bluuebunny/crossref_metadata_2025 huggingface dataset:
Osmolality of Liquid and Defined Formula Diets: The Effect of Hydrolysis by Pancreatic Enzymes
Authors: Cha Chung‐Ja M. , Randall Henry T.
Published: May 2008

The effect of hydrolysis was determined by a pancreatic enzyme preparation (Viokase) on a series of diets available for enteral nutrition. The increase in osmolality resulting from digestion by Viokase was measured. Small amounts produced very rapid increase in osmolality in almost all diets evaluated. Neither incubation at 37°C nor the addition of larger amounts of the pancreatic enzyme preparation produced further substantital increases in osmolality. The importance of proper and adequate nutritional support of acutely and chronically ill patients is discussed, and a guideline for the choice of diets, route of delivery, and concentration of diets is suggested.
Cyclic Parenteral Nutrition During Allogeneic Bone Marrow Transplantation
Authors: Reed Michael D. , Halpin Thomas C. , Herzig Roger H. , Gross Samuel ,   UNIVERSITY HOSPITALS OF CLEVELAND BONE MARROW TRANSPLANT TEAM
Published: May 2008

Two adolescents who underwent successful allogeneic bone marrow transplantation were nutritionally managed on a‐fat‐free cyclic parenteral nutrition (PN) regimen. Serum concentrations of prealbumin, albumin, and transferrin were prospectively evaluated to assess the efficacy of nutritional therapy. Both patients tolerated the cyclic PN metabolically. Serial albumin and transferrin concentrations varied slightly and were less sensitive indices of changing nutritional status. In contrast, prealbumin concentrations decreased uniformly during periods of metabolic stress. At the cessation of PN therapy, all serum proteins were within the normal range. Cyclic PN appears to be a safe, practical approach to the nutritional management of patients undergoing bone marrow transplantation.
Enteral Nutrition: Frequency of Formula Modification
Authors: Freed Bruce A. , Hsia Betty , Smith John P. , Kaminski Mitchell V.
Published: May 2008

A retrospective study was undertaken to determine with what frequency one of the 12 standard enteral formulations routinely used by the Metabolic Support Service could not be used without modification. Forty‐three percent of the 83 patients studied required modification of one or more of the 5 individual components of the enteral product being utilized (ie, carbohydrate, protein, fat, electrolytes, and vitamins). Organ dysfunction was the reason for 31% of those changes in formula, other conditions included vitamin deficiencies (30%), electrolyte imbalances (27%), and essential fatty acid deficiencies (12%). The results of the study confirm the fact that no single formula can be effective in meeting every patient's fluid and electrolyte requirements while addressing the specific nutritional aspects of their disease. It would appear that a totally modular system for enteral nutrition similar to that used in parenteral nutritional support would allow maximum flexibility in the preparation of formulae that conform to patient's needs.
Nutritional Compromise in Radiation Therapy Patients Experiencing Treatment‐Related Emesis
Authors: Welch Deborah
Published: May 2008

This article reviews the findings of a research study which investigated the phenomenon of nausea and vomiting in cancer patients receiving radiation therapy. One of the variables studied was nutritional status and how it was related to nausea and vomiting. The relationship between treatment‐related emesis and nutritional status is described in two ways: how the patient's nutritional status may have affected the incidence of nausea and vomiting, and how the clinical occurrence of emesis affected the patient's nutritional status. Significant findings included the following. A decrease in appetite was experienced more frequently in patients undergoing therapy of either short (less than 12 days) or long duration (greater than 20 days), in comparison with those patients undergoing therapy of a moderate duration (between 14–20 days) (p = 0.05). A significant relationship was also documented between poor nutritional intake during treatment and a higher incidence of nausea and vomiting (p = 0.01). Another important finding included the fact that those patients who lost more than 5% of their total body weight prior to starting radiotherapy, went on to experience further weight loss during therapy. Recommendations for further research and implications for clinical practice are outlined.
Cimetidine and Parenteral Nutrition
Authors: Moore Richard A. , Feldman Stuart , Treuting John , Bloss Robert , Dudrick Stanley J.
Published: May 2008

A number of patients receiving continuous intravenous infusions of hyperalimentation solutions require cimetidine (CT) for treatment of gastric hypersecretory conditions. Four patients were selected to receive a CT‐hyperalimentation mixture and serial blood sampling for CT concentrations. Rates of infusion of CT ranged from 38 to 56.3 mg/hr. Average serum concentrations (Css) of CT at steady state ranged from 0.6 to 1.0 μg/ml. This concentration range is near levels reported in patients receiving long‐term oral CT and is lower than levels reported to be associated with central nervous system toxicity. No evidence of renal toxicity was noted. Pharmacokinetic parameters were comparable to previous reports in the literature. This initial investigation reveals that continuous intravenous infusion of CT in hyperalimentation solutions appears to be a safe mode of drug administration. More definitive studies are needed to assess efficacy.
Anabolic Steroid Administration During Nutritional Support: A Therapeutic Controversy
Authors: Lewis Larry , Dahn Michael , Kirkpatrick John R.
Published: May 2008

Nitrogen balance was determined in 48 patients who were entered into a randomized prospective double‐blind study, comparing anabolic steroids versus placebo in our parenteral nutritional support system. The group included both young and old patients suffering from catabolic illnesses, in whom intravenous feeding ranged from 14–21 days. All participants received the active agent or placebo biweekly throughout the study. During the period of intravenous nutrition, there was no statistically significant difference in nitrogen balance and protein conservation in the patients receiving the active agent.
Comparison of Continuous vs Intermittent Tube Feedings in Adult Burn Patients
Authors: Hiebert John M. , Brown Anne , Anderson Roland G. , Halfacre Susan , Rodeheaver George T. , Edlich Richard F.
Published: May 2008

In an effort to determine an optimal method of utilizing the gastrointestinal tract to meet the nutritional need of burn patients, a comparison was made between continuous and intermittent delivery of lactose‐free tube‐fed diets in similar groups of burn‐injured patients. It was found that significantly less stool frequency and time required to achieve the nutritional goal occurred in patients treated with continuous pump tube feeding over those fed intermittently.
Use of Hickman Right Atrial Catheter in Pediatric Oncology Patients
Authors: Merritt Russell J. , Ennis Carol E. , Andrassy Richard J. , Usaf Ltc , Hays Daniel M. , Sinatra Frank R. , Thomas Daniel W. , Siegel Stuart E.
Published: May 2008

Eighteen pediatric oncology inpatients had 21 Hickman right atrial catheters placed for total venous access; 16 patients received parenteral nutrition. Mean duration of catheterization was 43 ± 29 (SD) days. Four catheters had to be removed for infection or clotting. The catheter‐related sepsis rate was 10%. Serious catheter‐related complications were no more frequent in this population than in patients receiving only parenteral nutrition via Broviac or pediatric Broviac catheters.
Clinical Effectiveness of a Pancreatic Enzyme Supplement
Authors: Valerio David , Whyte Eric H.A. , Schlamm Haran T. , Ruggiero John A. , Blackburn George L.
Published: May 2008

In 23 adult patients with pancreatic insufficiency, we evaluated the efficacy of a pancreatic enzyme delivered as pH‐sensitive enteric‐coated pancrelipase microspheres, and compared it with placebo and other available enzyme supplements. In a short‐term study, fecal fat was 23.5 ± 7 g/day with the microspheres, compared with 29.9 ± 8 with other supplements, providing fat utilization of 76 ± 7% versus 63 ± 10% (p < 0.05). Microspheres reduced daily stool frequency to 1.9 movements from 4.3 on other enzymes (p < 0.01). These results were obtained with an average intake of 10 microsphere capsules/day. In a year‐long study of 22 patients, an average weight gain of 4.0 ± 1.1 kg was observed associated with return of near‐normal social and work life‐style in previously housebound patients.
Medium Chain Triglycerides in Parenteral Nutrition
Authors: Sailer Dietmar , Muller Michael
Published: May 2008

Until recently, medium chain triglycerides (MCT) have not been used in parenteral nutrition (PN) although they are considered to be ideal sources of energy on account of their biochemical properties. The tolerance and utilization of 10% fat emulsion with 75% MCT was tested on 10 healthy males after an overnight fast. During an infusion period of 6 hr the total fat supply rate was 0.12 g/kg body weight/hr. A commercial 10% fat emulsion (Lipofundin‐S‐10) served as control. The fat emulsion containing MCT was tolerated without any side effects. Compared with the commercial fat emulsion, the increase of triglycerides was markedly lower and clearing of the serum was completed earlier. By gas chromatographic analysis of the serum fatty acid pattern, medium chain fatty acids rapidly achieved a steady state. During infusion of the fat emulsion containing MCT, the production of ketone bodies was considerably higher although acidosis was not induced. The results obtained indicate that the fat solutions containing MCT bypass gluconeogenesis and are utilized quickly without side effects.
Crohn's Disease of the Appendix: Remission Obtained By Total Parenteral Nutrition
Authors: Jacobson Stefan , Gabrielsson Nils , Granqvist Staffan
Published: May 2008

A woman, aged 37 years, who had been suffering from advanced Crohn's disease for many years, was treated with long‐term total parenteral nutrition (TPN), given in two 2‐month periods at an interval of 6 months. Prior to the introduction of TPN there was inflammation of the appendix, the terminal ileum, and the entire colon. During the first period of TPN there was a temporary clinical and radiological improvement in the state of the intestinal tract, including the appendix. Two months after the first period of TPN abdominal pain recurred, and colonoscopy disclosed renewed severe inflammation of the mucosa from the cecum to the rectum. At operation, on day 45 of the second period of TPN, due to remaining stenosis of the terminal ileum, there was no longer any inflammation of the appendix, confirmed by histological examination.
Changes in Phosphorus Distribution During Total Parenteral Nutrition
Authors: Mashima Y. , Ogawa M. , Aoki Y. , Ichiki N. , Swan D.K.
Published: May 2008

To investigate the mechanism of hypophosphatemia during total parenteral nutrition (TPN), changes in phosphate (P) contents in the liver and muscle of rats supported by TPN for 2 days at 270 cal/g were studied in 39 Sprague Dawley rats (200 g body weight), divided into 5 groups as follows: G‐I: starved for 24 hr (n = 7); G‐II: TPN (5 mEq P/1000 cal) after 24 hr starvation (n = 7); G‐III: starved for 4 days (n = 7); G‐IV: TPN (5 mEq P/1000 cal) after 4 days starvation (n = 9); G‐V: TPN (35 mEq P/1000 cal) after 4 days starvation (n = 9). P contents of the tissues were measured colorimetrically. Results indicated that muscle P content decreased in the depleted rat supported by TPN with low P intake, while an increase in P content in the liver was a constant finding in each TPN group. Increase in P intake tended to preserve the P content in the muscle. These findings suggest that the changes in P distribution in major body tissues must be considered in addition to the changes in the serum inorganic P levels to evaluate an adequate P requirement for TPN.
Fat Emulsion Catabolism in Vitro and in Vivo—Sex Related Differences
Authors: Jesmok Gary J. , Woods Eugene F. , Ditzler William S. , Walsh Gerald
Published: May 2008

The removal rates of an intravenously administered 10% fat emulsion (Intralipid) from plasma in male and female conscious rats are described. The plasma concentration of fat emulsion particles at various time intervals following a bolus administration (0.2 g/kg) was measured by nephelometry. At the dose employed, the removal of fat emulsion from the plasma followed first order kinetics, ie, a constant fraction was removed from the plasma per unit of time, K2 (%/min). Females exhibited a significantly greater fractional removal rate (K2) than comparably aged males (21.0 ± 1.0 vs 15.0 ± 1.4, p < 0.05). Postheparin lipoprotein lipase, measured using fat emulsion as substrate, also was significantly greater in female rats compared with males. Our results demonstrate that, in rats, fat emulsion (Intralipid) is catabolized more rapidly in females than in males and a greater lipoprotein lipase activity in female rats may be the causative factor.
Maintenance of Gastrointestinal Function After Bowel Surgery and Immediate Enteral Full Nutrition. II. Clinical Experience, with Objective Demonstration of Intestinal Absorption and Motility
Authors: Moss Gerald
Published: May 2008

Eighteen patients undergoing colorectal excision had gastrointestinal function preserved. Paralytic ileus was avoided by efficient exclusion of swallowed air by aspiration of the esophagus. Full strength elemental diet was delivered into the duodenum immediately postoperatively at 100–150 ml/ hour. Virtually stoichiometric digestion, absorption, and utilization of dietary protein was demonstrated in six patients, for whom 125I‐albumin was added to the initial feedings. The 24‐hour urine contained 94 ± 4% of the activity. The same group of patients had hourly determinations of nitrogen balance. Each had achieved positive protein balance by 5 ± 3 hours postoperatively.

The morning following surgery (17–24 hours postoperatively) the special nasogastric device was removed and intravenous feedings were discontinued, with transition to per os intake of elemental diet. Twelve patients had oral barium motility studies initiated at this time, with continued oral intake of elemental diet. On serial x‐rays, each showed clinically adequate peristalsis, with prompt passage of the contrast agent out of the stomach, through intestine and colon. The barium traversed anastomoses to enter the rectum and exit in a spontaneous bowel movement within the second 24‐hour period. Three patients were discharged within 48 hours of surgery (sigmoid resection, 2; right hemicolectomy, 1).

Paralytic ileus develops after the usual postoperative regimens. Clinically adequate gastrointestinal function can be preserved by a regimen that includes efficient exclusion of swallowed air. This study documents the immediate enteral absorption of full nutrition (ie, 3000 kcal/day) as elemental diet. The x‐ray studies document preservation of even gastric and colonic function, permitting normal per os intake and discharge within 24–48 hours of major abdominal surgery.
Effect of Intravenous Nutrition, with Glucose as the Only Calorie Source, on Muscle Glycogen
Authors: King Roderick F.G.J. , Macfie John , Hill Graham L. , Smith Ross C.
Published: May 2008

This study was undertaken to assess the clinical significance of changes in muscle glycogen in the calculation of the energy requirements of patients fed intravenously. The glycogen content of the vastus or rectus muscle of 27 ill surgical patients with serious complications of the gastrointestinal tract was determined before and after a course of intravenous nutrition with various quantities of glucose as the caloric source. The quantity of glycogen in muscle before intravenous nutrition for all patients was 37 ± 23 mg/g dry muscle; this was increased significantly (p<.01) to 69 ± 44 mg/g dry muscle after 14 days of feeding. In 5 patients who received intravenous nutrition for another 2 weeks, the glycogen content of the vastus muscle increased from a mean value of 80 mg/g dry muscle on day 14 of feeding to 106 mg/g on day 28, but this was not significant. The administration of glucose is invariably associated with an increase in the stores of muscle glycogen but the calorie equivalent of this gain in glycogen is small and, by our calculations, is no more than 530 kcal over the 14 days. We suggest that this gain is small relative to the energy expenditure of this type of patient and is of little clinical significance in the determination of their calorie requirements.
Vitamin A Inhibits Some Aspects of Systemic Disease Due to Local X‐Radiation
Authors: Seifter Eli , Rettura Giuseppe , Stratford Frank , Yee Corine , Weinzweig Jeffrey , Jacobson Neil L. , Levenson Stanley M.
Published: May 2008

We have previously reported that supplemental vitamin A ameliorates the stress response to a wide variety of noxious agents. The present study was carried out to determine how supplemental vitamin A influences the course of radiation sickness in C3H female mice subjected to 3000 R irradiation of one lower hind limb. All mice ingested a chow diet containing about 13,000 units of vitamin A/kg diet (about half as preformed vitamin A and half as β‐carotene) which supports normal growth, development, and reproduction of normal mice. One hundred fifty thousand units of vitamin A/kg chow was added for the vitamin A supplemented mice. All mice ate and drank ad libitum. The supplemental vitamin A feeding was begun either 3 days before radiation or immediately after radiation. There were no significant differences in the effects of these two regimens. The supplemental vitamin A prevented the weight loss, moderated the adrenal hypertrophy, prevented the thymic involution, and lessened the lymphopenia due to radiation. We conclude that supplemental vitamin A has both prophylactic and therapeutic benefits in radiation‐induced disease.
Early Postoperative Nutritional Support Using the Serosal Tunnel Jejunostomy
Authors: Cobb L. Mason , Cartmill Andrea M. , Gilsdorf Robert B.
Published: May 2008

A silicone rubber serosal tunnel jejunostomy for postoperative nutritional therapy was placed in 38 patients who had major operations. A dilute, chemically defined diet was begun within 48 hours of surgery and an attempt made to advance it slowly to full strength by the fifth day.

No catheter‐related complications occurred. Intravenous fluid therapy was shortened to less than three days in 11 (29%) patients. Only 17 (45%) patients tolerated full‐strength feedings within the protocol time. Three (8%) patients depended on their tube feedings for over 30 days and the need for parenteral nutrition was avoided. Of six septic patients, four had complete intolerance of the diet; two of these developed massive gastric hypersecretion. Serum albumin was a statistically significant indicator of whether a patient could tolerate tube feedings. No patient with an albumin less than 3 g/dl tolerated full‐strength feedings and the patients with albumin greater than 4 g/dl had no problems.

Postoperative feeding utilizing the serosal tunnel jejunostomy is technically safe, but feeding difficulties can be anticipated in those patients who are septic or severely malnourished; these are the patients whose nutritional needs are the greatest. The greatest benefits accrue to those patients who are in need of long‐term nutritional support. We recommend routine placement of these catheters in major operations.
Zinc and Copper Status of Treated Children with Phenylketonuria
Authors: Acosta Phyllis B. , Fernhoff Paul M. , Warshaw Hope S. , Hambidge K. Michael , Ernest Arlene , Mccabe Edward R.B. , Elsas Louis J.
Published: May 2008

Children with phenylketonuria (PKU) are treated with semi‐synthetic diets restricted in phenylalanine. Low or phenylalanine‐free formulae provide the majority of protein and energy in the diet while phenylalanine requirements are met by low‐protein natural foods. Because of the restriction of natural protein sources in this diet, the study assessed the zinc and copper nutriture of treated children with PKU and correlated linear growth with zinc status. The plasma zinc of the PKU population was 66.6 ± 3.3 μg/dl (mean ± SEM). The hair zinc was 70.2 ± 11.5 μg/g (mean ± SEM). The mean plasma and hair zinc of the PKU population were significantly different (p < 0.05) when compared to normal values of 84.2 ± 2.9 μg/dl and 130.7 ± 8.3 μg/g (mean ± SEM), respectively. The dietary zinc intake of 10 PKU patients was 8.56 ± 2.68 mg/day (mean ± SD). No significant differences (p < 0.123) were found when the mean zinc intake was compared with recommended dietary allowances for age of 10 mg/day. No significant correlations were found when plasma and hair zinc were plotted with height percentiles. Plasma copper of the PKU subjects (87.6 ± 6.6 μg/ dl, mean ± SEM) was significantly less than that of normal young children (121.5 ± 3.1 μg/dl, mean ± SEM) despite a copper intake of 1.45 ± 0.35 mg/day (mean ± SD).
Oral Correction of Essential Fatty Acid Deficiency in Cystic Fibrosis
Authors: Landon Christopher , Kerner John A. , Castillo Ricardo , Adams Lynn , Whalen Ray , Lewiston Norman J.
Published: May 2008

A combination of pancreatic insufficiency and inadequate caloric intake may produce essential fatty acid (EFA) deficiency in patients with cystic fibrosis. Seventy‐five percent of the adolescents and young adults with poor weight gain in our clinic were EFA‐deficient by total plasma linoleic acid criteria. Twenty of these patients were placed on an oral hyperalimentation regimen containing 230% of calories required for basal energy expenditure, 40% as fat. Forty percent of these (8/20) achieved normal EFA levels on this diet. Eight of the nonresponding patients were given an additional 5% of their caloric intake as linoleic acid monoglyceride. All who maintained caloric intake achieved normal EFA levels. Normalization of EFA levels was associated with a number of clinical benefits including increase in weight and activity and, in five teenage girls, regulation of menses. The 16 control patients who received standard pancrelipase therapy and nutritional supplements remained fatty acid deficient. We conclude that oral hyperalimentation can restore EFA levels in cystic fibrosis patients if adequate calories are available to provide energy needs.
Urinary Carnitine Excretion in Surgical Patients on Total Parenteral Nutrition
Authors: Tanphaichitr Vichai , Lerdvuthisopon Nusiri
Published: May 2008

Urinary free and total carnitine excretions were measured in 41 normal adults and seven surgical patients on fat‐free total parenteral nutrition for 8 to 45 days. The means (±SEM) of urinary free and total carnitine excretions in normal adults were 162 ± 19 and 328 ± 28 μmol/days, respectively. All of the patients exhibited protein‐calorie malnutrition with a mean carnitine intake of 11.6 ± 1.5 μmol/day. Under this stringent carnitine economy with the adequate supply of lysine and methionine, urinary total carnitine excretion significantly reduced to 127 to 162 μmol/day. This probably reflects the carnitine biosynthetic rate. However, during the periods of operation and/or infection, urinary total carnitine excretion significantly increased 2‐ to 7‐fold that of normal levels. Significant positive correlation was found between the two forms of urinary carnitine and total nitrogen excretions. Serum free and total carnitine levels in patients were significantly higher than normal adults. Such findings can be explained by the endocrine responses to the stress phenomenon and indicate a catabolic response of skeletal muscle in which most of the body carnitine resides. This can impair their carnitine status.
Asssessing Energy Requirements of Patients on Respirators
Authors: Mccamish Mark A. , Dean Richard E. , Ouellette Thomas R.
Published: May 2008

This report documents a specific situation in which indirect calorimetry produced large overestimations of oxygen consumption and energy expenditure of a patient on a respirator. High positive‐end expiratory pressures combined with high fractional concentrations of O2 led to perforation of lung parenchyma with considerable loss of O2, which produced subcutaneous emphysema and recurrent pneumothoraces. Typical calculations for determining energy expenditure from O2 consumption, therefore, could not be employed. Calculations utilizing the volume of CO2 expired, however, were less sensitive and variable during this time period. Resting energy expenditures were calculated from the volume of CO2 expired by using 5.52 kcal/1 as the caloric equivalent of CO2. This procedure does not overestimate energy needs when a physiological gas leak exists (high positive‐end expiratory pressures and high fractional concentrations of O2 or chest tube). This is very important in the ventilatory patient as excess carbohydrate can further stress the compromised pulmonary status.
Home Total Parenteral Nutrition: A Psycho‐Social Viewpoint
Authors: Robinovitch Arlene E.
Published: May 2008

Home total parenteral nutrition (TPN) usually necessitates major and probably permanent changes in the patient's lifestyle. Among the nonmedical, nontechnological issues these patients face are the need to: (1) adhere to prescribed regimens to avoid crises and to control symptoms; (2) alter their self‐perceptions; (3) modify their accustomed roles; (4) reorder their priorities and re‐think their values; (5) deal with machine and medical center dependency; and (6) assign a monetary value to their lives. The emotional and environmental pressures that are the chief issues for these patients include financial, employment, psychological, and interpersonal problems such as depression, anger, anxiety, relief, body image, and self‐esteem.

Patients on home TPN are best treated with a clinical team that serves both the patient and family as individuals and as a social system. Services offered include: (1) medical diagnosis, treatment, and rehabilitation; (2) professional and technical support services including pharmacy, dietary, and nursing to teach, demonstrate and monitor self‐care, nutrition, and use of the home TPN system; and (3) professional social work services to assist patients and families to deal with the feelings, relationships, environmental pressures, and advocacy needs associated with home TPN.
Parenteral 20% Safflower Oil Emulsion Safety and Effectiveness as a Caloric Source in Newborn Infants
Authors: Marchildon Michael B.
Published: May 2008

Five surgical infants, ages 3 to 30 days, were studied while receiving peripheral total parenteral nutrition for a period of 2 weeks. By a randomized sequence, either 10 or 20% safflower oil emulsion was infused the first week, followed by the alternate solution during the second week. Caloric intake was 80 to 100 cal/kg/day, of which lipids comprised one‐third to one‐half. No adverse side effects were noted. Eosinophilia developed in three patients, but otherwise no changes in hematologic and biochemical parameters, including liver enzymes, were noted. Weight gain averaged 11.1 g/kg/day during the study period and was similar for the 10 and 20% solutions. Intravenous fluid intake averaged 21 ml/kg/day less during the week the patients received 20% lipid emulsion. The 20% safflower oil emulsion proved comparable to the 10% solution in both safety and efficacy and enabled significant reduction of fluid intake while maintaining infused caloric levels.
Serum‐Sulfated Lithocholate as an Indicator of Cholestasis During Parenteral Nutrition in Infants and Children
Authors: Farrell Michael K. , Balistreri William F. , Suchy Frederick J.
Published: May 2008

Serum‐sulfated lithocholate concentrations were followed in 55 patients receiving parenteral nutrition. Elevation of serum lithocholate occurred in 18 (10/34 under 6 months of age, 8/21 older than 6 months). Serum sulfated lithocholate concentrations were a more sensitive indicator of cholestasis than either direct bilirubin or aminotransferases. The serum lithocholate concentrations in parenteral nutrition‐associated liver disease were similar to those seen in patients with known cholestasis.
Evaluation of Opsite Catheter Dressings for Parenteral Nutrition: A Prospective, Randomized Study
Authors: Powell Carla , Regan Christine , Fabri Peter J. , Ruberg Robert L.
Published: May 2008

A prospective, randomized study compared the use of Opsite and standard gauze/tape dressings in 261 patients receiving parenteral nutrition. Eighty‐four patients had a source of external drainage and were evaluated as a separate group. Catheter‐related sepsis was assessed by blood culture, catheter tip culture, clinical sepsis, and clinical defervescence of fever after catheter removal. Although no statistically significant difference between Opsite and standard dressings could be identified, Opsite‐treated patients consistently had increased parameters of catheter‐related sepsis in all comparisons. As used here, Opsite is probably not a suitable catheter dressing system for parenteral nutrition.
Utility of Skin Testing in Nutritional Assessment: A Critical Review
Authors: Twomey Patrick , Ziegler Diana , Rombeau John
Published: May 2008

To evaluate the claim that delayed cutaneous hypersensitivity skin testing is useful in nutritional assessment of hospitalized patients, we reviewed the English language literature of the last 12 years. Although several hundred publications discussed delayed cutaneous hypersensitivity testing and nutritional status, only 15 provided new, objective data correlating these variables in hospitalized adults. Of these, only three provided age‐matched control groups to control for antigen variability, lack of prior exposure, and other technical problems. The majority of reports took no account of diseases (cancer, immune disease, infection) or therapies (radiation, drugs, surgery) known to affect skin test response. In the reports specifying different degrees of malnutrition, the most important group, those with less than obvious malnutrition, were not abnormal by skin testing. Ten reports described serial skin testing during nutritional intervention. None reported serially tested controls without nutritional intervention, important since serial testing alone can augment skin test response. Nonnutritional intercurrent therapy which might affect skin tests was seldom mentioned. In the few reports specifying that nutritional repletion was even achieved, repleted patients were not separated from unrepleted in subsequent analyses. No report examined skin testing for its predictive accuracy, cost/benefit ratio, or influence on outcome. Because of these problems in experimental design, the frequent lack of appropriate controls, and the low specificity of abnormal delayed cutaneous hypersensitivity responses, we conclude that the utility of skin testing in nutritional assessment remains unproved.
Sustained Flexibility in Infant Feeding Tubes Containing Nonmigrating Plasticizer
Authors: Pereira Gilberto R. , Herold Rima , Ziegler Moritz , Roth Karl , Jacobowski Diane , Boettcher Millie D.
Published: May 2008

Due to medical complications related to stiffness developed in polyvinyl chloride (PVC) feeding tubes presently manufactured with di‐octylphthalate (DOP), we have assessed the flexibility of PVC tubes manufactured with a nonmigrating plasticizer, ti‐octyltrimellitate (TOTM) (National Catheter Co., Argyle, NY). Two sizes of DOP and TOTM PVC feedings tubes were evaluated, #5 French and #8 French. Number 5 French DOP tubes became significantly stiffer as early as 1 to 2 days after intubation and continued to stiffen up to 8 days of use. Among the #5 French DOP tubes, those placed in the jejunum were found to become significantly stiffer than those placed in the stomach. No correlations were found between the development of stiffness and gestational age, postnatal age, sex, birthweight, or kinds of feedings. In contrast, #5 French TOTM and #8 French tubes (DOP and TOTM) did not develop any significant stiffness up to 5 to 8 days of use. This study demonstrates the sustained flexibility of TOTM tubes, an important factor to increase the safety of enteral feedings in newborn infants.
Use of Lipid Calories During Pneumococcal Sepsis in the Rhesus Monkey
Authors: Wannemacher Robert W. , Kaminski Mitchell V. , Dinterman Richard E. , McCabe Thomas R.
Published: May 2008

A number of studies in patients and monkeys have suggested that intravenous infusion of lipids can be utilized as a major source of calories during sepsis and/or trauma. Others, however, have observed that lipid calories were not as effective as glucose calories in sparing body protein in severely septic and/or burned patients. In trying to resolve this controversy, a parenteral nutrition model was utilized during pneumococcal sepsis in the rhesus monkey. Earlier studies indicated that when monkeys were infused with 0.55 grams amino acid nitrogen and 13 kilocalories per kilogram per day, they lost approximately 13% of their body protein as a result of the clinical illness associated with pneumococcal sepsis. Addition of 85 kilocalories per kilogram per day of either dextrose or lipid emulsion (Intralipid) effectively prevented this infection‐related loss of body protein. The present study was designed to determine whether the elevated plasma insulin concentrations associated with glucose infusions are necessary for protein sparing or would interfere with utilization of lipid calories. In this study, septic and control monkeys were infused with a hypocaloric amino acid‐dextrose solution to which was added lipid emulsion. If septic monkeys were totally maintained on a hypocaloric infusion of amino acids and 32 kilocalories per kilogram per day from dextrose, they lost 6.8 ± 1.0% of their body protein over the 6‐day experimental period. Addition of lipid calories (55 kilocalories per kilogram per day) to this mixture resulted in a gain of 1.1 ± 0.7% of body protein. In both experimental groups plasma insulin was approximately 100 to 200 microunits per milliliter, which resulted in a marked inhibition of ketogenesis and lipolysis. Despite elevated plasma insulin, the septic monkey appeared able to utilize the fatty acids from the infused lipid effectively as a calorie source to spare body protein. Since lipid emulsion contains approximately 13% glycerol calories, septic monkeys were infused with a hypocaloric amino acid‐dextrose solution and an amount of glycerol calories equivalent to that found in Intralipid. Under these conditions, the loss of body protein was very similar to that seen when the hypocaloric amino acid‐dextrose solution alone was infused in the septic monkey. Thus, the protein‐sparing effects of the lipid emulsion are not related to its glycerol content.
A Comparison of Essential and General Amino Acid Infusions in the Nutritional Support of Patients with Compromised Renal Function
Authors: Mirtallo Jay M. , Schneider Philip J. , Mavko Kay , Ruberg Robert L. , Fabri Peter J.
Published: May 2008

A comparative study of an essential amino acid (EAA) solution versus a general amino acid (GAA) solution in combination with a high density caloric solution (350 gram dextrose per 750 milliliter total volume) in patients with impaired renal function and receiving total parenteral nutrition was conducted. Forty‐five patients were randomly assigned to receive either EAA [17 grams per liter (24)] or GAA [20 grams per liter (21)]. BUN values for days 1 to 10 of the study for each group declined at the same rate, 3.7 milligrams per deciliter per day for the GAA group and 2.8 milligrams per deciliter per day for the EAA group (p > 0.05, analysis of variance). BUN values at the start of the study were 78 ± 6.5, mean ± standard error of mean milligram per deciliter for the GAA group and 75 ± 7.5, mean ± standard error of mean, mg/dl for the EAA' group which were not different (p > 0.05, analysis of variance). Serum creatinine values of 5.9 ± 0.9, mean ± standard error of mean, milligram per deciliter for the GAA group and 5.0 ± 0.6, mean ± standard error of mean, milligram per deciliter for the EAA group remained the same and there was no significant difference between groups over days 1 to 10 of the study (p > 0.05, analysis of variance). Urine urea nitrogen was determined twice weekly and estimated nitrogen balance, urea appearance rate, and net protein utilization were calculated. There were no significant differences found in any of these parameters between groups (p > 0.05, Student unpaired t‐test). Serum potassium, magnesium, and phosphate were the same between groups over the study period (p > 0.05, Student unpaired t‐test). The mortality rate of 38 and 25% in the GAA and EAA groups, respectively, was not significantly different (p = 0.32, Fisher's exact probability test). In this study, there was no demonstrable advantage to the use of the essential amino acid solution when compared with a reduced concentration general amino acid solution for parenteral nutrition in renal failure patients.
Detection of Dangerous Malnutrition
Authors: Klidjian A.M. , Archer T.J. , Foster K.J. , Karran S.J.
Published: May 2008

The assessment of malnutrition by simple methods was studied in 120 patients undergoing elective major abdominal surgery to determine which index was of the most value in predicting postoperative complications. Weight for height and weight loss were of little significant value; serum albumin <35 g/l was more significant (p < 0.05) but predicted only a quarter of those patients who developed serious complications. Measurements of muscle stores by anthropometry (arm and forearm muscle circumference) predicted nearly half the patients (p < 0.01). By far the most useful index was hand‐grip dynamometry, which predicted 90% of those who developed complications (p < 0.001). The incidence of serious complications was 6 times greater in those patients with a low grip strength. Hand‐grip dynamometry appears to be a useful screening test of patients at risk, and a valuable additional test for nutritional assessment.
Rickets in Premature Infants Receiving Parenteral Nutrition: A Case Report and Review of the Literature
Authors: Kien Craig L. , Browning Carol , Jona Juda , Starshak Robert J.
Published: May 2008

There is a multifactorial etiology for rickets in premature infants receiving total parenteral nutrition. As an example of this, we describe a premature infant fed almost exclusively parenterally for the first 8 months of life who developed biochemical and radiologic evidence of rickets despite receiving vitamin D, calcium, and phosphorus at presently recommended levels. From our experience and a review of previous literature, there appears to be considerable uncertainty regarding the intravenous requirements of calcium, phosphorus, and vitamin D, particularly in low‐birth weight infants. Therefore, measurements of serum 25‐hydroxyvitamin D levels, vitamin D, and mineral intakes, and calcium and phosphorus excretion might be clinically useful for monitoring premature infants receiving total parenteral nutrition. Further research delineating more precisely the vitamin D, calcium, and phosphorus requirements of such infants is also suggested.
Rapid Determination of Cold Insoluble Globulin by Laser Nephelometry. Application in Patients Receiving Preoperative Total Parenteral Nutrition
Authors: Brodin Bengt , Cederblad Gitten , Larsson Jörgen , Schildt Bo , Sjödahl Rune , Symreng Tommy , Wetterfors Jarl
Published: May 2008

A simple and rapid method for determining plasma fibronectin or cold insoluble globulin (CIG) based on immunochemical precipitation and laser nephelometry is described. The coefficient of variation within the series was 4.2% and between the series 9.1%. The mean value for 37 control subjects was 100.1% ± 20.6 (SD). Nineteen patients with gastrointestinal carcinoma or Crohn's disease were investigated on admission. The mean value of their plasma CIG was 104.7 ± 26.9 (SD), which was not statistically different from the control subjects. Twelve of the patients received total parenteral nutrition (TPN) during the two preoperative weeks. The concentration of CIG was significantly increased after one and two weeks of TPN compared to the initial value. Six out of seven patients that postoperatively showed signs of infection had CIG values below 90% on admission. Of several other plasma proteins determined on admission, only a statistically significantly negative relationship to transferrin was found. CIG did not significantly relate either to the acute phase reactants, haptoglobin and orosomucoid, or to the visceral proteins albumin, choline esterase or prealbumin.
Reduced Metabolic Complications in Total Parenteral Nutrition: Pilot Study Using Fat to Replace One‐third of Glucose Calories
Authors: Meguid Michael M. , Schimmel Elihu , Johnson Willard C. , Meguid Victoria , Lowell Barbara Cohen , Bourinski James , Nabseth Donald C.
Published: May 2008

The limitations of glucose‐based TPN solutions are high glucose concentration, high osmolality, lack of fat, and essential fatty acids, which result in glucose intolerance and hepatotoxic effects. We replaced one‐third of the calories in a standard amino acid‐glucose solution with Liposyn 10% for 14 days in 23 critically ill men who needed total parenteral nutrition. Serial measurements included weight, albumin, glucose, triglyceride concentrations, and liver function tests. Serum osmolality was calculated, and found to remain constant. Body weight and serum albumin were maintained. Minor changes occurred in hepatic enzymes which were physiologically insignificant. Glycosuria occurred in 15%. Adverse side effects of hypoglycemia, hyperosmolar coma, and hypertriglyceridemia were avoided. Our results show that the addition of fat reduced glucose and hepatic related metabolic complications.
Selenium Status of Seven Chronic Intravenous Hyperalimentation Patients
Authors: Lane Helen W. , Barroso Alberto O. , Englert Deann , Dudrick Stanley J. , Macfadyen Bruce S.
Published: May 2008

Selenium status was determined on seven patients receiving long‐term intravenous hyperalimentation (IVH) and they were followed monthly for 4 to 17 months. Analysis of the IVH solutions for selenium revealed no detectable amounts. The selenium indices measured were (1) erythrocyte selenium levels, (2) erythrocyte glutathione peroxidase activities (GSH‐Px), and (3) plasma selenium levels. In general, the IVH population had significantly lower values (p < 0.001) for these selenium indices than a healthy population (n = 275). The plasma selenium levels decreased to below the normal range within one to two months after initiation of IVH. The below normal ranges varied by patient: three patients by three months, one patient by nine months, and three patients had low and normal values throughout the study. No consistent correlation of individual patient's erythrocyte GSH‐Px activities and erythrocyte selenium levels existed, but a positive correlation (r = 0.51, p < 0.01) occurred between plasma selenium levels and erythrocyte GSH‐Px activities. Thus, erythrocyte GSH‐Px activities decrease parallel to decreases in plasma selenium levels but not with changes in erythrocyte selenium levels. These data suggest that some of these IVH patients may be at risk for selenium deficiency and that selenium supplementation of IVH solutions may be required. Furthermore, these data suggest that the measurement of erythrocyte GSH‐Px activity or selenium levels in some IVH patients may not be related to available body selenium.
Body Weight Measurement of Patients Receiving Nutritional Support
Authors: Guenter Peggi A. , Moore Karen , Crosby Lon O. , Buzby Gordon P. , Mullen James L.
Published: May 2008

A review of patient records over a 14‐day period revealed that daily weights were recorded in only 65.5% of patients receiving parenteral nutrition and 53% of patients receiving enteral alimentation despite a hospital nursing practice requirement for daily weights during nutritional support. A semi‐structured questionnaire was given to staff nurses to elicit their opinions regarding the importance of weight obtainment and to ascertain their reasons why patients are not weighed. Of 74 staff nurses who completed the survey, 68% considered weights “very important” but only 34% believed this attitude to be prevalent among their co‐workers. The three reasons most often cited for failure to weigh patients were: (1) “patient too critically ill”; (2) “nurse felt other priorities of care existed; and, (3) ”patient refuses.” The two factors nurses most often felt should be changed to increase body weight measurement were “nurse staffing shortage” and “scales broken and/or unreliable.” This study documents a need for both logistical changes (eg, equipment availability and reliability and timing of patient weights) and educational changes at both nursing staff and patient level to improve compliance with established requirements for daily weights during nutritional support.
Nutrition and Protein Turnover: A Review
Authors: Stein T. Peter
Published: May 2008

The proteins of the body are continuously being broken down and resynthesized. This review discusses the physiological significance of this process, how it can be measured in patients, and how it is altered by malnutrition and various disease states.
Protracted Postpoliomyelitis Dysphagia Managed with Enteral Feeding and Cricopharyngeal Myotomy
Authors: Mamel Jay J.
Published: May 2008

A 52‐year‐old female with postbulbar poliomyelitis dysphagia and malnutrition was treated with enteral nutritional support resulting in improved deglutition. Subsequent cricopharyngeal myotomy resulted in a return to normal swallowing and maintenance of a normal nutritional status. Postpoliomyelitis dysphagia is reviewed.
Changes in Circadian Rhythmicity of Liver and Serum Parameters in Rats Fed a Total Parenteral Nutrition Solution by Continuous and Discontinuous Intravenous or Intragastric Infusion
Authors: Lanza‐Jacoby Susan , Sitren Harry S. , Stevenson Nancy R. , Rosato Francis E.
Published: May 2008

Circadian rhythms were assessed in rats (224–246 grams) receiving either an intragastric (IG) or intravenous (IV) infusion continuously (C), or IG or IV infusions discontinuously (D) from 0000 to 1400 hours daily. A control group was maintained on a stock diet ad libitum. IV‐ and IG‐fed rats were infused with 50 milliliters per day of a solution containing 25% dextrose and 4.25% amino acids plus vitamins and minerals. After 10 to 11 days, groups of rats were killed from each treatment every 6 hours over a 24‐hour period. Results showed that IG feeding promoted better growth and nitrogen retention than IV feeding. Rhythm patterns for liver weight, glycogen, and protein content were similar between D‐IG and D‐IV infused rats. All groups except the D‐IV fed rats exhibited fluctuations of serum insulin. A rhythm was not present for serum glucose in C‐IV fed rats and a rhythm was also absent for serum albumin in both C‐IV and D‐IV fed rats. C‐IV feeding increased serum glucose and insulin levels and decreased serum albumin levels in comparison to IG feeding. In comparison to the ad libitum‐fed, control rats, C‐IV or D‐IV or IG infusions led to alterations in liver and serum parameters.