bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Lymphatic Fistulas by Total Parenteral Nutrition
Authors: Bozzetti F. , Arullani A. , Baticci F. , Terno G. , Ammatuna M. , Cappello G.
Published: May 2008

Lymphatic fistula is a rare surgical complication, which mainly occurs after cervical or retroperitoneal lymph node dissection and which frequently requires a surgical repair. A small series of nine postoperative lymphatic fistulas treated conservatively with total parenteral nutrition (TPN) is reported. All the patients were malnourished at the beginning of the TPN, and all exhibited an objective improvement of their nutritional status after completion of the treatment. Due to the interruption of the enteral alimentation or to the nutritional repletion, spontaneous closure of the fistula was achieved in eight of nine patients treated with TPN longer than 1 week. The authors conclude that whenever the immediate surgical repair is not recommended, or it is not successful, a 2‐ to 3‐week course of TPN may be used with the chance of spontaneous healing. In any case, patients conservatively treated by TPN can undergo a delayed operation with minimal risk because of the improved nutritional status.
Accidental Intracranial Hyperalimentation Infusion
Authors: Beaumont ED , Malin Seth , Meny Robert
Published: May 2008

A case of infusion of hyperalimentation fluid into the subarachnoid space is presented. Massive loss of cerebral and cerebellar tissue and cerebrospinal fluid inflammation distinguish this case from a previous report.
Effects of Hypertonic Glucose on the Rates of Plasma Clearance and CO2 Production of Intravenously Administered Intralipid Emulsion in Dogs
Authors: Wei Jao Chen
Published: May 2008

Simultaneous infusion of glucose and Intralipid was carried out on dogs to evaluate the effect of glucose on utilization of the fat emulsion. For control experiments, normal saline was used in place of glucose. Results of these studies revealed that clearance of Intralipid and also of triglyceride and free fatty acid (FFA) from the plasma did not differ between the dogs receiving glucose and those receiving saline infusion. The rates of Intralipid clearance were 0.049 ± 0.003 and 0.047 ± 0.003 per minute (n = 16), respectively. Study with radioactive [14C]Intralipid also gave similar rates of 14C clearance from the plasma, 0.037 ± 0.003 and 0.040 ± 0.003 per minute (n = 4), respectively for the two groups. These suggested that clearance of Intralipid from the plasma was not affected by glucose. However, data on expired 14 CO2 revealed that oxidation of the fat, which yielded CO2 as end product, was inhibited by glucose. The amount of 14CO2 expired in 2 hours was 10.4 ± 1.4% for the saline group, which was significantly reduced to 3.0 ± 0.4% (n = 4; p < 0.01) for the glucose group. In each group, CO2 production was much delayed as compared to fat clearance from the plasma. Thus, the rate of clearance of Intralipid from plasma does not reflect the actual utilization of fat emulsion. In accordance with an experiment with insulin, it appears that suppression of CO2 production is directly related to plasma insulin levels.
Evaluation of Clinical and Biological Parameters in Marastic Kwashiorkor Children Treated by Parenteral Nutrition
Authors: Janssen Françoise , Bouton J.M. , Vuye A. , Vis H.L.
Published: May 2008

Reduction of hospital stay and mortality rate due to dehydration and electrolyte imbalance in children suffering from severe marasmic Kwashiorkor was attempted. A program of parenteral nutrition providing 70 to 100 milliliters water, 30 to 40 kilocalories, and 3 to 4 grams amino acids per kilogram daily was given.

Seventy‐seven African children suffering from protein deficiency and calorie deficiency were given an intravenous perfusion of casein hydrolysate or cristalloid amino acids for a mean period of 6 days. An oral supplement of tea and sugar, boiled rice, and palm oil was also given. The total mortality has not been modified in comparison with that in children given an oral diet (semi‐liquid) consisting of low fat milk and locally available proteins. In more than half of the cases, the parenteral nutrition has favored water and salt retention and the development of cardiac failure possibly due to adynamic circulatory state. Weight curve, serum albumins, serum and urine amino acids were followed closely for 1 month. In eleven patients, nitrogen balance studies were done. All were positive independently of the coexisting infectious pathology. Correlating the increase in serum proteins with the cumulative nitrogen balance allowed us to consider casein hydrolysate as particularly useful for hepatic protein synthesis while cristalloid amino acids seem to favor muscular protein synthesis.

The introduction of parenteral nutrition as a therapeutic regimen for standard use in the malnourished child seems less favorable than oral realimentation programs and does not seem desirable in developing countries.
Transcellular Movement and Intracellular Concentration of Sodium in Erythrocytes After Surgery and in Seriously III Patients
Authors: Radcliffe Andrew G. , Goode Anthony W. , Johnson Andrew W. , Chan Steven T.F. , Dudley Hugh A.F.
Published: May 2008

Erythrocyte intracellular sodium concentration and transmembrane sodium flux were measured in nine healthy patients undergoing uncomplicated elective abdominal surgery. Intracellular sodium concentration was determined by in vitro washing of cells in a solution approximating to intracellular constituents and measuring extracellular sodium contamination with 51Cr EDTA. Sodium flux was determined by radioactive 22Na tracer both as influx and efflux. No change in erythrocyte intracellular sodium concentration or in sodium flux was found postoperatively.

In 14 seriously ill surgical patients, all of whom had plasma sodium levels outside the tolerance range of our surgical population, erythrocyte intracellular sodium concentration decreased, but not significantly, compared with patients undergoing uncomplicated surgery (p = 0.16). Furthermore, sodium flux in seriously ill patients was proportional to intracellular sodium concentration. These results are at variance with the hypothesis of ‘sick cell syndrome’ which is said to be typified by a high intracellular sodium concentration and a reduced sodium efflux. In the surgical patients studied, it is more likely this hyponatremia does not result from a change in sodium flux but is dilutional.
Parenteral Nutrition in Anuria of Infancy: Evidence for Sustained Net Protein Synthesis
Authors: Takala Jukka , Kekomäki Martti
Published: May 2008

The effects of total parenteral nutrition were studied in two anuric neonates and an anuric infant. Based on the observations of urea production, nitrogen balance, and serum osmolality, the bulk of the infused nitrogen appeared to be incorporated into the body proteins. The need for potassium, calcium, phosphorous, and magnesium substitution was also indicative of net anabolism. Despite effective utilization of the amino acids, high plasma levels of phenylalanine and methionine, and extremely low levels of the urea cycle intermediates were measured. We conclude that the application of carefully planned parenteral nutrition may aid in the management of newborns with failing kidneys and that it influences considerably the indications of dialysis in early infancy.
Nutritional Support to Long‐Term Anesthetized and Curarized Patients Under Extracorporeal Respiratory Assist for Terminal Pulmonary Failure
Authors: Iapichino Gaetano , Pesenti Antonio , Radrizzani Danilo , Solca Maurizio , Pelizzola Amerigo , Gattinoni Luciano
Published: May 2008

Low‐frequency positive pressure ventilation with extracorporeal carbon dioxide removal, a new form of respiratory assist, has been applied to 12 patients with terminal respiratory failure, for a cumulative time of 1706 hours (range 27–309). Survival rate was 65% versus an expected 10%. During the procedure, the patients were kept under continuous anesthesia and muscle relaxation.

Nutritional support was provided in all but one patient after an initial fasting lag of 13.4 ± 1.8 (SEM) hours, time devoted to bypass connection and subsequent hemodynamic and respiratory equilibration (9% of the total time on bypass).

Three patients received only parenteral nutrition, two underwent, from the beginning, mixed, parenteral, and enteral nutrition, whereas the other six patients switched from parenteral to mixed treatment during the extracorporeal procedure.

Under parenteral nutrition we were careful to refrain from excessive calorie administration and in water intake restriction.

Enteral nutrition was administered for an overall time of 860 hours in eight patients, ie, for 62% of the bypass duration, and provided about two‐thirds of the energy and protein intake. It had to be interrupted in four cases for: intolerance to the diet, gastric hypotone due to polyradiculoneuritis, and two episodes of gastric bleeding in septic shock.

In our opinion, effective nutritional support can be provided safely to patients acutely and severely ill, undergoing highly invasive and long‐term procedures such as extracorporeal respiratory assist. Moreover, enteral nutrition is generally possible, and well‐tolerated, even if the patients are kept continuously anesthetized and curarized.
Clinical Zinc Deficiency in Total Parenteral Nutrition: Zinc Supplementation
Authors: Younoszai Hayat D.
Published: May 2008

The incidence of clinical zinc (Zn) deficiency was rare when solutions used for total parenteral nutrition (TPN) contained amino acids derived from hydrolyzed casein or fibrin, inasmuch as the Zn content of these solutions was high. Between 1978 and 1979 at The University of Iowa Hospitals, the incidence of clinical Zn deficiency increased significantly and was noted in eight patients (3%). During this time, the solution used for TPN contained crystalline amino acids and contained lower levels of Zn. The incidence of clinical Zn deficiency apparently decreased in 1980 and 1981, when the TPN solutions were supplemented with Zn intermittently. Only three patients (1%) developed clinical Zn deficiency. The clinical course of these three patients is reported. All three were in a poor nutritional state and had diseases of the gastrointestinal tract or of the pancreas which are known to be associated with decreased absorption and/or excessive loss of Zn from the body, The signs and symptoms of Zn deficiency developed at a time when the nutritional status of the patients was improving. Zinc serum levels were low (15–40 micrograms per deciliter); but none of the three patients had essential fatty acid deficiency. Treatment with intravenous ZnCl2 or oral ZnSO4 caused a rapid and dramatic improvement in the signs and symptoms. Skin lesions disappeared within 8 days after initiation of therapy. It is suggested that in similar patients Zn supplementation should be on a daily basis. Urine, stool, and serum Zn levels should be monitored closely, especially when the nutritional status of the patient is improving.
CaxP and Ca/P in the Parenteral Feeding of Preterm Infants
Authors: Knight Philip , Heer Deborah , Abdenour George
Published: May 2008

Preterm infants requiring prolonged intravenous feeding frequently develop pathologic fractures and rickets. Infants who receive large amounts of calcium have fewer fractures. This observation led us to determine the maximal amounts of calcium and phosphate that can be added to parenteral nutrition solutions without the precipitation of calcium phosphate and to determine the optimal ratio of calcium to phosphate in these solutions.

Clinical observations and in vitro experiments indicate that the product of calcium × phosphate (CaxP) in the dextrose‐amino acid solution should not exceed 75 square millimolar (square millimole per square liter) to prevent calcium phosphate precipitation in barium‐impregnated silicone rubber catheters and should not exceed 100 square millimolar in solutions administered through peripheral veins. Seven intake and output studies were performed in preterm infants to determine the ratio of calcium to phosphate (Ca/P) in the total parenteral nutrition solutions that minimized urinary losses. A Ca/P ratio of 5.0 minimized the sum of the calcium plus phosphate losses in the urine. However, experience with long‐term total parenteral nutrition in preterm infants, awareness of the acute and life‐threatening effects of body phosphate depletion, and an unmeasured endogenous enteric calcium secretion all suggest that a Ca/P ratio of approximately 3.0 provides a safer compromise between the acute and serious complications of phosphate deficiency and the chronic problems of fractures and rickets due to calcium deficiency.
Factors Influencing Nutritional Assessment in Abdominal Trauma Patients
Authors: Jones Todd N. , Moore Ernest E. , Van Way Charles W.
Published: May 2008

Previous work has shown that an abdominal trauma index (ATI) based on anatomic severity of injury reliably predicts complications following abdominal trauma, whereas the Prognostic Nutritional Index (PNI) does not. This study was undertaken to reconcile the disparity between the PNI and ATI as predictors of postoperative morbidity and mortality. Twenty‐four patients undergoing immediate laparotomy following acute abdominal trauma were evaluated. Their mean age was 32.8 years (range 18–59 years); 18 were men. All patients underwent nutritional assessment within 12 hours of surgery. A statistical comparison of blood replacement, operating time, ATI, and PNI was performed. The mean PNI was 51 and mean blood replacement was 12.5 units. Using linear regression the PNI and amount of blood replacement correlated significantly (r = 0.44, p < 0.05). Operating time and ATI did not correlate with PNI. In conclusion, the PNI was more strongly influenced by blood loss than severity of intraperitoneal injury. For this reason it is relatively ineffective in predicting complications following trauma.
Supplementation of Total Parenteral Nutrition Solutions with Ferrous Citrate
Authors: Sayers Merlin H. , Johnson David K. , Schumann Louis A. , Ivey Marianne F. , Young Jeffry H. , Finch Clement A.
Published: May 2008

Daily infusion of a total parenteral nutrition (TPN) formulation containing 1 liter of 5.5% Travasol provides less than 0.1 milligrams of iron. By comparison, a formulation which includes a liter of 10% Travamin provides 2 milligrams of iron per day. To meet iron requirements in patients infusing formulations containing Travasol, iron was added as ferrous citrate. In in vitro experiments, 74% of this iron was available to transferrin. In seven patients in whom in vivo availability was tested by red cell incorporation, the mean availability was 81%. Ferrous citrate is recommended as a safe, effective additive to TPN solutions for adult patients requiring iron supplements.
Growth and Metabolic Response of Healthy Low Birth‐Weight Newborns Fed a Semi‐Elemental Diet
Authors: Pardou Anne , Brion Luc
Published: May 2008

Twelve normal low birth‐weight newborns weighing between 1100 and 1765 grams (means ± SD, 1614 ± 191) were fed by continuous intragastric drip a semi‐elemental diet, providing per kilogram and per day 120 kilocalories, 2.9 grams of proteins, 17.5 grams of carbohydrates, 4.2 grams of fat and 2.4 milliequivalents of sodium. The diet contained a lactalbumin hydrolysate, dextrin maltose, and medium and long chain triglycerides. The newborns regained their birthweight between 6 and 16 days (mean ± SD, 10.4 ± 3.1) and gained 14 to 37 grams/day (mean ± SD, 25.4 ± 6.8) during the first month of life. The diet proved to be safe and clinically well‐tolerated in low birth‐weight infants and induced a weight gain similar to the intrauterine growth, once the birthweight had been regained.
Evaluation of Nitrogen Utilization in Patients Receiving Total Parenteral Nutrition
Authors: Mirtallo Jay M. , Fabri Peter J. , Radcliffe Kathleen , Shaw‐Regan Christine , Johnson Jerome A. , Ruberg Robert L.
Published: May 2008

This two phase study evaluates nitrogen utilization by the body as a function of fixed caloric intake but different nitrogen loads. Nitrogen use by the body was estimated from measures of nitrogen balance, net protein utilization, and urea accumulation rate.

Phase 1 of this study included 411 measurements of nitrogen use in 120 patients assigned, according to clinical condition, to receive one of the four following therapies: dextrose (D) 25%, amino acids (CAA) 4.25% (Group 1); D 35%, CAA 4.25% (Group 2); D 25%, CAA 2.13% (Group 3); or D 35%, CAA 2.13% (Group 4). Forty patients in Phase 2 were assigned in a randomized, prospective, double blind manner, to receive one of the following regimens: D 35%, CAA 2.75% (Group 5); D 25%, CAA 2.75% (Group 6); D 35%, CAA 4.25% (Group 7); or D 25%, CAA 4.25% (Group 8).

In Phase 1, positive nitrogen balance was achieved with the exception of Group 3 where neither the estimated caloric nor nitrogen needs of the patients were met. It appeared that protein utilization was maximal in patients receiving the therapy of highest calorie:nitrogen ratio (Group 4). Phase 2 patients achieved positive nitrogen balance to the same extent (p > 0.05) and although net protein utilization improved from 53 to 71%/d as the calorie:nitrogen ratio was increased, the differences were not significant (p > 0.05). There was a significant improvement in total iron binding capacity in Phase 2 patients (p < 0.01) that was most prominent at the lower concentrations of amino acids (high cal:n ratio) (Groups 5 and 6).

Smaller amounts of nitrogen appear adequate in producing a positive nitrogen balance and may be better utilized in hospitalized patients if the patients' caloric requirements are achieved.
Changes in Essential Fatty Acids in Plasma Lipid Fractions of Traumatized Patients
Authors: Jelen S. , Tempel G. , Lohninger A. , Blümel G.
Published: May 2008

Changes in the fatty acid pattern of plasma lipids in four different groups of polytraumatized patients were investigated. All of the patients received amino acid solutions containing 0.24 gN/day/kg body weight and 30 kal/day/kg body weight (BW). In group 1, all calories were administered as carbohydrates (glucose and fructose). In group 2, 30 to 40% of the calories were provided as a fat emulsion. When compared to the control group, a reduction in the essential fatty acid concentration in the phospholipid fraction was detected in both groups during the early post‐traumatic period. In group 1, a continuous decline was observed during the remainder of the trial period. In group 2, however, the concentration of essential fatty acids remained constant after the initial decline and increased slightly from the 7th day on. In the second part of the investigation, the effect of human growth hormone (HGH) administration on the fatty acid pattern was evaluated. Groups 3 and 4 received intravenous feedings identical to the patients in group 2; in group 4, however, 10 mg of HGH per day were added to the infusion.

The results of this study confirm the hypothesis that supplemental infusion of a fat emulsion prevents a continuous reduction of essential fatty acids in plasma lipids. An effect of 10 mg/ day of HGH on essential fatty acid concentration or composition, however, could not be observed. There were no detectable differences in the percentage of essential fatty acids between those patients receiving and those not receiving HGH.
Prehepatic Total Parenteral Nutrition in the Chair‐adapted Primate
Authors: Fairman Ronald M. , Crosby Lon O. , Stein T. Peter , Buzby Gordon P. , Mullen James L.
Published: May 2008

The relative efficacy of prehepatic and central venous infusion of total parenteral nutrition (TPN) was evaluated in a chair‐adapted primate model. Four adult male monkeys (Macaca fascicularis) underwent surgical placement of a silastic catheter in both the portal vein (PV) and superior vena cava (SVC). Following recovery (10 days), each animal received two courses of TPN (100 kcal and 4 g of protein/kg/day) for 10 days each via the PV and SVC in an alternating crossover manner.

The prehepatic (PV) infusion of TPN in the well nourished, chair‐adapted primate results in maintenance of weight (PV:Δ — 0.07 kg; SVC:Δ — 0.07 kg), nitrogen equilibrium (PV:+ 0.8 g N/day; SVC: + 0.7 g N/day), and trends in serum albumin (PV:Δ— 0.35 g %; SVC: Δ — 0.38 g %), and total iron binding capacity (PV:Δ + 44 mg %; SVC:Δ + 8.67 mg %) comparable to the SVC route. No significant abnormalities in liver enzyme production were observed with either route of infusion. Whole body protein synthesis rates using 15N‐glycine tracer were likewise comparable (PV = 2.05 g N/kg/day; SVC = 2.18 g N/kg/ day). Prehepatic delivery and primary hepatic modulation of substrates does not substantially improve the efficacy of parenteral nutrient administration. Intestinal modification of substrates may be the most important contributing factor in the supposed superiority of enteral alimentation.
Nonlinear Kinetic Analysis of the Elimination of Lipid Emulsion Administered Intravenously to Dogs
Authors: Cotter R. , Martis L. , Cosmas F. , Sargent H. , Taylor C. , Remis W. , Young S. , Rowe W.B. , Woods E.
Published: May 2008

A model based on a Michaelis‐Menten nonlinear kinetic approach was used to analyze the kinetics of elimination of an intravenously infused lipid emulsion in the dog. The emulsion was administered at doses of 0.3, 3, or 6 g of lipid/kg of body weight. The model was applicable to all data regardless of the kinetic order of the elimination process operating. This can be either zero (linear), mixed, or first order (exponential). Furthermore, it was also found that parameters derived with the model can be used to predict the kinetics of elimination at different dosages. However, it was also shown that elimination parameters for a single bolus dose of lipid emulsion cannot be used to predict the manner in which a continuously infused dose will be eliminated.
Triglyceride and Fatty Acid Clearance in Neonates Following Safflower Oil Emulsion Infusion
Authors: Burckart Gilbert J. , Whitington Peter F. , Halbrehder Deborah K. , Helms Richard A.
Published: May 2008

Fifteen neonates requiring parenteral nutrition with lipid emulsion were given a 1.0 g/kg dose of safflower oil emulsion to evaluate triglyceride (TGY) and free fatty acid clearance. The dose was infused intravenously over 4 hr, and serum was obtained at 0, 2, 4, 6, and 8 hr. Peak serum TGY averaged 592 mg/dl for the appropriate for gestational age newborns and 606 mg/dl for the small for gestational age babies. The small for gestational age neonates had significantly higher serum free fatty acids at 2 and 4 hr into the infusion than did the appropriate for gestational age infants. Peak serum free fatty acids ranged from 0.915 to 3.233 mM in the appropriate for gestational age babies and 2.518 to 3.586 mM in the small for gestational age infants. In contrast to previous work with soybean oil emulsion, we did not demonstrate differences in TGY clearance between small for gestational age and appropriate for gestational age neonates and did demonstrate a markedly elevated serum TGY in these critically ill newborns. Serum TGY and free fatty acids must be monitored in newhorns administered intravenous fat emulsion to avoid the complications of iatrogenic hyperlipemia.
The Effects of Intravenous Administration of 10% Travamulsion Fat Emulsion to Beagle Dogs for 91 Consecutive Days
Authors: Izzo Rodger S. , Leissing Nancy , Woods Eugene , Remis William , Napoli Martha , Kroes Roger , Larcker Sally
Published: May 2008

The tolerance of 10% Travamulsion Intravenous Fat Emulsion (Travenol Laboratories, Inc., Deerfield, IL) was studied using beagle dogs. Physiological (0.9%) saline, USP, was used as the control, and Intralipid 10% Fat Emulsion (Vitrum, Sweden) as the reference article. The emulsions were administered intravenously to each of 10 animals for 91 days at a dosage of 40 ml (approximately 4 g)/kg of body weight/day. The saline was administered to 10 animals at 40 ml/kg/day. On day 92, 7 of the 10 animals in each group were necropsied. The remainder were observed and necropsied at approximately day 160. Toxicity was assessed on the basis of animal survival; changes in body weight, hematology, and serum chemistry; gross pathology; and histopathology.

The results obtained for the Travenol emulsion correlated well with those for the Vitrum emulsion. The emulsions were well tolerated and they did not produce any major clinical signs of toxicity. All animals survived and gained weight. The Travenol emulsion administered provided about 45% of the total caloric requirement of the dog which is equal to an often used clinical dose. However, the emulsion was infused at six times the indicated clinical rate. Thus, in addition to demonstrating the similarity of Travenol and Vitrum emulsions, the results of this study indicate that the Travenol emulsion is safe for prolonged administration.
Riboflavin Enhances Photo‐oxidation of Amino Acids under Simulated Clinical Conditions
Authors: Bhatia Jatinder , Stegink Lewis D. , Ziegler Ekhard E.
Published: May 2008

In neonatal nurseries, solutions of amino acids with added vitamins may be exposed to relatively intense light from phototherapy units. Light, especially in the presence of photosensitizers such as certain vitamins, is capable of destroying amino acids. In the present study, the effect of riboflavin on amino acid concentrations in solutions exposed to light was studied. Solutions of crystalline amino acids with and without added riboflavin were infused into shielded collecting vessels for 24 hr under conditions simulating those occurring during phototherapy. Decreases in concentrations of some amino acids were observed with light exposure alone. Decreases in concentrations of methionine, proline, tryptophan, and tyrosine were significantly greater in the presence of riboflavin that in its absence. Riboflavin concentrations were also significantly reduced after light exposure. Although the losses of amino acids are probably not nutritionally significant, the photo‐oxidation products are largely unknown and may be toxic.
Fluoroscopic Placement of Nasojejunal Feeding Tubes with Immediate Feeding Using a Nonelemental Diet
Authors: Grant John P. , Curtas Mary S. , Kelvin Frederick M.
Published: May 2008

A method for fluoroscopic placement of an Erythrothane (8 French) feeding nasojejunostomy tube with a wire stylet is described. Two hundred thirty‐eight feeding tubes were passed successfully to or beyond the Ligament of Treitz in 141 patients with an average fluoroscopy time of 5.3 min/ patient. A nonelemental diet was administered without difficulty through the tubes by continuous infusion immediately after placement. This technique was found useful in avoiding total parenteral nutrition in patients with poor gastric emptying in situations such as the immediate postoperative period, drug‐induced nausea, and in the presence of an altered mental status.
Can Elemental Diets Reduce the Intestinal Toxicity of 5‐Fluorouracil?
Authors: Plumb Jane A. , Gardner Michael L.G.
Published: May 2008

In order to test the hypothesis that elemental diets protect the intestinal mucosa against 5‐fluorouracil toxicity, we have estimated water absorption, cytoplasmic peptide hydrolase activities, and mucosal DNA contents in isolated intestines from rats fed on one of three elemental diets or a standard diet and injected with 5‐fluorouracil. Water absorption rates were significantly increased when rats, not injected with 5‐fluorouracil, were fed on Flexical or Vivonex‐HN. However, water absorption was severely impaired 3 days after administration of 5‐fluorouracil and none of the elemental diets alleviated this impairment of absorption. Cytoplasmic peptide hydrolase activities and mucosal DNA contents were also severely decreased after 5‐fluorouracil injection, the changes observed being independent of the diet. Also, none of the elemental diets reduced the body weight losses observed after 5‐fluorouracil administration. Although the effects of the sodium salt of 5‐fluorouracil on body weight and food intakes were much less severe than those of the Tris salt the two salts had identical effects on intestinal absorption even when an elemental diet was used. Although there was a smaller incidence of diarrhea after 5‐fluorouracil administration when the rats had been fed on one of the elemental diets, diet B, the results do not support the suggestion that elemental diets might reduce the intestinal toxicity of 5‐fluorouracil. (Journal of Parenteral and Enteral Nutrition 7:351–357, 1983)
Calcium and Phosphorus in Neonatal Parenteral Nutrition Solutions
Authors: Poole Robert L. , Rupp Claudia A. , Kerner John A.
Published: May 2008

Due to calcium and phosphorus solubility problems in parenteral nutrition solutions, it is difficult to provide the premature infant with enough of these two minerals for adequate bone mineralization. In order to determine the maximum amounts of both Ca and P soluble in neonatal parenteral nutrition solutions, we employed the following procedure: (1) using concentrations of dextrose 10 to 25% and amino acid 0.5 to 4.0% with standard electrolyte and vitamin concentrations, Ca and P additions were sequentially made to determine the critical concentrations at which precipitates formed; (2) the pH of each test solution was determined; (3) all test solutions were incubated for 30 hr at room temperature; (4) following incubation, all tests were visually observed for calcium‐phosphate crystals; (5) the solutions not obviously precipitated were filtered using black Millipore filters to determine the presence of any microprecipitates. Multiple graphs of Ca and P solubility in various dextrose/amino acid solutions were prepared from data generated by the study. The Ca and P interaction is primarily pH sensitive. Factors affecting the solution pH include both dextrose and amino acid concentrations. Our study showed that increases in amino acid concentrations enabled us to increase both Ca and P in the solutions. (Journal of Parenteral and Enteral Nutrition 7:358–360, 1983)
Taste Threshold and Acceptability of Commercial Diets in Cancer Patients
Authors: Gallagher Patrick , Tweedle David E.
Published: May 2008

An important factor in the etiology of anorexia in cancer may be a change in the sensation of taste. Taste thresholds for the four basic tastes were measured in 50 cancer patients and 50 control subjects. Cancer patients had a higher mean threshold for recognition of sweet (126 mmol/1 sucrose), and a lower mean threshold for bitter (620 mmol/1 urea), compared to the controls (86 mmol/1 sucrose, p = 0.027, and 728 mmol/1 urea,p = 0.002). There was no significant difference in the mean threshold for sour or salt. Eight commercial diets (Build‐up, Nutrauxil, Ensure, Clinifeed, Triosorbon, Complan, Isocal, Vivonex) were given to each of the cancer patients and control subjects in order to investigate any possible difference in preference.

Scores were often improved by the addition of tasting agents such as Nesquick. Scores for each feed were similar for control and cancer patients apart from Nutrauxil, Ensure and Isocal, which appeared to be preferred by cancer patients. Too much emphasis is often placed upon the contents of formulated diets and too little upon taste and patient acceptability. (Journal of Parenteral and Enteral Nutrition 7:361–363, 1983)
Nutritional Efficacy and Hepatic Changes during Intragastric, Intravenous, and Prehepatic Feeding in Rats
Authors: King Walter W.‐K. , Boelhouwer Roelof U. , Kingsnorth Andrew N. , Ross Jeffrey S. , Young Vernon R. , Malt Ronald A.
Published: May 2008

The nutritional efficacy and hepatic changes in rats given a total parenteral nutrition (TPN) solution consisting of 4.25% amino acids and 25% dextrose by intragastric, intravenous, or prehepatic routes were studied over a 4‐day period. Rats fed Purina Chow or given intragastric TPN maintained body weight and showed no appreciable fatty change of liver. In contrast, weight loss, hepatomegaly, and a 37% increase in liver lipid content were observed in rats given intravenous TPN and a 60% increase after prehepatic TPN. Approximately half the rats given intravenous or prehepatic TPN developed fatty changes in the liver. Serum albumin concentration and hepatic protein content were not improved after prehepatic TPN. Serum SGOT and SGPT were elevated in rats given prehepatic TPN only. Prehepatic TPN may result in hepatic injury and offers no apparent benefit over conventional intravenous TPN in rats. (Journal of Parenteral and Enteral Nutrition 7: 443–446, 1983)
Low Antithrombin III in Morbid Obesity: Return to Normal with Weight Reduction
Authors: Batist Gerald , Bothe Albert , Bern Murray , Bistrian Bruce R. , Blackburn George L.
Published: May 2008

Morbidly obese adults are at increased risk for perioperative thrombotic complications. Antithrombin III (AT III) is a major endogenous anticoagulant and its deficiency is associated with more frequent thrombotic diseases. We measured AT III quantity and function in 23 morbidly obese adults and in 19 otherwise identical people who had reduced their mean weight to 160% of ideal body weight. Both groups were compared to normal weight controls (<120% ideal body weight). Serum and plasma AT III function and serum AT III antigenic concentration were significantly lower in the morbidly obese people compared to the weight reduced group in all three assays. The reduced group had values within the normal range of the normal weight group. In addition, three patients studied both before and after weight loss had similar significant changes in their AT III. We conclude that AT III is reduced in morbidly obese adults and normalizes as weight is reduced. Possible mechanisms of this deficiency and therapeutic approaches are considered. (Journal of Parenteral and Enteral Nutrition 7:447–449, 1983
Iron Supplementation of Total Parenteral Nutrition: A Prospective Study
Authors: Norton J.A. , Peters M.L. , Wesley R. , Maher M.M. , Brennan M.F.
Published: May 2008

A prospective study to evaluate the iron dosage needed to restore serum iron levels was performed on patients receiving prolonged total parenteral nutrition (TPN). Intravenous iron intakes of 0, 25, 87.5, and 175 mg/wk were sequentially studied. No untoward responses were seen in 42 patients studied for 2758 patient days. When compared to pre‐TPN levels, serum iron levels increased significantly with increasing iron dosage (p < 0.002). In every single patient at the two highest dosage levels, serum iron levels at 3 wk rose from the pre‐TPN level. Hemoglobin, reticulocyte count, transfusion requirement, total iron binding capacity, and red cell indices were not affected by iron dosage. There was no increased incidence of sepsis in patients who received increasing iron dosage. Both the 87.5 and 175 mg/wk iron doses increased serum iron levels from pre‐TPN values, but the highest dose increased serum iron levels above the normal range in 80% of patients after 3 wk of administration allowing us to recommend the 87.5 mg/wk dose. (Journal of Parenteral and Enteral Nutrition 7:457–461, 1983)
Hemodynamic Effects of Intravenous 20% Soy Oil Emulsion following Coronary Bypass Surgery
Authors: Abel Ronald M. , Fisch Daniel , Grossman Martin L.
Published: May 2008

Because of its high caloric density, intravenous fat emulsions have been suggested as useful sources of calories and essential fatty acids in patients with serious heart disease in whom fluid restriction must be closely monitored. Previous studies in the experimental animal have suggested a myocardial depressant effect of intravenous fat emulsions at high infusion rates. In the present study, 19 adult patients, following uncomplicated isolated coronary artery bypass surgery, were divided into two groups. A constant infusion of 2 ml/min of soy oil emulsion (20% Intralipid) was administered to the first group. The second group received 20% Intralipid at 1 ml/min followed by a 2 ml/min infusion. In the group receiving the 2 ml/min infusion (averaging 5.25 mg/kg/min), significant decreases in cardiac output and increases in pulmonary capillary wedge pressure occurred. One patient suffered an adverse side effect which may have been related to myocardial ischemia. The second group of patients received an initial infusion of 1 ml/ min (averaging 2.35 mg/kg/min) following which the rate was doubled. No significant hemodynamic changes or adverse side effects occurred in the second group. It is concluded that 20% soy oil emulsion can be administered safely to the recently postoperative cardiac surgical patient recovering from coronary bypass grafting, but the rate should not exceed the maximum clearance rate of 1 ml/min (2.67 mg/kg/min). (Journal of Parenteral and Enteral Nutrition 7:534–540, 1983)
Complications Occurring during Enteral Nutrition Support: A Prospective Study
Authors: Cataldi‐Betcher Emma L. , Seltzer Murray H. , Slocum Bernadette A. , Jones Kenneth W.
Published: May 2008

A review of 253 patients treated with enteral nutrition support via tube feedings is presented for the purpose of evaluating the incidence of complications. Thirty patients, (11.7%) experienced either gastrointestinal, (6.2%) mechanical (3.5%), or metabolic (2.0%) complications. The recognition and treatment of such complications are discussed and it is concluded that tube feedings are safely tolerated by most patients; however, constant attention must be exerted to either avoid or recognize such complications. (Journal of Parenteral and Enteral Nutrition 7:546–552, 1983)
An Outbreak of Staphylococcus Epidermidis Septicemia
Authors: Deitel Mervyn , Krajden Sigmund , Saldanha Colin F. , Gregory Wayne D. , Fuksa Milan , Cantwell Ellen
Published: May 2008

During 45 wk from August 1980 to June 1981, the catheter sepsis rate increased from a prior 2 to 34% (23 of 68 patients on intravenous hyperalimentation). The causative organism was Staphylococcus epidermidis, grown on blood cultures in 21 of the 23 patients and on the catheter‐tips of all 23. Routine cultures of the catheter‐tips of the 45 patients who received intravenous hyperalimentation during this period with no evidence of catheter sepsis grew S. epidermidis on three catheter‐tips (6.7%), possibly contamination during catheter removal. Sepsis resolved within 24 hr after catheter removal, with no antibiotics given for the sepsis. The organism had identical antibiograms on the blood and catheter‐tip cultures in each patient, but antibiograms varied between patients. In these complex patients undergoing multiple medical events, the intravenous hyperalimentation nurse recorded that iv tubing in septic patients had leaked solution at the attachment to the catheter hub, and a review of nursing notes on charts of patients who had been on intravenous hyperalimentation revealed that a leak had been noted in the patients who subsequently had catheter sepses. The leak was due to a manufacturing defect resulting in a decrease in diameter of the plastic connection of the iv tubing, which produced a loose attachment to the hub. The problem was remedied by switching to a Luer‐lok attachment. However, in July 1982, two patients had separation of the Luer due to a manufacturing defect in the threads, followed by a catheter sepsis. Sepsis from the local contamination was not manifest until 5.4 ± 2.7 days later. Quality control by manufacturers is emphasized. (Journal of Parenteral and Enteral Nutrition 7: 569–572, 1983)
The Impact of Total Parenteral Nutrition on Antithrombin III
Authors: Nehme Alexander E. , Boyd Michael C.
Published: May 2008

A prospective study was undertaken to elucidate the effect, if any, of total parenteral nutrition on plasma Antithrombin III levels. A total of 309 patients were included in the study. The patients suffered from cancer, or chronic illness, or major trauma which necessitated total parenteral nutrition. Each patient acted as his own control. Pre and postinfusion Antithrombin III levels were measured at regular intervals. Statistically, the results of the study have shown that total parenteral nutrition does not significantly alter Antithrombin III levels. (Journal of Parenteral and Enteral Nutrition 7: 573–574, 1983)
Direct Azygos Vein and Superior Vena Cava Cannulation for Parenteral Nutrition
Authors: Malt Ronald A. , Kempster Michael
Published: May 2008

As a result of superior vena cava thrombosis and ligation of the inferior vena cava, central venous access was limited in a patient with large, recurrent, intestinal fistulas. Transthoracic catheterization of the azygos vein provided a successful route for parenteral nutrition for 9 wk on one occasion, and transthoracic catheterization of the superior vena cava allowed parenteral nutrition for over 9 months on another. (Journal of Parenteral and Enteral Nutrition 7: 580–581, 1983)
Utilization of Exogenous Fat Emulsion (Intralipid) in Septic Rats
Authors: Wei Jao Chen
Published: May 2008

Utilizations of exogenous fat emulsion (Intralipid) in control, early septic, and late septic rats were studied. After intravenous infusion of 14 C‐Intralipid, cumulative amounts of 14CO2 in the expired breath in the 6‐hr period were 42.8 ± 1.8, 35.0 ± 1.8, and 28.5 ± 1.6% of the injected dose, respectively, for the three groups. The amount and the maximum rate of CO2 production correlated with the severity of sepsis. Significantly greater amounts of plasma triglyceride and free fatty acids were also observed in septic rats. The hyperlipemia associated with the observed decrease in plasma clearance of lipids may account for the decreased utilization of exogenous fat in septic rats. (Journal of Parenteral and Enteral Nutrition 8:14–17, 1983)
Bacterial Contamination of Continuously Infused Enteral Alimentation with Needle Catheter Jejunostomy—Clinical Implications
Authors: Baldwin Brad A. , Zagoren Allen J. , Rose Norman
Published: May 2008

The administration of elemental diet through fine needle catheter jejunostomy is becoming a common alternative route for postoperative feedings. The current review describes a septic syndrome which has been attributed to contamination of these feedings. The authors discuss a number of patient reports, as well as the etiology of the septic‐like syndrome. Recommendations for the elimination of this syndrome are made and further review of patients during the course of changes in technique is described. (Journal of Parenteral and Enteral Nutrition 8:30–33, 1983)
Pancreatic Exocrine Response to Parenteral Nutrition
Authors: Bivins Brack A. , Bell Richard M. , Rapp Robert P. , Toedebusch William H.
Published: May 2008

Animal experimental data concerning pancreatic exocrine secretory response to parenteral nutrition is contradictory. We have studied the pancreatic exocrine output in a patient with a pure pancreatic fistula. In this patient, parenteral nutrition with hypertonic glucose, amino acids and fat emulsion was not associated with increases in fistula volume or protein output. Enteral protein and fat in this patient caused rapid increases in both fistula volume and protein output. This study supports the use of parenteral nutrition as a means of maintaining the pancreas at rest. (Journal of Parenteral and Enteral Nutrition 8:34–36, 1984)
A Simple and Accurate Indirect Calorimetry System for Assessment of Resting Energy Expenditure
Authors: Head C. Alvin , Mcmanus Clifford B. , Seitz Susan , Grossman Gilbert D. , Staton Gerald W. , Heymsfield Steven B.
Published: May 2008

An indirect calorimetry system was assembled from three readily available major components: a digital pneumotachograph, an oxygen analyzer, and a carbon dioxide analyzer. A one‐way valve, face mask, and meteorological balloon completed the system. Accuracy was assessed by comparison to direct calorimetry in hospitalized patients undergoing enteral hyperalimentation. Each subject was on continuous infusion of formula during a 7‐day metabolic balance. Direct and indirect calorimetry was performed over the last 4 days of the balance. The overall agreement between the two methods was within 1%. A simple and inexpensive calorimetry system can therefore be assembled to provide an accurate measure of resting energy expenditure. (Journal of Parenteral and Enteral Nutrition 8:45–48, 1984)
Comparison of the Elimination and Metabolism of 10% Travamulsion and 10% Intralipid Lipid Emulsion in the Dog
Authors: Cotter R. , Martis L. , Cosmas F. , Sargent H. , Taylor C. , Young S. , Rowe W.B. , Woods E.
Published: May 2008

A study was performed comparing the elimination kinetics of two soybean oil/egg phosphatide lipid emulsions (10% Travamulsion υs 10% Intralipid) from the vascular compartment of the dog. Elimination kinetics were evaluated after bolus injection and after continuous infusion studies. Evaluation of triglyceride and free fatty acid data indicates the emulsions are similar metabolic substrates. Phospholipid and cholesterol data indicate a possible difference in remnant particle removal. At the higher lipid dosages, remnant particles from Travamulsion injection were removed at a faster rate than those from Intralipid. (Journal of Parenteral and Enteral Nutrition 8: 140–145, 1984)
Plasma Ammonia Levels in Preterm Infants Receiving Parenteral Nutrition with Crystalline L‐Amino Acids
Authors: Shohat M. , Wielunsky E. , Reisner S.H.
Published: May 2008

In order to investigate the severity and incidence of hyperammonemia in preterm infants receiving total parenteral nutrition (TPN) with crystalline L‐amino acids having high arginine content (Travasol), we determined the plasma ammonia (PA) levels in a group of 29 preterm infants on TPN, weekly and 1 wk posttherapy. Their mean gestational age was 29.9 ± 2.6 wk and mean birth weight 1208 ± 262 g. Thirty five blood samples obtained from 15 preterm infants not on TPN with mean gestational age 32.2 ± 1.9 wk and a birth weight of 1495 ± 161 g served as a control. In the parenteral nutrition group the mean PA level (140 ± 58 μg/100 ml) was significantly higher (p < 0.001) than that in the same group one week post TPN (97 ± 34 μg/100 ml) and in the control group (86 ± 35 μg/100 ml). The incidence of hyperammonemia (>160 μg/100 ml) was 30% in the TPN group versus 3% in the controls (p < 0.01). Maximal PA level during that treatment was 405 versus 216 μg/100 ml 1 wk post‐TPN versus 163 μg/100 ml in the controls. The data show a significant increase in PA levels in preterm infants receiving TPN with Travasol, possibly because of its high glycine content. (Journal of Parenteral and Enteral Nutrition 8:178–180, 1984)
Maintenance of Pregnancy in a Home Parenteral Nutrition Patient
Authors: Tresadern J.C. , Falconer G.F. , Turnberg L.A. , Irving M.H.
Published: May 2008

A case is reported of successful conception and completion of pregnancy in a patient with intestinal failure due to Crohn's disease, nourished entirely by home parenteral nutrition. The nutritional regimen included both dextrose and lipid as calorie sources, together with synthetic amino acids and appropriate additives. Nutritional status was monitored by blood biochemistry, anthropometry, urinary nitrogen losses, and measured resting energy expenditure. Obstetric progress was monitored by standard methods, including abdominal ultrasound, maternal weight gain, and measurement of plasma hormone levels. Herein, particular attention is given to the use of intravenous lipid in pregnancy. (Journal of Parenteral and Enteral Nutrition 8:199–202, 1984)