bluuebunny/crossref_metadata_2025 huggingface dataset:
Tube Feeding‐Related Diarrhea in Acutely III Patients
Authors: Guenter Peggi A. , Settle R. Gregg , Perlmutter Shelley , Marino Paul L. , Desimone Gary A. , Rolandelli Rolando H.
Published: May 2008

Acutely ill patients received tube feeding for an average of 15.8 days and, on average, 35% of those days were spent in the intensive care unit (ICU). Patients were prospectively assigned either a fiber‐free formula (FFF‐OSMOLITE HN, Ross; n=50) or a fiber‐supplemented (soy polysaccharide 14.4 g/L) formula (FSF=JEVITY, Ross; n=50). Diarrhea was defined as three or more loose or watery stools per day and occurred in 30% of all patients. Diarrhea developed in 29 (41%) of the 71 patients who received antibiotics during, or within 2 weeks prior to, the feeding period, whereas only 1 (3%) of the 29 patients not receiving antibiotics developed diarrhea (p < 0.005); and this patient developed diarrhea on the day of death. Among the 30 patients with diarrhea, stool Clostridium difficile (CD) toxin was positive in 15 (50%), negative in 11 (37%), and was not measured in four. The mean serum albumin was significantly lower in patients with diarrhea (2.43) than in those without diarrhea (2.75) (p = 0.043). There were no significant differences in age, sex, diagnoses, number of feeding days, and percent ICU days between patients with and without diarrhea. While not statistically significant, patients who received FSF were observed to have a lower incidence of diarrhea, a lower percentage of diarrhea days per total feeding days, and a lower frequency of positive CD toxin assays than patients who received FFF. In this patient population, antibiotic usage was the factor most strongly associated with diarrhea during tube feedings. (Journal of Parenteral and Enteral Nutrition 15 :277–280, 1991)
Comparative Effects of an Elemental and a Complex Enteral Feeding Formulation on the Absorption of Phenytoin Suspension
Authors: Marvel Matthew E. , Bertino Joseph S.
Published: May 2008

The effect of an elemental formula (Vivonex TEN) and a lactose‐free complex formula (Ensure) on the oral absorption of a single dose of phenytoin suspension was determined in 10 normal volunteers. Following an overnight fast, subjects were randomly administered 400 mg of phenytoin suspension alone, phenytoin plus Vivonex TEN (unflavored), and phenytoin plus Ensure. The enteral feedings were given every 4 hours throughout the first 24 hours. Serum phenytoin concentrations were obtained over the 72‐hour period following drug administration. No statistical difference in area under the curve (AUC), time to peak phenytoin concentration, or peak phenytoin concentration was observed during the three treatment phases. These data suggest that the two enteral feeding formulations investigated do not interfere with nor enhance or accelerate phenytoin absorption as determined by a single‐dose study. (Journal of Parenteral and Enteral Nutrition 15:316–318, 1991)
Home Parenteral Nutrition for Patients with Inoperable Malignant Bowel Obstruction
Authors: August David A. , Thorn Deborah , Fisher Rosemarie L. , Welchek Cynthia M.
Published: May 2008

The use of home parenteral nutrition (HPN) in patients with inoperable malignant bowel obstruction (IMBO) is controversial. The efficacy, safety, and indications for HPN in these patients is uncertain, and its benefit is difficult to demonstrate. The records of 17 patients (9, ovarian cancer; 4, colon cancer; 4, other) with IMBO receiving HPN managed by the Nutrition Support Team (NST) at Yale‐New Haven Hospital from 1980 to 1989 were reviewed. Median survival was 53 days and was longest in the two patients with appendiceal carcinomatosis (208 and 159 days), intermediate in patients with colon cancer (median 90 days), and shortest in patients with ovarian cancer (median 39 days). Survival was unrelated to age or sex. All patients died of their underlying disease; 82% of deaths occurred at home. Only one treatment‐related complication requiring readmission occurred. Fourteen patients and their families (82%) perceived their therapy as highly beneficial or beneficial. The NST agreed with this assessment in 11 patients but did not share this perception in three patients. These three patients had a short duration of HPN (less than 25 days) or minimal rehabilitation. It is concluded that HPN for patients with IMBO is associated with a low complication rate, may be most beneficial for those patients with gastrointestinal tract primary tumors, and is usually perceived by patients and care providers as beneficial. HPN has palliative benefit and facilitates compassionate home care for carefully selected patients with IMBO. (Journal of Parenteral and Enteral Nutrition 15:323–327, 1991)
Osmotic Diarrhea Induced by Sugar‐Free Theophylline Solution in Critically III Patients
Authors: Hill Daniell B. , Henderson Lisa M. , Mcclain Craig J.
Published: May 2008

It is widely accepted that early enteral nutrition is beneficial to critically ill patients. Diarrhea is a common problem in this setting and is often erroneously ascribed to enteral feedings. More often medications cause the diarrhea. Multiple cases of severe diarrhea associated with the use of a sugar‐free theophylline solution (SFTS) were discovered by a nutrition support team. SFTS may induce an osmotic diarrhea because it contains sorbitol. A 55‐year‐old man admitted for a dissecting aneurysm was started on isotonic formula enteral feedings and within a day of starting SFTS developed severe diarrhea. The sorbitol‐induced osmotic diarrhea persisted for 36 of his 83 days of hospitalization with direct cost for the evaluation of this diarrhea being $4,250. His prolonged hospitalization cost $166,200. A retrospective review of 20 consecutive patients receiving SFTS revealed that 15 patients had diarrhea for 2 or more consecutive days compared with 20 patients receiving iv aminophylline, of whom only two patients had diarrhea. Furthermore, SFTS was administered to healthy volunteers and a prominent breath hydrogen response was noted. The polyalcohol sorbitol is used as a sweetner in “sugar‐free” products and not quantified on labeling because it is considered an inactive ingredient. Nutritionists should be aware that medicinal solutions can contain enough sorbitol to create a laxative effect which is an easily reversible cause of diarrhea in enterally fed patients. (Journal of Parenteral and Enteral Nutrition 15:332–336, 1991)
Identifiability and Parameter Estimation
Authors: Jacquez John A.
Published: May 2008

In experiments on biological systems one often cannot measure all state variables (compartments). Given a particular experiment of that type, a basic kinetic parameter may have no effect on the observations; such a parameter is an insensible parameter for that experiment. A parameter may influence the observations and not be uniquely determinable; such a parameter is nonidentifiable for that experiment. Only identifiable parameters can be estimated uniquely, by that experiment. I review the basic theory to check identifiability for a nominal value of a parameter (local identifiability), and present some examples of problems that may arise in estimation. (Journal of Parenteral and Enteral Nutrition 15:55S‐59S, 1991)
Factors Which Regulate Net Hepatic Glucose Uptake In Vivo
Authors: Cherrington Alan D. , Pagliassotti Michael J. , Myers Sharon R. , Adkins‐Marshall Bess , Mcguinness Owen P.
Published: May 2008

The regulation of net hepatic glucose uptake in vivo occurs by way of the hormonal milieu (insulin and glucagon), the glucose level, and the route of glucose delivery. Hyperglycemia in the absence of changes in pancreatic hormones (i.e., increased insulin and/or decreased glucagon) does not elicit significant glucose uptake by the liver. Net hepatic glucose uptake is augmented in a dose‐dependent manner by a rise in insulin and is further stimulated by the presence of a “portal signal.” The presence of coordinated changes in insulin, glucagon, and the glucose level in combination with the “portal signal” ensures adequate glucose uptake by the liver in response to a meal. (Journal of Parenteral and Enteral Nutrition 15:71S‐73S,1991)
Four Years of North American Registry Home Parenteral Nutrition Outcome Data and Their Implications for Patient Management
Authors: Howard Lyn , Heaphey Lenore , Fleming C. Richard , Lininger Lloyd , Steiger Ezra
Published: May 2008

The OASIS Registry started annual collection of longitudinal data on patients on home parenteral nutrition (HPN) in 1984. This report describes outcome profiles on 1594 HPN patients in seven disease categories. Analysis showed clinical outcome was principally a reflection of the underlying diagnosis. Patients with Crohn's disease, ischemic bowel disease, motility disorders, radiation enteritis, and congenital bowel dysfunction all had a fairly long‐term clinical outcome, whereas those with active cancer and acquired immunodeficiency syndrome (AIDS) had a short‐term outcome. The long‐term group had a 3‐year survival rate of 65 to 80%, they averaged 2.6 complications requiring hospitalization per year, and 49% experienced complete rehabilitation. The short‐term group had a mean survival of 6 months; they averaged 4.6 complications per year and about 15% experienced complete rehabilitation. The registry data also indicated HPN was used for 19,700 patients in 1987 with therapy growth averaging about 8% per year. This growth was chiefly from new cancer patients. The number of new patients with long‐term disorders in whom HPN was initiated appeared rather constant. We conclude that these clinical outcome assessments justify HPN for long‐term patients, but the utility and appropriateness of HPN for the cancer and AIDS patients remains uncertain and requires further study. Medical, social, and fiscal aspects of HPN management in long‐term and short‐term patients appear to involve quite separate considerations. (Journal of Parenteral and Enteral Nutrition 15:384–393, 1991)
A New Approach to the Diagnosis of Central Venous Catheter Sepsis
Authors: Bozzetti Federico , Bonfanti Giuliano , Regalia Enrico , Cozzaglio Luca , Callegari Laura
Published: May 2008

One hundred forty‐four cancer patients harboring a central venous catheter (CVC) were prospectively investigated to assess the relationship between hub culture, clinical assessment of sepsis before removal, and CVC sepsis. In 22 patients, the CVC was removed because of clinical assessment of catheter sepsis expressed by the staff prior to the removal. For each CVC removal, peripheral blood (qualitative method), hub, and CVC tip (quantitative method) cultures were performed. Clinical sepsis (disappearance of fever after CVC removal) was observed in 13 patients, microbiologic “sepsis” (identification of the same microorganisms on the CVC tip and in the peripheral blood) in seven patients, and clinical and/or microbiologic sepsis in 16 patients. Staphylococcus epidermidis was the microorganism most frequently identified. Hub culture was negative in 48% and positive for a low number and a high number of colonies in 35% and 17%, respectively. The predictive value of hub culture was 96% when testing negative and 8% and 37% (p = 3 x 10−3) when testing positive for a low and a high number of colonies, respectively. Predictive values of clinical assessment were 55% if positive and 97% if negative. Combining hub cultures and clinical assessment, the risk of sepsis varied from 2% with both evaluations negative to 89% in the case of positive clinical assessment associated with positive high‐count hub. Inasmuch as the CVCs used have a disposable hub, it is possible to have an accurate diagnosis of CVC sepsis without removing the CVC. (Journal of Parenteral and Enteral Nutrition 15:412–416, 1991)
Assessment of Energy Expenditure by Indirect Calorimetry in Healthy Subjects and Patients with Liver Cirrhosis
Authors: Vermeij C.G. , Feenstra B.W.A. , Oomen A.M.F.A. , De Graaf E.J.R. , Zillikens M.C. , Swart G.R. , Bruining H.A.
Published: May 2008

The reliability of resting energy expenditure (REE) measurements by indirect calorimetry with a ventilated hood was investigated in 50 healthy controls and 10 patients with liver cirrhosis. In each subject basal energy expenditure (BEE) was determined once and REE three times (morning REE1, noon REE2, afternoon REE3). In controls and patients the first 5‐minute BEE and first 5‐minute REE (controls also second 5‐minute REE) were higher than in the remainder of the 30‐minute recording. Only the last 20 minutes of recordings were used to calculate BEE (1645 ± 315, mean ± SD, in kilocalories per day), REE1 (1880 ± 365), REE2 (1782 ± 384), and REE3 (1775 ± 316) in controls, and in cirrhotics: BEE (1530 ± 235), REE1 (1714 ± 267), REE2 (1715 ± 238), and REE3 (1779 ± 275). REE was higher than BEE in controls and cirrhotics (p < 0.05). The REE variation coefficient was 5 ± 3% in controls and 5 ± 2% in cirrhotics. No systematic difference between REE1, REE2, and REE3 was found. Energy expenditure predicted by the Harris‐Benedict equation differed up to 21% from measured BEE in individual controls; group mean BEE, however, was correctly predicted. In cirrhotics differences between measured and predicted BEE up to 26% occurred, while measured BEE was higher than predicted BEE (p = 0.06). It is concluded that REE can be reliably assessed by indirect calorimetry with a ventilated hood system in controls and patients at any time of the day, when values obtained in the first 10 minutes are deleted. BEE and REE differ considerably in controls as well as in cirrhotic patients, so conditions under which measurements are performed should be standardized. (Journal of Parenteral and Enteral Nutrition 15: 421–425, 1991)
Parenteral Nutrition and Oral Intake: Effect of Glucose and Fat Infusions
Authors: Gil Karen M. , Skeie Bjørn , Kvetan Vladimir , Askanazi Jeffrey , Friedman Mark I.
Published: May 2008

The effect of intravenous nutrition on voluntary oral intake was studied in healthy male volunteers. Subjects were confined to the Surgical Metabolic Unit for the 17 to 19 day study and were restricted to a commercial liquid diet. Each study consisted of three consecutive phases: (1) Ringer's lactate (RL), (2) peripheral parenteral nutrition (PPN) administered for 5 or 6 days as a combination of glucose (caloric load equal to 34% resting energy expenditure, REE), fat (34% REE), and amino acids (17% REE) or a single nutrient infusion of glucose (68% REE), fat (68% REE), glucose (34% REE), or fat (34% REE), and (3) RL for the third period. When all three nutrients or glucose alone (68% REE) were given, subjects decreased daily voluntary food intake within 24 to 48 hr by an amount that closely compensated for the infused calories. Intake was reduced by only 20% to 40% of the infused calories when fat alone (68% REE) was given. There were no significant effects when the lower levels of glucose and fat were given. These data suggest the presence of a postabsorptive control of food intake in humans that is sensitive to the circulating supply of fuels. (Journal of Parenteral and Enteral Nutrition 15:426–432, 1991)
Effects of Glutamine Infusion on Colonic Anastomotic Strength in the Rat
Authors: Mccauley Rosalie , Platell C. , Hall J. , Mcculloch R.
Published: May 2008

Glutamine is one of the primary respiratory fuels of the colon. However, it is not included in commercial preparations of parenteral nutrients because of its short shelf life. It has been suggested that colonic atrophy induced by conventional parenteral nutrition can be reversed by the intravenous infusion of fresh solutions of glutamine. This study evaluated the hypothesis that glutamine‐enriched parenteral nutrition would enhance the strength of a standard colonic anastomosis in undernourished rats. After surgery, the rats were randomized to receive 6 days of postoperative support with either rat chow, conventional parenteral nutrition, or parenteral nutrition containing 1.2% glutamine. Measurement of colonic bursting tension failed to demonstrate any significant differences between the groups under study. In conclusion, the administration of 1.2% glutamine‐enriched parenteral nutrition failed to influence the healing of colonic anastomoses in undernourished rats. (Journal of Parenteral and Enteral Nutrition 15:437–439, 1991)
Infusion of Enteral vs Parenteral Nutrients Using High‐Concentration Branch‐Chain Amino Acids: Effect on Wound Healing in the Postoperative Rat
Authors: Delany Harry M. , Teh Eutiquio , Dwarka Brian , Levenson Stanley M.
Published: May 2008

Starting total parenteral nutrition (TPN) the day after acute surgical stress has beneficial effects on body weight, nitrogen balance, and colonic anastomosis bursting pressure in normally nourished rats. In view of the reported favorable utilization of high‐concentration branch‐chain amino acids (BCAA) following severe stress, we compared enteral (TEN) to parenteral (TPN) nutrient infusions containing increased BCAA starting the day of operation. Twenty‐four male Sprague‐Dawley rats, in two groups paired by weight under IP pentobarbital anesthesia underwent jugular vein catheter (CVP) insertion, laparotomy, gastrostomy, colon anastomosis, dorsal skin incision and SC polyvinyl alcohol sponge insertion. The rats were maintained for 6 days with continuous IV infusion in the TPN group (gastrostomy plugged) and continuous gastric infusion for the TEN group (CVP plugged). Urine and feces were collected daily. The infusions contained 1000 to 1002 Kcal, 847 to 845 nonprotein Kcal, 38 to 39 g of amino acids, 206 to 209 g of carbohydrates, and 2.8 to 2.9 g of rat per liter in the TEN and TPN, respectively, with indentical ratios of dietary essential amino acids to nonessential amino acids (52/ 48), and 28.34% BCAA in the TPN and 33.10% BCAA in the TEN. There were 491 mg/100 mL of glutamine in the TEN and 170 mg of glutamic acid in the TPN. Amino acids were infused at 8.59 g/kg per day for TEN and 8.34 g/kg per day for TPN. The vitamins, minerals, and trace minerals were essentially the same in the TEN and TPN except for the absence of iron, iodine, selenium, and molybdenum in the TPN. There were no statistically significant differences between the two groups in body weight change, daily and cumulative nitrogen intake, urinary and fecal nitrogen excretion, and nitrogen balance, colonic bursting strength, (215.8 ± 7.0 mm Hg for TEN, 203.3 ± 4.6 for TPN), colon anastamosis hydroxyproline (2.15 ± 0.20 μg/mg for TEN, 1.94 ± 0.13 μg/mg for TPN) skin incision breaking strength (Fresh, 100 ± 6.1 g for TEN, 105 ± 5.7 g for TPN) and after formalin fixation 379 ± 27 g for TEN, 370 ± 23 g for TPN and hydroxyproline content of reparative tissue in the SC sponges (1259 ± 92 μg/100 mg sponge for TEN, 1312 ± 86 μg/100 mg sponge for TPN).

In conclusion, the overall utilization of high BCAA concentration nutrients of very similar composition infused enterally (TEN) or intravenously (TPN) are equivalent and the route of their administration does not influence cutaneous, subcutaneous, and colonic wound healing, weight change, or daily and cumulative nitrogen balance following acute surgical stress. (Journal of Parenteral and Enteral Nutrition 15: 464–468,1991)
Glycero‐ vs Glucose‐Phosphate in Parenteral Nutrition of Premature Infants: A Comparative in Vitro Evaluation of Calcium/Phosphorus Compatibility
Authors: Raupp P. , Kries R.V. , Pfahl H.‐G. , Manz F.
Published: May 2008

In total parenteral nutrition (TPN) of premature infants, glycero‐ and glucose‐phosphate have been recommended, and clinically used, because of their considerable compatibility with calcium. However, a systematic comparative in vitro assessment of the therapeutic potential and safety of these substances has not yet been provided. We investigated the stability of TPN solutions containing calcium‐gluconate and glycero‐ or glucose‐phosphate in high concentrations. Evaluation was performed by visual inspection, absorptiometry, light microscopy, measurement of pH, and determination of calcium concentration before and after microfiltration. Even under circumstances promoting precipitation of calcium and phosphate—such as body temperature, relatively high pH, and concentrations of calcium and phosphorus exceeding those necessary to provide intrauterine accretion rates, all but one of the examined TPN admixtures remained stable. Our data suggest that the use of glycero‐phosphate, and particularly glucose‐phosphate, together with calcium‐gluconate, is an uncomplicated and safe procedure to administer simultaneously high amounts of calcium and phosphorus in TPN of premature infants. (Journal of Parenteral and Enteral Nutrition 15:469–473, 1991)
Use of Albumin as a Volume Expander
Authors: Doweiko John P. , Nompleggi Dominic J.
Published: May 2008

In some hospitals, albumin products account for 10% of the pharmaceutical budget.4 As much as 60% of these prescriptions are empiric, and from 40 to 70% of albumin that is administered is given for inappropriate reasons.4–6,14,15 Although the reasons for albumin administration vary, prevention or reversal of hypovolemia is part of the reason in the majority of cases. (Journal of Parenteral and Enteral Nutrition 15:484–487, 1991)
Coughing and Central Venous Catheter Dislodgement
Authors: Jacobs William R. , Zaroukian Michael H.
Published: May 2008

Silastic central venous catheters are subject to dislodgement from a variety of causes. Only one occurrence of catheter dislodgement has been previously reported in connection with coughing. We report four additional cases of silastic central venous catheter dislodgement associated with forceful coughing paroxysms, alone or in combination with emesis or rectal tenesmus. Three episodes of catheter dislodgement occurred in adolescents or young adults with cystic fibrosis, who may constitute a particularly high‐risk group. Dislodgement in two patients was asymptomatic. These cases suggest that patients with frequent or severe paroxysms of increased intrathoracic pressure may be at higher risk of catheter dislodgement. Since dislodgement may be initially asymptomatic and can cause serious complications, a high index of suspicion for dislodgement in patients with silastic central venous catheters and coughing paroxysms is advised. (Journal of Parenteral and Enteral Nutrition 15:491–493, 1991)
Circulatory Indirect Calorimetry in the Critically III
Authors: Williams R.R. , Fuenning C.R.
Published: May 2008

Circulatory indirect calorimetry (CIC) is a potentially useful method to assess the energy requirements of critically ill patients. Unlike respiratory indirect calorimetry (RIC), which measures oxygen utilization from inhaled and exhaled gases, CIC measures oxygen utilization from arterial and mixed venous blood. Twenty‐two measurements in eight critically ill patients comparing RIC, CIC, and commonly used estimates of energy expenditure were performed. A significant correlation between RIC and CIC was identified (r = 0.831, p < 0.001). Poor correlation was noted with either method and the commonly used estimates. CIC may be a useful tool in estimating energy expenditures in the critically ill. (Journal of Parenteral and Enteral Nutrition 15:509–512, 1991)
Action of Enterally Administered Ornithine α‐Ketoglutarate on Protein Breakdown in Skeletal Muscle and Liver of the Burned Rat
Authors: Vaubourdolle Michel , Coudray‐Lucas Colette , Jardel Alain , Ziegler Frédéric , Ekindjian Ovhanesse G. , Cynober Luc
Published: May 2008

Several studies concerning burn patients have shown that supplementation of enteral nutrition with ornithine α‐ketoglutarate (OKG) favorably modifies protein metabolism. Therefore, the effect of OKG administration on muscular and hepatic protein catabolism was evaluated in burned rats. Four groups of six rats were used. Two groups were scalded by immersion of the dorsum in water at 90°C for 10 seconds and then starved for 24 hours. Controlled enteral nutrition was then administered in three boluses daily (Osmolite, 210 kcal/kg/d, 1.2 g N/kg/d); one group was supplemented with OKG (5 g/ kg/d, ie, 0.68 g N/kg/d), while the other group received an equivalent amount of nitrogen in the form of glycine. One group of healthy control rats received Osmolite supplemented with glycine and the last group was fed ad libitum. The animals were killed after 2 days of nutrition. Protein catabolism was assessed in vitro by measuring the amount of valine (liver catabolism) and phenylalanine (muscle catabolism) released into the incubation medium of isolated tissues. Tissular and serum glutamine were also assayed. Burn injury induced muscle hypercatabolism without affecting hepatic catabolism. The administration of OKG limited both muscle weight loss and muscle protein hypercatabolism and significantly improved the muscle glutamine pool. These results demonstrate the nitrogen‐sparing effect of OKG in muscle in hypercatabolic states. (Journal of Parenteral and Enteral Nutrition 15:517–520, 1991)
Effect of Methionine‐Deprived Nutrition on Cell Growth and Cell Kinetics in Cell Cultures and Experimental Tumors
Authors: Usami Makoto , Ohyanagi Harumasa , Ishimoto Sachiko , Nishimatsu Shinichi , Ueda Tomoki , Saitoh Yoichi
Published: May 2008

The effect of methionine‐deprived nutrition on cell growth and cell kinetics was investigated in cell cultures and in tumor‐bearing rats using the total parenteral nutrition (TPN) technique. A simultaneous flow cytometric measurement of the cellular DNA content and the amount of 5‐bromodeoxyuridine incorporated into cellular DNA was performed for analysis of cell kinetics. The methionine‐free medium demonstrated a cytocidal effect on the growth of SLC cells after 6 hours of culturing. It decreased viability from 80% in the control medium to 23%, and it decreased the S phase and increased the G0/G1 phase of the cell cycles. The methionine‐deprived medium showed a concentration‐dependent inhibition in cellular growth. Methionine‐deprived TPN was seen to inhibit AH109A and SLC tumor growth compared with conventional TPN and decreased the S phase and increased the Go/ G1 phase of cell cycles. These results confirm that methionine deprivation blocks cells from processing into the G1 phase and recycling, and that it is effective in inhibiting tumor growth in cultures and in vivo. (Journal of Parenteral and Enteral Nutrition 15: 540–545, 1991)
Lipiduria After Intralipid Infusion of a Lipid Emulsion in a Boy With an Abdominal Trauma
Authors: Nielsen Hans Kirkegaard , Lybecker Hans
Published: May 2008

A 4‐year‐old boy with an abdominal trauma had lipiduria following treatment with total intravenous nutrition for 4 days. Renal function was normal throughout the course and the lipiduria ceased after withdrawal of the intravenous nutrition. The lipids were possibly excreted through the kidneys or entered the urine through a traumatic communication between the lymphatic vessels and the urinary system. Control of renal function and lipiduria after 1 year revealed normal conditions. (Journal of Parenteral and Enteral Nutrition 15:572–573, 1991)
Spontaneous Migration of Long‐Term Indwelling Venous Catheters
Authors: Digiacomo J. Christopher , Tarlian Henry S.
Published: May 2008

Our institution recently encountered two patients with an unusual complication of indwelling catheters, spontaneous migration of the catheter tip. Both patients had indwelling subcutaneous ports placed via the left subclavian vein into the superior vena cava for the treatment of breast cancer. Both catheters functioned well but were noted on follow‐up radiographs to have repositioned themselves, one into the azygous vein and the other into the internal jugular vein. One patient required surgical intervention to properly position the catheter for further chemotherapy. Chest roentgenograms are indicated to confirm the continued appropriate position o indwelling catheters when their position is in doubt to minimize the likelihood of complications associated with delivery o caustic chemotherapeutic agents in low flow vessels. (Journa of Parenteral and Enteral Nutrition 15:574–577, 1991)
A Method for Increasing Confidence in Respiratory Gas Exchange Measurements in Mechanically Ventilated Patients
Authors: Sue Darryl Y. , Wolff Craig
Published: May 2008

Measurement of O2 uptake (VO2) and C02 output (VCO2) with automated instruments can be used to optimize nutritional management of critically ill patients. However, these measurements may be made infrequently because of calibration problems or suspected inaccuracies, especially when the patient is given supplemental oxygen. A simple method is described for periodic testing of automated gas exchange measurements. While a test lung is mechanically ventilated an accurately known mixture of C02 and nitrogen is introduced into the inspired gas, simulating VO2 by dilution and VCO2 by addition of CO2. The ratio of VCO2:VO2 (respiratory gas exchange ratio, R) in the “expired gas” should be [FGco2/(1‐ FGcO2)] x [(1 ‐ FIO2)/FIO2], where FGCO2 is the fraction of CO2 in the diluting gas and FIO2 is the fraction of O2 in the inspired gas. R is independent of the flow rate of the diluting gas or the rate of ventilation of the test lung. Using a mixing chamber‐mass spectrometer, we found that R calculated from measurement of CO2 and O2 concentrations in the simulated mixed expired gas closely matched the predicted R for FIO2 = 0.21 — 0.50. On the other hand, when an automated gas exchange measurement device was tested, R was sometimes excessively high, especially for FIO2 > 0.35. This method, using a single diluting gas and without precision flowmeters, may be useful for periodic testing of respiratory gas exchange instruments in the intensive care unit. If a discrepancy is found between measured and predicted R, measurements should not be relied upon until further calibration or repairs can be effected. (Journal of Parenteral and Enteral Nutrition 15 :625–629, 1991)
Histopathologic Study of Cholestasis Induced by Total Parenteral Nutrition or Intraperitoneal Sepsis in Rats
Authors: Zhijun Shu  , Jieshou Li  , Zishao Zhou  , Qunli Shi  , Taihe Zhang
Published: May 2008

Wistar rats were divided into two groups, intraperitoneal sepsis group (group IS) and total parenteral nutrition group (group TPN), to evaluate the characteristics of pathologic alterations in rats with cholestasis. Biochemical assay showed that cholestasis developed in both groups after 10 days. Light microscopic examination of liver specimens revealed that the degeneration in the intermediate and external zone of hepatolobules was the major alteration in group IS, and group TPN showed characteristic dilation of central veins and hepatic sinuses and the proliferation of Kupffer cells with marked phagocytosis. Electron microscopic pictures presented the enlargement of bile canaliculi with altered microvilli in group IS and many highly electron‐dense bile particles within cytoplasm and secondary lysosomes near dilated bile canaliculi in group TPN. It is concluded that there were different histopathologic alterations of liver specimens in TPN‐supported animals and septic animals when cholestasis developed. It is unsuitable to take intraperitoneal sepsis as a unique factor of cholestasis in TPN‐supported rats. Bile stasis is only one sign of TPN‐induced hepatic lesion, which needs further exploration to determine its causes and mechanisms. (Journal of Parenteral and Enteral Nutrition 15:630–636, 1991)
Effect of Intravenous Fat on Cholecystokinin Secretion and Gallbladder Motility in Man
Authors: De Boer S.Y. , Masclee A.A.M. , Jebbink M.C.W. , Schipper J. , Jansen J.B.M.J. , Lamers C.B.H.W.
Published: May 2008

During total parenteral nutrition (TPN) gallbladder bile stasis and hypomotility have been well documented. Little is known, however, about the effect of the separate components of TPN on gallbladder motor function. Inasmuch as fat, administered intraduodenally, is a potent stimulus of cholecystokinin (CCK) secretion and gallbladder contraction we have investigated whether intravenous (IV) fat affects gallbladder motility. Six healthy volunteers were studied on two separate occasions, during infusion of Intralipid 10%, 200 mL/h or saline infusion (control) for 3 hours, to evaluate the effect of IV infusion of fat on (1) plasma CCK concentration and gallbladder volume and (2) CCK‐induced gallbladder emptying. Intravenous infusion of Intralipid resulted in significant increases in serum triglycerides from 0.9 ± 0.1 to 5.1 ± 1.3 mmol/L (at 90 min). During fat infusion no significant changes in plasma CCK and gallbladder volume were noted when compared with basal values or to the control experiment. During IV fat, concomitant infusion of 0.25, 0.5, and 1.0 Ivy dog unit (IDU) per kilogram per hour of CCK‐33 resulted in a significant reduction in gallbladder volume from 26 ± 6 cm3 (basal) to 15 ±4cm3 (p<.05),6±2cm3(p<.05) and 2.5±1cm3(p<.05), respectively. No significant differences in CCK‐induced gallbladder emptying were observed between IV fat and saline infusion (control). It is concluded that, in contrast to intraduodenal fat, IV infusion of fat does not affect (1) basal plasma CCK and gallbladder volume and (2) CCK‐induced gallbladder contraction. (Journal of Parenteral and Enteral Nutrition 16:16–19, 1992)
Use of Even‐Numbered Carbon Atom Dicarboxylic Salts in Parenteral Nutrition as Fuel Substrate
Authors: Mingrone G. , Tacchino R.M. , Castagneto M. , Finotti E. , Greco A.V.
Published: May 2008

Sebacic acid (C10), a saturated, straight‐chain dicarboxylic acid with 10 carbon atoms in disodic salt form, was given intravenously to two groups of healthy male volunteers in order to evaluate its possible use in total parenteral nutrition. The first group, composed of six subjects, received 1000 mg of sebacate as a bolus; six other subjects (second group) received 10 g of sebacate dissolved in 500 mL of double‐distilled water at an infusion rate of 3.33 g/h over 3 hours. The serum sebacate data for each subject were analyzed by computer, using biexponential fit corresponding to a 2‐compartment open model. The distribution half‐life (t½) was 0.34 ± 0.06 hour and the elimination phase was rather rapid (Ke = 2.10 ± 0.38/h); the volume of the central compartment was 2.79 ± 0.54 L and the volume of tissue compartment 3.72 ± 0.14 L. These data showed a good tissue fixation of sebacate. The plasma clearance was evaluated to be 5.96 ± 2.19 L/h and the renal clearance was 19.22 ± 10.69 L/h, indicating that a tubular secretion of C10 takes place. The serum concentration of sebacate raised to the maximal value at the end of the infusion (180 minutes), corresponded to 480.50 ± 43.02 μg/mL. Respiratory and metabolic parameters were evaluated by indirect calorimetry from the beginning of the infusion for 210 minutes. The O2 consumption (VO2 mL/min per square meter) remained essentially unchanged throughout the experiment (from 154.3 ± 28.3 at time 0 to 155.3 ± 39.5 at time 180 minutes). The CO2 production (VCO2 mL/min per square meter) decreased from below basal values (147.7 ± 27.3) to 123.7 ± 25.0 at the end of the infusion. Thus, respiratory quotient (RQ) decreased significantly (from 0.96 ± 0.04 to 0.81 ± 0.06) and the percentage of calories derived from lipids increased during and after the infusion (from ‐0.13 ± 13.3 to 52.1 ± 26.2). Metabolic rate (MR, kcal/h per square meter) remained constant during the entire study period. In conclusion sebacate seems to be a valuable new substrate for use in total parenteral nutrition and may have properties useful in special metabolic conditions. In this study, the urinary excretion of C10 and its products of β‐oxidation (suberic [C8] and adipic [C6] acids) was found to be low (totaling less than 16% of the administered dose) and the energy production high (6.64 kcal/g) with C10 being completely oxidized in the organism to CO2 and H2O. (Journal of Parenteral and Enteral Nutrition 16:32–38, 1992)
Emulsion Stability in Total Nutrient Admixtures Containing a Pediatric Amino Acid Formulation
Authors: Bullock Linda , Fitzgerald Joseph F. , Walter William V.
Published: May 2008

Emulsion stability of total nutrient admixtures containing TrophAmine amino acid injection admixed with Intralipid, Nutrilipid, and Liposyn II was studied. High and low electrolyte concentrations were added to each total nutrient admixture before storage at 4°C for 48 hours then at 20–22°C for 24 hours. Stability studies were also performed on total nutrient admixtures containing higher concentrations of fat emulsion and total nutrient admixtures with added cysteine hydrochloride and carnitine. High electrolyte concentrations only were added to these total nutrient admixtures before being stored refrigerated for 24 hours then at room temperature for 24 hours. Visual assessment, pH determination, and particle size analysis were performed immediately after compounding and after refrigerated and room temperature storage. Particle size was assessed by measuring the mean diameter of the fat emulsion and the percent of oil volume in particles greater than 5 μm. Repeated‐measures analyses of variance were used to determine significance of type or concentration of fat emulsion, electrolyte concentrations, or time on mean diameter or percent particles >5 μm. There were minimal changes in pH values over time. Creaming was observed in all total nutrient admixtures at all sampling times except time zero. This was reversible upon agitation. Results of particle size analysis over time indicated little change in mean diameter or percent particles >5 μm. These minimal changes did not seem to be clinically significant. It is concluded that total nutrient admixtures prepared with this pediatric amino acid formulation are stable when prepared and stored as reported. (Journal of Parenteral and Enteral Nutrition 16:64–68, 1992)
Hepatic Cytolytic and Cholestatic Changes Related to a Change of Lipid Emulsions in Four Long‐Term Parenteral Nutrition Patients With Short Bowel
Authors: Gerard‐Boncompain M. , Claudel J.P. , Gaussorgues P. , Salord F. , Sirodot M. , Chevallier M. , Robert D.
Published: May 2008

Long‐term parenteral nutrition hepatic‐related impairment is commonly reported and diversely explained. However, with a low cyclic caloric intake (100% to 130% of basal metabolism calculated with the Harris‐Benedict formula) consisting of two‐thirds glucose, one‐third lipid, and 0.20 to 0.25 g of nitrogen per kilogram per day, these complications were infrequent in a clinical practice of home long‐term parenteral nutrition. Retrospectively, it was noticed that the switch from Intralipid 20% to Ivelip 20% at the same amount was followed within 2 months by four cases of jaundice in a population of four home long‐term parenteral nutrition patients with short bowel disease. Hepatic disturbances were characterized by cytolysis and cholestasis and were reversible after switching from Ivelip 20% back to Intralipid 20%. Neither viral, nor biliary, nor septic etiologies were detected. The exact pathological mechanism remains unknown. The basal composition of both lipid emulsions seems to be identical: soy oil emulsion emulsified by egg phospholipids. However, some differences exist such as the size of particles, the presence of sodium oleate in Ivelip 20%, and the purification process of lecithin. These may explain the difference in hepatic tolerance during long‐term parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 16:78–83, 1992)
Addition of Lipid to Total Parenteral Nutrition Prevents Hepatic Steatosis in Rats by Lowering the Portal Venous Insulin/Glucagon Ratio
Authors: Nussbaum Michael S. , ShuJun Li  , Bower Robert H. , Mcfadden David W. , Dayal Rameshwar , Fischer Josef E.
Published: May 2008

Hepatic steatosis in rats is associated with an infusion of excessive carbohydrate calories. Previous work from this laboratory suggested that this is associated with an elevated portal insulin/glucagon molar ratio (I/G) and is reversed by parenteral glucagon administration. Although hepatic steatosis is not related to essential fatty acid deficiency, addition of lipid to total parenteral nutrition (TPN) has been reported as being protective against the development of hepatic steatosis. Therefore, we propose that lipid may exert its salutary effect via an alteration of the I/G ratio. To test this hypothesis, adult rats (seven per group) received internal jugular catheters: group 1, saline (3 mL/h) plus chow ad libitum; group 2, 25% dextrose base TPN; group 3, 17% dextrose base TPN + 2.5% lipid; group 4, 25% dextrose base TPN + 2.5% lipid. At 7 days, portal and peripheral venous blood was drawn for insulin and glucagon radioimmunoassay and liver function tests; livers were removed for histology and lipid content determination. Panlobular vacuolization, on histology, and lipid content were excessive in group 2, and the portal I/G was increased because of elevated portal insulin. In contrast, portal venous insulin and I/G did not increase, and hepatic steatosis was absent in groups 3 and 4. The results suggest that the addition of lipid to TPN in rats decreases the portal insulin level and lowers the portal I/G, and thereby prevents hepatic steatosis. (Journal of Parenteral and Enteral Nutrition 16:106—109, 1992)
Effect of a Diet Deficient in Essential Fatty Acids on the Translocation of Intestinal Bacteria
Authors: Barton Richard G. , Cerra Frank B. , Wells Carol L.
Published: May 2008

Normal intestinal bacteria can initiate systemic disease by translocating out of the intestinal lumen to extraintestinal sites such as the mesenteric lymph nodes (MLN), liver, and spleen. To determine whether dietary essential fatty acids can affect the incidence of bacterial translocation, separate groups of mice were fed one of two diets for 8 days: an essential fatty acid‐replete diet (EFA‐R) containing a basal formula supplemented with arginine, yeast RNA, menhaden oil, and safflower oil, or an essential fatty acid‐deficient diet (EFA‐D) containing the same ingredients with the safflower oil replaced by menhaden oil. Mice were given either diet alone, diet plus 50 μ g of intraperitoneal lipopolysaccharide (LPS), or diet plus 3 days of 4 mg of intramuscular metronidazole (MET) three times a day. (Both LPS and MET have been shown to increase the incidence of bacterial translocation to the MLN.) Within treatment groups there were no significant differences in the total numbers of viable ileal bacteria (separate quantitation of strict anaerobes, aerobic, and facultative Gram‐positive results, and aerobic and facultative Gram‐negative results). The incidence of bacterial translocation to the MLN was increased in mice fed EFA‐D as compared with EFA‐R in mice treated with diet alone (17% us 0%; p <.005) and in mice treated with diet plus LPS (71% us 48%; p =.027). There was no difference in the incidence of bacterial translocation in mice fed EFA‐D or EFA‐R and treated with MET (83% us 81%). (Journal of Parenteral and Enteral Nutrition 16:122–128, 1992)
Standardized Enteral Orders Attain Caloric Goals Sooner: A Prospective Study
Authors: Chapman Gayle , Curtas Susan , Meguid Michael M.
Published: May 2008

Standardized enteral nutrition order forms were introduced listing the enteral formulary, the advancement schedule of formulae, and whether feedings should be given continuously or intermittently. The efficiency of these forms was evaluated prospectively by counting the number of days needed to reach the patient's estimated caloric needs in a total of 113 patients studied 3 months before (pre‐group) and 3 months after (post‐group) the introduction of the form. When the standardized enteral order forms were used, patients in the post‐group reached their caloric goals 3.1 days sooner than did those in the pre‐group. Use of standardized enteral nutrition order forms decreases the time needed to reach a patient's estimated caloric needs, thereby achieving effective nutritional therapy sooner. (Journal of Parenteral and Enteral Nutrition 16:149—151, 1992)
A Cross‐Sectional Study of Plasma and Urinary Aluminum Levels in Term and Preterm Infants
Authors: Bougle D. , Bureau F. , Voirin J. , Neuville D. , Duhamel J.F.
Published: May 2008

High aluminum levels have been reported in sick and intravenously fed premature infants; however, aluminum is a ubiquitous pollutant of food. This study compares the usual aluminum levels of healthy newborns from birth to the third month of life with those of enterally fed premature infants free of renal failure. Plasma and urine concentrations were determined 66 times in full‐term newborns (n = 58), 56 times in a group of preterm infants whose gestational age at birth was 28 to 32 weeks (n = 36) and 54 times in another group of preterm infants whose gestational age at birth was 33 to 36 weeks (n = 50). Daily aluminum intakes (±SE) of the full‐term infants and the two groups of preterm infants were 0.42 ± 0.05, 0.64 ± 0.03, and 0.52 ± 0.03 μmol/kg per day, respectively (p =.05). Plasma aluminum levels were 0.29 ± 0.05, 0.49 ± 0.06, and 0.39 ± 0.05 μmol/L (p =.007); urine excretion levels were 0.80 ± 0.12, 0.77 ± 0.21, and 0.78 ± 0.2 μmol of aluminum/ mmol of creatinine (p value not significant). Although the metabolic consequences of the high aluminum intakes and blood levels we have observed in very low birth weight infants remain to be assessed, these results suggest that more attention should be paid to the aluminum status and intake of healthy premature babies. (Journal of Parenteral and Enteral Nutrition 16: 157–159, 1992)
Clinical and Immunologic Effects of Lipid‐Based Parenteral Nutrition in AIDS
Authors: Singer Pierre , Rubinstein Arye , Askanazi Jeffrey , Calvelli Terry , Lazarus Tadd , Kirvelä Olli , Katz David P.
Published: May 2008

The effect of lipid‐based parenteral nutrition was assessed in eight patients with AIDS and weight loss of 10% or greater. All patients received home parenteral nutrition consisting of a lipid‐based system with 50% of nonprotein calories given as fat. Measurements were made of body weight, serum albumin, and immune function as assessed by mitogen responses, P24 antigen levels and T‐cell counts. Over a period of 2 months, weight gain and improved well‐being were noted in all patients. An improved in vitro lymphocyte mitogenic response to phytohemagglutinin and to concanavalin A was also noted. No change in T‐cell subsets was observed. Viral cultures and P24 serum levels also remained unchanged. Lipid‐based parenteral nutrition is safe and probably efficacious in AIDS. (Journal of Parenteral and Enteral Nutrition 16:165–167, 1992)
Polyamine Excretion in Depleted Patients With Gastrointestinal Malignancy: Effect of Perioperative Nutrition and Tumor Removal
Authors: Pöyhönen Mikko J. , Takala Jukka A. , Pitkänen Otto , Kari Aarno , Alhava Esko , Alakuijala Lsa A. , Eloranta Terho O.
Published: May 2008

Polyamines, synthesized by all mammalian cells, are involved in protein and energy metabolism. We measured urinary excretion of polyamines, putrescine, spermidine, spermine, and their metabolites N 1‐acetylspermidine and N 8acetylspermidine, resting energy expenditure, and nitrogen excretion in 12 depleted patients with gastrointestinal malignancy during preoperative and postoperative parenteral nutrition and in 7 patients with multiple trauma receiving similar parenteral nutrition. During preoperative nutrition support, the excretion of putrescine (p <.05) and total polyamines (p <.01) increased by 420% and 60%, respectively. Increases in energy balance and resting energy expenditure during nutrition could entirely explain the observed changes in polyamine excretion. Preoperatively, the excretion of N 1‐acetylspermidine (p <.05), N 8acetylspermidine (p <.001) and total polyamines (p <.05) was higher in patients with a surgically noncurable tumor than in those with a surgically curable tumor. The energy balance and resting energy expenditure could also explain the differences in polyamine excretion between patients with surgically curable and noncurable disease, excluding the increased N 8‐acetylspermidine. Postoperatively, the excretion of N 8‐acetylspermidine in patients with multiple trauma without malignancy and in patients with palliative operation was similar, and was higher than in patients with a totally resected malignancy (p <.01). Our results suggest that the excretion of polyamines reflects the activity of energy metabolism in general and that polyamine excretion is not specific for any particular disease. (Journal of Parenteral and Enteral Nutrition 16:226–231, 1992)