Methodologic Considerations
Authors: Miles J.M. , Jensen M.D.
Published: May 2008

Plasma‐free fatty acids (FFA) are an important source of energy for a variety of tissues. Recently, there has been an increased interest in the measurement of FFA kinetics in vivo, using radiolabeled or stable isotopic tracers.

Standard techniques for measurement of FFA‐specific activity are relatively imprecise and have limited sensitivity. We have developed a method for determination of the concentration and specific activity of individual plasma FFA that is precise (coefficient of variation <2%) and sensitive (detection limit in the high femptomolar to low picomolar range). Using this method, one can measure the kinetics of three or more long‐chain fatty acids simultaneously. Its sensitivity is a particular advantage if one wishes to measure low rates of FFA turnover such as are encountered during hyperinsulinemia.

It has been suggested that, for optimal accuracy in the determination of substrate kinetics, the tracer should be administered in the left ventricle and mixed venous blood samples should be obtained from the right heart. We have conducted experiments in dogs which demonstrate that peripheral tracer infusion and more conventional arterial (or arterialized venous) sampling actually provide more accurate estimates of FFA turnover; this is fortunate, since intracardiac infusion and sampling are not practical for human studies. (Journal of Parenteral and Enteral Nutrition 15:90S‐92S, 1991)
Methods of Investigating Intestinal Transport
Authors: Acra Sari A. , Ghishan Fayez K.
Published: May 2008

This article provides a brief overview of well‐established in vivo and in vitro methods that have contributed the most to the understanding of transport processes across the gastrointestinal epithelium. In vivo perfusion techniques in humans revolve around double‐ and triple‐lumen per oral tubes. In animals, in vivo techniques include the single and recirculation perfusion techniques and the double‐isotope technique for measurement of net absorption. In vitro methods of studying intestinal transport include the everted gut sac technique, the Üssing chamber, the use of isolated epithelial cells, and the use of brush border and basolateral membranes isolated from enterocytes. The use of fluorescent probes for the measurement of intracellular ionic concentrations is a new and powerful in vivo technique that is now being applied to the gastrointestinal tract. (Journal of Parenteral and Enteral Nutrition 15:93S‐98S,1991)
Stimulation of Protein, RNA, and Nucleotide Synthesis in Lymphocytes After Abdominal Surgery Is Not Affected by Postoperative Amino Acid Supply
Authors: Chikenji Tohru , Mizutani Masahiko , Furukawa Hitoshi , Kitsukawa Yukio
Published: May 2008

The effects of abdominal surgery on protein, RNA, and de novo purine nucleotide synthesis in lymphocytes, and modification of these changes by postoperative amino acid supply, were investigated in 24 patients undergoing cholecystectomy (n = 12) or removal of gastric cancer (n = 12). Mononuclear cells were isolated from the peripheral venous blood and incubated with radioactive tracers in vitro. Protein and RNA synthesis, as measured using [14C]glycine and [3H]uridine, respectively, increased postoperatively. Nucleotide synthesis determined by the incorporation of radioactivity from [14 C] glycine into nucleotides increased simultaneously. The concentration of 5‐phosphoribosyl 1‐pyrophosphate (PRPP) estimated by the incorporation of [14C]adenine into nucleotides also increased. These changes were greater and of longer duration in patients with cancer operation than in those with cholecystectomy. In neither case were they affected by the amount of amino acid intake, or increases in energy intake. These results suggest that abdominal surgery stimulates protein and ribonucleic acid (RNA) synthesis in lymphocytes. Increased RNA synthesis may be ensured by increased synthesis of nucleotides, and increased PRPP concentrations appear to regulate the rate of nucleotide synthesis. The responses are apparently dependent upon the severity of surgery, but unrelated to the amount of amino acid supplied postoperatively. (Journal of Parenteral and Enteral Nutrition 15:371–375, 1991)
Effects of Immediate Postoperative Enteral Nutrition on Body Composition, Muscle Function, and Wound Healing
Authors: Schroeder David , Gillanders Lyn , Mahr Kerry , Hill Graham L.
Published: May 2008

Thirty‐two patients undergoing bowel resection were randomized to receive either immediate postoperative nasojejunal feeding with full strength Osmolite solution for 56 hours (n = 16) or routine postoperative hypocaloric fluids and gradual reintroduction of diet (n = 16). Body composition changes were measured at 14 days after operation with in vivo neutron activation analysis, the wound healing response by subcutaneous implantation of Gortex tubes, and muscle function by grip strength, maximum ventilatory volume, and stimulation of the ulnar nerve at the wrist. Postoperative fatigue up to 3 months after operation was assessed using a 10‐point analogue. Successful immediate enteral nutrition was established in 12 of the 16 patients. Enterally fed patients had a mean daily caloric intake of 1179 ± 388 kcal/d (mean ± SD) over the first 4 postoperative days compared with 382 ± 71 kcal/d for the controls (p < 0.0001). The amount of hydroxyproline accumulating in the Gortex tubes was also significantly greater (2.5 ± 1.1 nmol/g tube vs 1.5 ± 0.8 nmol/g tube; p < 0.02). However, the amount and composition of the weight lost was not significantly different. Muscle function was not preserved, and postoperative fatigue occurred to an equal extent in both groups. Complications were similar in both groups, except for a preponderance of bowel obstructions in the controls. The time to passage of first flatus and first bowel motion, although shorter in the fed group, did not reach significance (p = 0.07). We conclude that immediate enteral nutrition is feasible and results in an improved wound healing response. However, we would recommend it only in patients in whom postoperative problems with recovery are anticipated. (Journal of Parenteral and Enteral Nutrition 15 :376–383, 1991)
Prospective Randomized Evaluation of Two Regimens for Converting from Continuous to Intermittent Feedings in Patients with Feeding Gastrostomies
Authors: Powers Tony , Cowan George S.M. , Deckard Marleen , Stark Nathene
Published: May 2008

Forty enterally fed male patients were randomized to one of two regimens designed to determine the better means of converting them from continuous to intermittent enteral feedings. All patients received a nutritionally complete iso‐osmolal 1 kcal/cc formula containing 6 g of nitrogen/L beginning on the second postgastrostomy day. Half of the patients (20) were randomized to a discontinuous regimen abruptly changing from continuous to gradually increasing intermittent feedings until reaching their nutritional goals. Intravenous fluids were given to maintain normal fluid balance. The other 20 patients were randomized to an overlapping regimen, receiving continuous feedings at a decreasing rate while intermittent feedings were progressively increased. Intravenous fluids were used during the first three stages only. There were no significant differences (p < 0.05) in major diagnosis, type of gastrostomy, age, weight, height, admission or discharge serum albumin concentration, calculated basal energy expenditure (BEE), or nutrient goals (1.5 x BEE, 1.5 g of protein/kg per day). The overlapping regimen resulted in a significant reduction in the total hospital stay measured in days (10.4 ± 2.45 vs 15.76 ± 3.9) (p < 0.05). The overlapping regimen‐managed patients maintained nutritional goals for a significantly greater percentage of the total hospital stay (65.35 ± 10.22% vs 31.85 ± 18.2%) (p < 0.05), had a significantly higher nitrogen balance (N BAL) (g/24 hours) [N BAL = Nitrogen in‐(urine urea nitrogen + 4) (3.17 ± 0.56 vs 2.63 ± 0.55) (p < 0.05), had fewer days of intravenous fluids (3.1 ± 0.46 vs 10.35 ± 3.33) (p < 0.05), and had less diarrheal episodes (3 vs 9) (p < 0.05), aspiration (0 vs 1) (p < 0.05), and vomiting (0 vs 4) (p < 0.05) vs the discontinuous regimen‐managed patients. We conclude that the use of an overlapping regimen is nutritionally and economically more efficient than a discontinuous one. (Journal of Parenteral and Enteral Nutrition 15: 405–407, 1991)
Evaluation of Serum Visceral Protein Levels as Indicators of Nitrogen Balance in Thermally Injured Patients
Authors: Carlson Dawn E. , Cioffi William G. , Mason Arthur D. , Mcmanus William F. , Pruitt Basil A.
Published: May 2008

The use of serum visceral protein concentrations as predictors of nitrogen balance was assessed during the first 4 weeks following thermal injury. The correlation between nitrogen balance and serum albumin was not significant. Statistically significant correlations were found between nitrogen balance and serum prealbumin, retinol‐binding protein, and transferrin. However, even the best correlation (retinol‐binding protein, r = 0.388) was too weak to permit prediction of nitrogen balance on the basis of the visceral protein concentration. The correlation between change in direction of nitrogen balance and change in direction of protein concentration over time showed all four visceral proteins to be poor predictors of change in nitrogen balance. The efficiency was less than 50% for each visceral protein. Stepwise multiple regression analysis performed to determine which indices were most closely correlated with nitrogen balance showed that a calculation using readily available information (nitrogen intake, postburn day, percent total body surface burned, and age) provided better prediction of nitrogen balance (r = 0.765) than any of the visceral protein concentrations. In view of these findings, measurement of serum visceral protein concentrations to monitor adequacy of nutritional support seems an unwarranted expense in patients with thermal injury. (Journal of Parenteral and Enteral Nutrition 15: 440–444, 1991)
Tissue Uptake and Oxidation of Disodium Sebacate in Man
Authors: Mingrone G. , Greco A.V. , Bertuzzi A. , Arcieri‐Mastromattei E. , Tacchino R.M. , Marino F. , Finotti E. , Castagneto M.
Published: May 2008

In order to better ascertain its possible use as an alternative fuel substrate in total parenteral nutrition, sebacate (Sb) metabolism was studied in seven overnight‐fasting healthy male volunteers, who received a constant iv infusion (99 mmoles over 8 hours) of disodium sebacate. Sb oxidation rate was determined using an isotopic sebacate (disodic salt of (1–10)14C‐sebacic acid) infusion (100 μCi from the fourth to the eighth hour of the cold sebacate infusion). Blood samples were collected during and after sebacate infusion at intervals of 30 minutes and Sb serum concentrations were determined by high performance liquid chromatography. Excreted radioactivity (μCi/min) was measured by bubbling the expired air into an apparatus containing 3 mEq hyamine to trap CO2 from a 20‐L Douglas‐bag. CO2 production and O2 consumption were measured before and at 4 and 8 hours after starting the infusion. Twenty‐four hour nitrogen excretion with urine was obtained. The RQ and the percent of calories derived from lipid oxidation were calculated by indirect calorimetry. The Sb serum level at the plateau phase was (mean ± SD) 4.54 ± 0.71 μmole/mL, the overall rate of tissue uptake was 180.89 ± 4.50 μmole/min, and the percent oxidation was 6.14 ± 0.44%. At the end of Sb infusion the RQ dropped to 0.839 ± 0.043, the percent of calories due to sebacate oxidation was 1.59 ± 0.52%, and the calories derived from lipids increased to 37.77 ± 12.90%. These data show that a definite amount of the sebacate infused is oxidized in human tissues. (Journal of Parenteral and Enteral Nutrition 15:454–459, 1991)
Tunneled Central Venous Catheter Sepsis: Risk Factors in a Pediatric Hospital
Authors: Mulloy R.H. , Jadavji T. , Russell M.L.
Published: May 2008

All tunnelled central venous catheters (TCVC) placed at the Alberta Children's Hospital in Calgary, Alberta, between November 1984 and July 1987, were retrospectively reviewed to study the association of catheter infection with a number of factors including age, diagnosis, catheter use, and areas caring for children.

One hundred children received 130 silastic catheters placed for a total of 17,861 days. Each catheter survived a median of 100 days. Thirty‐one episodes of catheter sepsis were identified (one episode for each 576 days of catheter use). Children under 2 years of age had more than two times the risk of catheter infection (p < 0.01). Children with malabsorption had a greater risk (45.7%) than did those with infection (25.0%) or cancer (15.5%). The use of catheters for total parenteral nutrition (TPN) or for multiple purposes markedly increased the risk of catheter infection.

The risk of infection of TCVC appears to be great in the young child, in particular, in those requiring TPN or multiple intravenous infusions. Use of TCVC in these children should be avoided if possible. (Journal of Parenteral and Enteral Nutrition 15: 460–463, 1991)
Septicemia Caused by Contaminated Parenteral Nutrition Pouches: The Refrigerator as an Unusual Cause
Authors: Dugleux Georges , Le Coutour Xavier , Hecquard Claudine , Oblin Isabelle
Published: May 2008

Eleven patients in a hospital presented with septicemia caused by Enterobacter cloacae. The origin was the contamination of parenteral nutrition admixture from a resting place in the refrigerator of the parenteral mixture preparation room. (Journal of Parenteral and Enteral Nutrition 15:474–475, 1991)