bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Intravenous Administration of Travenol 10% Lipid Emulsion to Miniature Swine for 28 Consecutive Days
Authors: Izzo Rodger S. , Mieszala James , Woods Eugene , Larcker Sally , Remis William , Leissing Nancy 
Published: May 2008

The potential toxicity of Travenol 10% lipid emulsion was studied using miniature swine. Physiological (0.9%) saline, USP, was used as the control, and Intralipid 10% fat emulsion as the reference article. The emulsions were administered intravenously at dosages of 40 milliliters (approximately 4 grams of lipid) and 60 milliliters (approximately 6 grams of lipid) per kilogram of body weight per day to eight animals (four males and four females) in each treatment group on each of 28 consecutive days. The saline was administered to eight animals at 60 milliliters per kilogram per day. On day 29, one half of the male and female animals in each group were necropsied. The remaining pigs were observed and necropsied on either day 56 or 57. Toxicity was assessed on the basis of animal survival; changes in body weight, urinalyses, and hematological, and serum biochemical analyses; ophthalmological examination; gross pathology; and histopathology.The results obtained for the Travenol emulsion correlated well with those for the Intralipid emulsion. The emulsions were well tolerated, and they did not produce any major clinical signs of toxicity. All Travenol emulsion‐treated animals survived. In addition to demonstrating the similarity of Travenol and Intralipid emulsions, the results of this study indicate that the Travenol emulsion demonstrated an adequate margin of safety for prolonged administration. Travenol emulsion was well tolerated by miniature swine infused at about one and one‐half (40 milliliters per kilogram per day) and two (60 milliliters per kilogram per day) times the proposed clinical dose, and at three and two times the anticipated clinical rate, respectively.
Central Venous Alimentation: A Prospective Study of the Frequency of Metabolic Abnormalities Among Medical and Surgical Patients
Authors: Weinsier Roland L. , Bacon Jane , Butterworth C.E. 
Published: May 2008

Many studies have described the frequency of septic and technical complications of central venous alimentation (CVA), but metabolic complications of CVA have received scant attention.Among 100 consecutive medical and surgical patients receiving CVA under routine hospital conditions, at least one severe biochemical defect (above the 99th percentile ranking) was observed in 63 cases (63%). Uncontrolled hyperglycemia (defined as blood glucose >300 milligrams per deciliter after more than 48 hours of CVA) was present in 47 individuals. Hypophosphatemia (serum phosphorus <2.0 milligrams per deciliter) occurred in 30 and was life‐threatening (<1.0 milligrams per deciliter) in 6. Although liver function tests (LFT) remained stable or improved in 26% of the 34 evaluable subjects, 74% showed deterioration in one or more tests, and 35% showed deterioration in two or more tests. Deterioration was defined as an abnormal result that was 50% or more above baseline in patients having weekly LFT and CVA for a minimum of 10 days.The study involved 1378 patient‐days of CVA, a mean of 14 days per patient with a range of 2 to 70 days, and an average of 2.2 catheter insertions per patient. Technical complications occurred in 3% and septic complications occurred in 4% of 220 catheter insertions. There was no significant difference in the type or frequencies of metabolic, septic, and technical complications occurring between medical and surgical patients. The findings suggest that many reports concerning septic and technical complications of CVA have promoted awareness of the problem and served to minimize these risks. However, this study demonstrates that serious metabolic complications of CVA occur at an unexpectedly high rate and that greater attention should be directed at their prevention.
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.
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.
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.
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.
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.
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)
Fatty Acid Changes in Plasma Lipids and Lymphocyte Phospholipids after Infusion of Intralipid to Newborn Infants
Authors: Andersen G.E. , Christensen N.C. , Johansen K.B. 
Published: May 2008

The fatty acid composition of the major plasma lipids and blood lymphocyte phospholipids was studied in four patients before and after 1 month of parenteral nutrition including 2 to 3 g/kg/day of Intralipid fat and in four matched controls before and after 1 month of breast‐feeding. After treatment with Intralipid the concentration of polyunsaturated fatty acids including linoleic acid increased in all plasma lipids. The total concentration of polyunsaturated fatty acids in lymphocyte phospholipids did not change. The increase of linoleic acid and decrease of arachidonic acid in lymphocyte phospholipids were not statistically significant.In control infants the concentration of polyunsaturated fatty acids including linoleic and arachidonic acid in lymphocyte phospholipids increased after 1 month of breast‐feeding to almost the same values as in the patients. The study indicates that at least in lymphocytes the incorporation of polyunsaturated fatty acids is actively regulated. The present way of administering Intralipid does not seem to cause any abnormal fatty acid pattern of the plasma and lymphocyte lipids. The use of intravenous fat emulsion with high content of linoleic acid in term newborns should thus not be expected to result in changes of the physical‐chemical properties of membranes and membrane dysfunction. (Journal of Parenteral and Enteral Nutrition 9:691–694, 1985)
Bone and Mineral Status of Patients Beginning Total Parenteral Nutrition
Authors: Epstein Sol , Traberg Hans , Levine Gary , Mcclintock Ron 
Published: May 2008

Total parenteral nutrition (TPN) is commonly used to provide nutrition in the seriously ill. Osteomalacia has been described with long‐term TPN and the administered solutions and/or vitamin D metabolites have been blamed for the occurrence of osteomalacia. These studies however were performed on patients on long‐term TPN programs. We in contrast measured the serum calcium (Ca), ionized calcium (Ca2+), phosphate (Pi), bone GLA protein (BGP), alkaline phosphatase (ALK‐P), 25(OH)D, 1,25(OH)2D, the iPTH (carboxyl terminal) in 25 malnourished patients just beginning TPN therapy. The patients ranged from 25 to 80 yr of age and suffered from a variety of diseases. No patient had symptoms, recent fractures, or radiographic evidence of osteomalacia. The results of our study revealed significantly lower 25(OH)D (p < 0.001), Pi (p < 0.01), and Ca (p < 0.01), but higher iPTH (p < 0.002) values when compared to normals. BGP, 1,25(OH)2D and Ca2+ and ALK‐P were not significantly different.We conclude that patients requiring TPN have low serum 25(OH)D values reflecting their nutritional status with a compensatory increase in PTH secretion to maintain their serum Ca2+ levels. The normal BGP levels may indicate depressed bone formation and skeletal resistance to PTH in the very ill patient. The cause of osteomalacia in these patients may therefore be multifactorial and not only related to the TPN infusions. (Journal of Parenteral and Enteral Nutrition 10:263–264, 1986)
Total Parenteral Nutrition by a Nutrition Support Team: Improved Quality of Care
Authors: Traeger Sheldon M. , Williams Gary B. , Milliren Ginny , Young Dawn S. , Fisher Marianne , Haug Marcus T. 
Published: May 2008

Most of the studies that have examined the effect of nutrition support teams (NST) on the quality of total parenteral nutrition (TPN) have found reductions in the frequency of metabolic and central venous catheter related complications. Previous studies have not examined the patterns of nutrient delivery (eg, calories and protein) when TPN is provided either by a primary physician or by a NST. We compared the quality of TPN care provided by our NST or by primary physicians utilizing nonspecialized hospital personnel and resources. As expected, catheter complications were significantly less frequent in NST patients. Assessment of nutritional status and nutrient requirements as well as nitrogen balance were performed and documented significantly more often in NST patients. In addition, nutritional goals for calories and protein were achieved and positive nitrogen balance documented more often in NST patients.The need to consult the NST physician to utilize the NST was not well received by primary attending and resident physicians and resulted in nonuse of the team. In the future, modification of NST policies will be explored to encourage greater utilization of the NST without compromising the high standard of nutrition care delivered by the NST. (Journal of Parenteral and Enteral Nutrition 10: 408–412, 1986)