ISSN:0148-6071    

DOI:10.1177/0148607184008002113

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

Phosphate supplementation during total parenteral nutrition (TPN) is essential to prevent hypophosphatemia but individual phosphate requirements vary. We reviewed 68 courses of TPN in 61 patients to determine the incidence of hypophosphatemia and to identify factors which indicate a need for additional phosphate supplementation. Eight (12%) patients were hypophosphatemic before initiation of TPN. Sixty (88%) patients were normophosphatemic when TPN was initiated and 25 (42%) became hypophosphatemic. Of these 60 patients, 20 (38%) of 52 patients became hypophosphatemic when supplemented with 13.6 mMphosphate/ liter or more, whereas five (63%) of eight patients became hypophosphatemic when supplemented with only 6.8 mMphosphate/liter TPN fluid. More hypophosphatemic patients required insulin during TPN (48 υs 26%), were initially hyperglycemic (24vs9%), were alcoholic by history (24vs11%), had evidence of chronic weight loss (64vs46%), and had a history of recent diuretic (40vs23%) or antacid therapy (56vs43%). Hypophosphatemia occurs frequently after initiation of TPN therapy despite phosphate supplementation. Provision of 13.6 mEq phosphate/liter prevents hypophosphatemia in most patients. However, patients who are hyperglycemic, require insulin during TPN, or have a history of alcoholism, chronic weight loss, or chronic antacid or diuretic therapy may require greater supplementation to prevent the development of hypophosphatemia. Chronically malnourished patients require a slower initial rate of infusion as well.(Journal of Parenteral and Enteral Nutrition8:137–139, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008002137

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

A study was performed comparing the elimination kinetics of two soybean oil/egg phosphatide lipid emulsions (10% Travamulsionυs10% 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 Nutrition8: 140–145, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008002140

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

A two part, prospective study was undertaken to establish the existing frequency of total parenteral nutrition‐(TPN) related mechanical, metabolic, and septic complications in an institution with a consultative TPN team (group A) and to determine if increasing the involvement of the TPN team in patient monitoring and verifying adherence to TPN infection control guidelines would reduce the incidence of these complications (group B). The initial 28 consecutive patients were managed entirely by their primary physicians with the role of the TPN team limited to consultative activities while the next 29 patients receiving TPN were managed jointly by their primary physicians and the TPN team. Analysis of the results show group B to have a significant reduction in metabolic complications, decreased incidence of mechanical abnormalities, and approximately equal incidences of documented sepsis. However, when compared to the results of an institution in which the TPN team has complete control of TPN therapy, even the group B patients had a relatively excessive number of TPN‐related complications especially in the categories of mechanical and metabolic abnormalities. Thus, consultative TPN teams do not necessarily ensure optimum TPN therapy and institutions using this approach to provide nutrition parenterally must be prepared to establish the incidence of TPN‐related complications and to expand the involvement of the TPN team as required to control the frequency of these anomalies.(Journal of Parenteral and Enteral Nutrition8:146–152, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008002146

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

Herein we describe a methodology which can be used to evaluate the predictive accuracy of nutritional assessment techniques. We use this methodology to compare seven techniques of nutritional assessment in terms of their ability to predict one nutrition associated hospital complication (infection) by dividing a sample of 59 surgical patients into high risk and low risk groups. One technique was subjective global assessment (SGA) of the patient's nutritional status on admission to hospital. Five techniques were single objective measurements (albumin, transferrin, delayed cutaneous hypersensitivity, anthropometry, and creatinine‐height index). The 7th technique was the prognostic nutritional index. The best combination of sensitivity (0.82) and specificity (0.72) was found with SGA. The second best combination (0.88 and 0.45) was found by using either the prognostic nutritional index or creatinine‐height index. We also found that combining the five objective measurements with SGA into a single index did not increase the discriminatory (or predictive) power over that of SGA alone in a clinically significant way. We conclude that a larger study comparing these approaches should be undertaken to confirm these findings and to develop methods which improve the predictive properties of SGA.(Journal of Parenteral and Enteral Nutrition8:153–159, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008002153

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

The tolerance of 20% Travamulsion intravenous fat emulsion (Travenol Laboratories, Inc., Deerfield, IL) was studied using male beagle dogs. Physiologic (0.9%) saline, USP, was used as the control, and 10% Travamulsion Intravenous fat emulsion (Travenol Laboratories) as the reference article. The 20 and 10% emulsions were administered intravenously to each of eight animals for 91 days at 20 and 40 ml/ kg/day, respectively. These dosages were administered over 4 hr and they correspond to approximately 4 g of lipid as soybean oil per kilogram of body weight. The saline was administered to eight animals at 40 ml/kg/day. On day 92, one‐half of the animals in each group were necropsied. The remaining dogs were observed and necropsied on day 122. Toxicity was assessed on animal survival; changes in body weight, urinalysis, and hematologic, and serum biochemical analyses; ophthalmologic examination; gross pathology; and histopathology. The results obtained for the 20% Travamulsion fat emulsion correlated well with those for the 10% Travamulsion fat emulsion. The emulsions were well tolerated and all animals survived and gained weight. The 20% Travamulsion fat emulsion administered provided about 45% of the total caloric requirement of the dog, which is equal to an often used clinical dose. However, caloric administration in the form of lipid emulsion in relation to total energy required was performed at three to six times the indicated clinical rate. In addition to demonstrating that it is safe for prolonged administration, the 20% Travamulsion fat emulsion offers an advantage over the 10% Travamulsion fat emulsion in providing the same amount of calories because it produces lower serum levels of phospholipid, cholesterol, and triglyceride, and the volume of emulsion required is reduced.(Journal of Parenteral and Enteral Nutrition8:160–168, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008002160

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

The responses to an exogenous lipid challenge of nonhypermetabolic surgical patients requiring parenteral nutrition and seriously ill septic patients were compared. All patients received a 500‐ml intravenous infusion of a 10% lipid emulsion over a 4‐hr period. An early elevation of glycerol and triglyceride was noted during the infusion suggesting chylomicron fractionation. Peak triglyceride levels were higher in the septic group but the rate of lipid clearance appeared essentially identical in both septic and nonseptic patients. Lipoprotein lipase levels remained constant and were equal for both groups. Significant late ketone body production was statistically identical in both groups despite depressed albumin levels in the septic group suggesting adequate hepatic ketogenic capacity in septic as well as nonseptic patients.(Journal of Parenteral and Enteral Nutrition8:169—173, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008002169

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

Leukocyte endogenous mediator (LEM), a protein produced by phagocytizing cells, plays a critical role in the metabolic response to injury and infection. There is an important interaction between protein‐calorie malnutrition and the capacity of cells to produce LEM, since severely malnourished or severely stressed individuals, have a reduced capacity to produce LEM. The leukocytes of 10 mildly to moderately malnourished patients undergoing elective major surgery, a moderate stress, had an intact ability to produce LEM on preoperative assessment. This ability was not affected by a 5‐day postoperative period of hypocaloric nutrient intake despite a significant loss of body protein in one‐half of the patients and a significant fall in serum protein concentrations. These results suggest a high biologic priority for LEM production during the metabolic response to injury and for infection.(Journal of Parenteral and Enteral Nutrition8:174–177, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008002174

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

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 (p160 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 Nutrition8:178–180, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008002178

出版商:SAGE Publications    

年代:1984

数据来源: WILEY

摘要:

Studies of care of patients with central venous catheters report a 3–7% incidence of catheter‐induced sepsis when sterile gauze and tape are used as an occlusive dressing. The technique requires that the dressing be changed three times each week for catheterization site inspection. From June 1979 to September 1980, a noncomparative evaluation of a transparent, self‐adhesive, polyurethane dressing which is permeable to water vapor but not bacteria was performed. This dressing was used for the care of 100 consecutive patients with central venous catheters. Dressing life averaged 5.3 days with silicone rubber catheters and 4.3 days for polyvinyl chloride catheters. One patient developed catheter induced sepsis (incidence 1%). This dressing material: (1) is acceptable for use as a dressing of central venous catheters; (2) continuously permits inspection of the insertion sites; (3) decreases nursing hours; (4) provides a comfortable dressing which secures the catheter to the patient; and (5) is durable even when exposed to high humidity therapy devices, or when possible permits the patient to take showers.(Journal of Parenteral and Enteral Nutrition8:181–186, 1984)

ISSN:0148-6071    

DOI:10.1177/0148607184008002181

出版商:SAGE Publications    

年代:1984

数据来源: WILEY