摘要:

A modular tube feeding recipe (MTF) was designed to meet the unique nutritional needs of burn patients, applying principles previously documented in our burned guinea pig model. MTF, a high‐protein, low‐fat, linoleic acid‐restricted formulation is enriched with omega‐3 fatty acids, arginine, cysteine, histidine, vitamin A, zinc, and ascorbic acid. Fifty patients, 3 to 76 years of age with burns ranging from 10 to 89% total body surface area were prospectively randomized into three groups which blindly compared MTF to two enteral regimens widely utilized in the nutritional support of burns. Age, percent total and third‐degree burn, resting energy expenditure, and calorie and protein intake were similar in all groups. Data analysis demonstrated significant superiority of MTF in the reduction of wound infection (p<0.03) and length of stay/percent burn (p<0.02). MTF was also associated with a decreased incidence of diarrhea, improved glucose tolerance, lower serum triglycerides, reduced total number of infectious episodes and trends toward improved preservation of muscle mass, although statistical significance was not achieved. Seventy percent of deaths occurred in the group supported with an inherently large dose of fat and linoleic acid. Combining these observations, it is believed that MTF is effective in modulating an improved response to burn injury.(Journal of Parenteral and Enteral Nutrition14:225–236, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014003225

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

To evaluate the efficacy of supplemental arginine with nutritional support in the presence of sepsis, eighty‐eight gastrostomized female Hartley guinea pigs were implanted with osmotic pumps effusing anEschericia coli/Staphylococcus aureusmixture. Animals were randomized and infused for two weeks with isocaloric and isovolumetric diets containing 0%, 2%, 4%, or 6% supplemental arginine as arginine hydrochloride. Survival was 12/22 (54%) in 0%, 9/22 (41%) in 2% and 4%, and 2/22 (9%) in 6%. Analysis by chi‐square test of independence was significant (p= 0.0141) with 6% survival lower than the others. Median survival was 11 days in 0%, 8 days in 2% and 6%, and 9 days in 4%. Median survival was longer in 0% than in 2% or 6% (Kruskal‐Wallis ANOVA:p= 0.02). Nitrogen balance was significantly lower in 6% compared to 0% on days 2 through 10, and lower than 2% and 4% on days 6 and 9. Nitrogen balance was higher in 0% than in 2% on days 4, 6, 10, and 13. Serum albumin and C3were lower in all experimental groups than normal controls (ANOVA: p = 0.01). Comparison of liver, spleen, adrenals, gastrocnemius, and carcass weights, cell‐mediated immunity as determined by contact sensitivity to DNFB, and transferrin showed no significant differences. There was a positive dose‐response effect seen amongst the experimental groups for the amino acids arginine, ornithine, and citrulline in relation to the amount of supplemental arginine. This study suggests that dietary arginine supplementation does not enhance survival in a guinea pig model of established peritonitis. (Journal of Parenteral and Enteral Nutrition14:237–244, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014003237

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Ketone bodies are an important metabolic fuel for the gastrointestinal system and as a consequence may promote colonic healing. Ketone bodies and glucose were compared in a dose dependent manner as nonprotein fuels for support of resected colon. Rats had their descending colons resected and received all nutrients by vein for 5 days postoperation. Colonic healing was evaluated from the air pressure required to break the wound. All rats received constant nutrients except for non‐protein energy which was fed at 10.5, 21, 31.5, and 42 kcal/day using either glucose or monoacetoacetin as substrate. Colonic bursting pressure was measured on day 5 after surgery. When energy intake was 21 kcal/day or greater, the bursting pressure was two‐thirds of nonwounded tissue and was independent of energy quantity and source. At 10.5 kcal/ day, bursting pressure for glucose‐fed animals was similar to that for animals with no added nonprotein energy while, in contrast, bursting pressure for animals fed monoacetoacetin was similar to that for animals fed 42 kcal/day. It was concluded that bursting pressure was influenced by dietary intake only if the energy intake was sufficiently low, and then ketone bodies were better than glucose for support of colonic healing.(Journal of Parenteral and Enteral Nutrition14:245–249, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014003245

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Feeding animals a diet high in linoleic acid for 7 days had no effect on thein vitroproduction of PGE2by unstimulated macrophages. Feeding animals the high linoleic acid diet for 30 days greatly increased the production of PGE2by macrophages when they were unstimulated, but decreased the production of PGE2when they were stimulated with LPS. Feeding animals a diet high in linoleic acid for 30 days increased the production of TxB2by macrophages when they were unstimulated, but decreased the production of TxB2when they were stimulated. Normal, unstimulated splenic macrophages produced almost 80 times more TxB2than PGE2. However, when the macrophages were stimulated the ratio decreased to six or less because of a greater increase in PGE2production. The high linoleic acid diet did not inhibit the antibody dependent cellular cytotoxicity of macrophages.(Journal of Parenteral and Enteral Nutrition14:250–254, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014003250

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Plasma carnitine levels were determined in 17 patients maintained on long‐term total parenteral nutrition (TPN) for a mean (±SEM) period of 69 ± 11 months (range 12–196). All had severe malabsorption and were dependent on intravenous feeding. Plasma carnitine was determined by a modified Cederblad enzymatic method. Mean plasma carnitine was significantly below the mean normal for females (p<0.02) and borderline low for males (p= 0.07). In six patients the levels were below the low normal range, and in five others they were at the lowest levels of normal. Of the six patients with normal levels, three had elevated serum creatinine, indicating renal dysfunction which may by itself elevate plasma carnitine. In 10 patients the plasma levels of lysine (a carnitine precursor) were determined and found to be lower than normal (p<0.05). Plasma carnitine levels correlated positively with serum albumin (r= 0.62, p<0.05), and negatively with serum alkaline phosphatase (r= ‐0.64, p<0.05). Thus, patients maintained on long‐term TPN may have low plasma carnitine, which could represent carnitine deficiency. The low plasma carinitine may be related to a deficiency of the carnitine precursor lysine. Further studies are required to determine the significance of the low plasma carnitine and whether carnitine supplementation should be required in long‐term TPN.(Journal of Parenteral and Enteral Nutrition14:255–258, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014003255

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Two portable metabolic cart systems of indirect calorimetry (Deltatrac Metabolic Monitor, 2900 MMC System) were validated. CO2and N2were delivered at precise rates into a constructed lung model to simulate CO2production (VCO2) and O2consumption (VO2). VCO2(200–400 ml/min) and VO2(250–750 ml/min) were measured at varying combinations of minute ventilation (VE) (6, 10, 20 liter/min) and FiO2(0.21, 0.30, 0.60, 0.80). VCO2was measured with overall errors of 1.5% and 2.4% for the Deltatrac and 2900 monitors, respectively. VO2was measured with overall errors of 1.9% and 3.2% by the Deltatrac and 2900 monitors, respectively. Both monitors performed equally well for measurement of VO2at FiO2up to 0.6, but the Deltatrac had less error for measurements of VO2at FiO2of 0.8.(Journal of Parenteral and Enteral Nutrition14:259–261, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014003259

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Insulin is frequently required in total parenteral nutrition (TPN) solutions to control hyperglycemia. The purpose of this study was to evaluate the recovery of human insulin from standard TPN solutions with and without lipids and from TPN solutions with specialized amino acid formulations and to compare it to the insulin recovery from normal saline.All solutions were mixed in currently utilized PVC‐free bags (ethylene vinyl acetate) and drained through PVC‐containing tubing. Human insulin (Humulin‐R) was spiked with125I‐labeled insulin and then added in concentrations of 10, 25, and 50 units to 1‐liter bags containing 39‐g amino acids (10% Freamine‐III; or 6.9% Freamine HBC; or 8% Hepatamine), 257‐g dextrose, electrolytes (Hyperlyte‐R), 1000 units of heparin, MVI‐12, and MTE‐5 Concentrate. Alternate sets of bags contained 125 ml of 20% Intralipid and an appropriate amount of sterile water to keep the final volume at 1 liter. Actual clinical conditions of preparation, storage, and administration were simulated in thisin vitroexperiment. Multiple samples were collected during the 8‐hr infusion period directly in gamma counter vials. All experiments and assays were done in triplicate.Our findings indicate that human insulin availability in TPN solutions is much higher (90%‐95%) than the 50% suggested in the literature. Insulin recovery was not appreciably altered by adding lipids or by using Freamine HBC. Insulin recovery from TPN solutions was significantly reduced if they contained Hepatamine (87% and 88%,p<0.05) as compared to Freamine (90% and 94%). In comparison, insulin recovery from normal saline was 65% (p<0.001) and, accordingly, insulin binding to the infusion materials was significantly greater than with TPN solutions.(Journal of Parenteral and Enteral Nutrition14:262–264, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014003262

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Adequate enteral nutritional support is often limited by gastrointestinal (GI) side effects. In this pilot clinical trial we compared an enteral nutrition formula based on soy hydrolysate (study formula, SF) against a widely used intact casein formula (control formula, CF) for the incidence of GI side effects in a completely randomized double blind design. Twenty‐three nonsurgical hospitalized patients requiring enteral nutritional support and free of GI symptoms were randomly assigned to receive either the CF or the SF for 6 days continuously. Both formulas were isotonic, low in residue, lactose free and isocaloric, but differed in the type and concentration of protein and the concentration of medium‐chain triglycerides. After randomization both groups were comparable in demographic characteristics, and nutritional status, but there were more patients on antibiotics in the CF group. The amount of formula infused per day and the route of administration were equivalent. The number of bowel movements per day was 1.0 ± 0.5 for the CF group and 0.6 ± 0.3 for the SF group (p<0.05). The incidence of diarrhea was 10.8% days for the CF group and 6.2% for the SF group (p= NS). High gastric residuals occurred in 16.9% of days in the CF group and 3.3% in the SF group (p<0.05). Vomiting incidence was 10.8% in the CF group and 1.5% in the SF group (p<0.05). After adjustment for the use of antibiotics as a covariate, the differences in number of bowel movements, vomiting and incidence of high residuals became less significant (p<0.10). No differences were found among groups in other digestive or mechanical complications and no significant change occurred in nutritional or metabolic status during the study. The nitrogen retention per gram of nitrogen intake was similar for both groups and the soy based formula produced a state of positive nitrogen balance similar to the casein‐based formula. We believe that further studies with larger sample sizes are needed to clarify clinical advantages to soy hydrolysate formulas.(Journal of Parenteral and Enteral Nutrition14:265–269, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014003265

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Ten adult, male, nonambulant and gastrostomy‐fed individuals had received commercially available enteral feedings containing negligible amounts of selenium, carnitine, and taurine for an average of 59 months. Blood levels of these three nutrients were below published normal ranges as were the urinary excretions of carnitine and taurine. After 9 weeks on a product that was fortified with 23 μg of selenium, 39 mg of carnitine, and 38 mg of taurine per 8 ounces, blood levels were significantly increased with the levels of selenium and carnitine being normalized.(Journal of Parenteral and Enteral Nutrition14:270–274, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014003270

出版商:SAGE Publications    

年代:1990

数据来源: WILEY

摘要:

Significant decreases have been reported in phenytoin absorption when the suspension is combined with continuous enteral feedings. Several theories for this interaction have been proposed including binding of phenytoin to the protein constituents of the enteral formula, phenytoin binding to the calcium in the enteral formula, and inadequate dissolution of the suspension when delivered with the enteral formula due to the high pKa of phenytoin and the acidic nature of the enteral formula. We therefore evaluated the effects of pH levels 2.0, 3.5, 6.0, and 8.0 on the interaction of phenytoin suspension with enteral formula (Osmolite) with equilibrium dialysis using a Spectra/Por 1 (MWCO 6000–8000) molecularporous dialysis membrane. Phenytoin concentrations in the dialysis membrane (internal phase) mimicked the expected stomach concentrations of a 100‐mg dose administered in an adult stomach containing 200 ml of gastric fluid. External phase buffers were sampled at 0.5, 1.0, 2.0, 4.0, 8.0, 12.0, and 24.0 hr after the start of the dialysis. The phenytoin concentrations in the external phase were compared between buffer alone or buffer combined with enteral formula at the same pH and time intervals. With pH 2.0 and 3.5 the enteral formula formed an aggregate with suspension whereas no aggregate was formed with pH 6.0 and 8.0. The phenytoin concentrations with pH 2.0 were 26% to 44% lower and with pH 3.5 were 11.5 to27%lower when phenytoin suspension was combined with enteral solution. However, at 24 hr there was no difference between the two conditions with both pH 2.0 and 3.5. With pH 6.0 there was a significant difference at 24 hr and with pH 8.0 significant differences were reached only at 0.5, 1.0 and 2.0 hr. These results show that the phenytoin suspension/enteral formula interaction is pH dependent. There appears to be a physical entrapment of the large suspension particles when the protein in the enteral solution denatures at lower pH's. These results may in part explain the decreased erratic absorption when phenytoin suspension is combined with enteral feedings.(Journal of Parenteral and Enteral Nutrition14:275–278, 1990)

ISSN:0148-6071    

DOI:10.1177/0148607190014003275

出版商:SAGE Publications    

年代:1990

数据来源: WILEY