摘要:

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.

ISSN:0148-6071    

DOI:10.1177/0148607181005003189

出版商:SAGE Publications    

年代:1981

数据来源: WILEY

摘要:

The study examined the cause of, and relationship between, the increased rates of glucose utilization and amino acid release that are uniquely exhibited by skeletal muscle underlying the burn wound. Ether‐anesthetized rats were subjected to a 3‐sec one hind limb‐scald and 3 days later glucose and amino acid metabolism of soleus muscles from the burned and unburned limbs of burned rats as well as from controls was studied in vitro. Metabolism of the unburned‐limb muscle did not differ from control under any experimental conditions. In contrast, muscles from the burned limb took up to 3 times more glucose than controls in 10 mM glucose. Anoxia increased glucose uptake by all muscle groups but did not eliminate the relative enhancement exhibited by the burned‐limb muscles. Muscles from the burned limb also released 101% more alanine, 68% more glutamate, 110% more glutamine, and 163% more tyrosine in the presence or absence of medium glucose. With the exception of a uniform increase in glutamate release, anoxia did not alter amino acid releases by any muscle group. Inclusion of 1 mM iodoacetate in the glucose‐free medium reduced alanine release and raised glutamate release in all muscle groups, eliminating their relatively enhanced release by burned‐limb muscles. Iodoacetate markedly diminished glutamine release by muscles from the burned limb and caused a relatively depressed glutamine release by these muscles as compared to control. The fact that ATP‐MgCl2reversed the depressed release of glutamine by burned‐limb muscles suggests that cellular ATP is the limiting factor for glutamine synthesis by these muscles in iodoacetate. It is concluded that muscle hypoxia is only partially responsible for the increased glucose utilization by muscle from the burned region, and does not contribute to the augmented release of amino acids. The stimulated alanine release by muscle from the burned region does, however, appear to depend upon the increased pyruvate supply evident in these muscles.

ISSN:0148-6071    

DOI:10.1177/0148607181005003193

出版商:SAGE Publications    

年代:1981

数据来源: WILEY

摘要:

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.

ISSN:0148-6071    

DOI:10.1177/0148607181005003200

出版商:SAGE Publications    

年代:1981

数据来源: WILEY

摘要:

The effects of feeding elemental diets on small bowel structure and function in normal rats has been investigated, and two commercial diets Vivonex (#1) and Flexical (#2) compared. Rats were fed Diet #1 (n = 12) or Diet #2 (n = 12) for 1 month and jejunal and ileal histology compared with that of an equal number of rats fed on a normal pelleted diet. Diets #1 and #2 significantly increased villus height and decreased crypt height to villus height ratio in both jejunum and ileum (p<0.02 in all cases). Crypt height was also significantly reduced in the ileum but not jejunum by both elemental diets (p<0.05 in both cases). Segments of jejunum or ileum were perfused by an in vivo technique and water absorption measured to assess small bowel function. No significant difference in absorption was found between the rats fed Diet #1 and controls but absorption of water was depressed in both jejunum and ileum of those fed Diet #2. Small intestinal absorptive function is thus influenced by the composition of the elemental diet.

ISSN:0148-6071    

DOI:10.1177/0148607181005003204

出版商:SAGE Publications    

年代:1981

数据来源: WILEY

摘要:

A moderate elevation of blood sugar and a reduction of glucose tolerance occur in association with surgical trauma. This may be due to an increased release of glucose from the liver or a reduced peripheral uptake of glucose, or both. The present study was undertaken to investigate the peripheral exchanges of energy substrates. Twenty‐six patients undergoing cholecystectomy underwent turnover studies on blood‐borne energy substrates in the leg before, during, and immediately after surgery. Measurements of leg blood flow and femoral arteriovenous differences in oxygen, glucose, lactate, pyruvate, glycerol, β‐hydroxybutyrate, and alanine were made. After induction of general anesthesia, leg oxygen uptake decreased by 34%. Postoperatively, the oxygen uptake was 150% higher than the preanaesthetic level. During surgery, leg blood flow did not change significantly, but postoperatively it was increased by 50%. Arterial blood glucose concentration increased about 1 mmol/liter hr during the operation. Glucose uptake in the leg did not change significantly, although a large number of negative arteriovenous differences were obtained towards the end of surgery. Assimilated glucose was estimated to have accounted for 7% of the leg oxygen uptake before surgery. Toward the end of surgery, and in the immediate postoperative period, lactate release exceeded glucose uptake. During surgery, lactate and pyruvate release from the leg increased. Alanine release was also increased towards the end of the operation. As judged by the raised free fatty acids, glycerol, and β‐hydroxybutyrate levels, lipolysis was stimulated during surgery. There was a correlation between leg uptake and arterial concentration of β‐hydroxybutyrate. It is suggested that the increased lipolysis and increased uptake of β‐hydroxybutyrate contribute to the low glucose utilization during surgery.

ISSN:0148-6071    

DOI:10.1177/0148607181005003207

出版商:SAGE Publications    

年代:1981

数据来源: WILEY

摘要:

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 whom125I‐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.

ISSN:0148-6071    

DOI:10.1177/0148607181005003215

出版商:SAGE Publications    

年代:1981

数据来源: WILEY

摘要:

Oral food tolerance is compromised by drug and radiation therapy administered to patients undergoing bone marrow transplantation for hematological malignancy or aplastic anemia. Resultant decreases in oral fat intake coincident with fat‐free parenteral nutrition may predispose patients to essential fatty acid (EFA) deficiency. Determinations were made of the fatty acid composition of plasma total lipid from 20 bone marrow transplant patients on admission, at the time of bone marrow transplant, and on days 7, 14, 30, and 60 post‐bone marrow transplant. Patients ate ad libitum but with little appetite and received fat‐free parenteral nutrition interrupted for numerous blood product and drug infusions. Abnormal EFA status was manifest (20:3ω9/20:4 ratio>0.2) in 12 of 20 patients during the course of treatment. Plasma EFA status was consistently correlated with oral fat intake but not with sex, age, percentage of ideal body weight, or amount of plasma infused. This suggests that dietary fat was absorbed limiting the severity of EFA deficiency. Interruptions of glucose infusion averaging only about 2 hours/day, also may have helped moderate the deficiency.

ISSN:0148-6071    

DOI:10.1177/0148607181005003221

出版商:SAGE Publications    

年代:1981

数据来源: WILEY

摘要:

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.

ISSN:0148-6071    

DOI:10.1177/0148607181005003226

出版商:SAGE Publications    

年代:1981

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/0148607181005003230

出版商:SAGE Publications    

年代:1981

数据来源: WILEY

摘要:

A new 20% safflower oil fat emulsion was compared with its 10% counterpart in a small series of pediatric patients. Five infants and children, studied for a 2‐week period, received either the 10% or 20% emulsion for 1 week and the other emulsion the 2nd week. No serious toxicity or side effects were noted in any of the patients following the infusion of either emulsion. In addition, significant weight gain was noted in the children, and clinical improvement was apparent in all cases. This preliminary study suggests that the 20% Liposyn is as safe and effective as its 10% counterpart.

ISSN:0148-6071    

DOI:10.1177/0148607181005003236

出版商:SAGE Publications    

年代:1981

数据来源: WILEY