摘要:

It has been suggested that malnourished patients respond to glucose intake in excess of energy needs by a rise in respiratory quotient (RQ) above 1.0, indicating net fat synthesis. This would represent inefficient utilization of glucose as an energy source. It is unclear, however, whether this also occurs when some of the energy source is provided as a fat emulsion.Energy expenditure was measured by indirect calorimetry using a canopy hood and RQ, calculated from the analysis of 2 X 5 minute collections of expired air, were measured every 3rd day in two groups of surgical patients who received a 14‐day course of intravenous nutrition [total parenteral nutrition (TPN)]. Group I (mean ± 1 S.D. 57.4 ± 15.4 yers, 9 females, 3 males) received glucose as the only source (46.6 ± 9.2 kilocalories per kilogram per day and group II (55.8 ± 14.2 years, 5 males, 3 females) 60% of their calories as fat (44.0 ± 7.5 kilocalories per kilogram per day). Both groups were given similar amounts of crystalline amino acid solution (0.34 ± 0.007, 0.32 ± 0.005 gram nitrogen per kilogram per day, respectively) and no other intake. There was no significant difference between the groups mean values of body weight (52.3 ± 7.9 versus 57.9 ± 12.5 kilograms) or energy expenditure before TPN commenced (31.3 ± 6.5, 32.3 ± 3.0 kilocalories per square meter per hour). In group I there was a persistent elevation (p<0.001) of mean RQ above 1.0 from the 9th day of TPN, together with a significant increase (p<0.001) in mean energy expenditure which attained the value of 38.0 ± 4.8 kilocalories per square meter per hour on the 14th day. In group II, the mean RQ never exceeded 1.0. The rise in the mean expenditure in group II was significantly less (p<0.02) than that observed in group I.This study shows that the use of glucose as the only energy source during TPN is associated with a greater rise in energy expenditure than is observed with a glucose‐fat regime and a persistent elevation of RQ above 1, indicating net lipogenesis. These results suggest, therefore, that complete oxidation of glucose occurs when it is the only source of nonprotein calories given during TPN.

ISSN:0148-6071    

DOI:10.1177/014860718300700101

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

Simultaneous infusion of glucose and Intralipid was carried out on dogs to evaluate the effect of glucose on utilization of the fat emulsion. For control experiments, normal saline was used in place of glucose. Results of these studies revealed that clearance of Intralipid and also of triglyceride and free fatty acid (FFA) from the plasma did not differ between the dogs receiving glucose and those receiving saline infusion. The rates of Intralipid clearance were 0.049 ± 0.003 and 0.047 ± 0.003 per minute (n = 16), respectively. Study with radioactive [14C]Intralipid also gave similar rates of14C clearance from the plasma, 0.037 ± 0.003 and 0.040 ± 0.003 per minute (n = 4), respectively for the two groups. These suggested that clearance of Intralipid from the plasma was not affected by glucose. However, data on expired14CO2revealed that oxidation of the fat, which yielded CO2as end product, was inhibited by glucose. The amount of14CO2expired in 2 hours was 10.4 ± 1.4% for the saline group, which was significantly reduced to 3.0 ± 0.4% (n = 4; p<0.01) for the glucose group. In each group, CO2production was much delayed as compared to fat clearance from the plasma. Thus, the rate of clearance of Intralipid from plasma does not reflect the actual utilization of fat emulsion. In accordance with an experiment with insulin, it appears that suppression of CO2production is directly related to plasma insulin levels.

ISSN:0148-6071    

DOI:10.1177/014860718300700106

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

The ward delivery of fat‐soluble vitamins in parenteral nutrition solutions was simulated in a laboratory situation. Radioactively labeled vitamins A, D, and E were used in tracer studies to follow their nonradioactive counterparts during addition to a parenteral solution and subsequent passage through a standard infusion set. Using this quick convenient method, it was possible to monitor delivery over an entire 24‐hour infusion period. Average recovery for vitamins A, D, and E was 31%, 68% and 64%, respectively. From comparison of various sampling sites during the experimental period, it seems clear that the fat‐soluble vitamins appear to adhere to the bag and tubing. In light of these findings, we suggest a reexamination of the method of solubilization of fat soluble vitamins and of the materials used in the manufacture of clinical infusion equipment.

ISSN:0148-6071    

DOI:10.1177/014860718300700111

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

The relationship of baseline nutritional test values to clinical outcome was prospectively studied in 55 consecutive surgical and critically ill patients referred for nutritional support. Eight nutritional tests were evaluated with respect to their ability to discriminate between patients who had major septic complications (MSC) and/or died, and patients who survived (without MSC). Our results show that a value of serum albumin (SA) less than 3.0 grams per deciliter had the best predictive accuracy for outcome (PPA) of the single tests (PPA = 76%, s = 0.86, f = 0.82), correctly separating 84% of the patients into the outcome groups. The combination of SA less than 3.0 grams per dl and serum transferrin (ST) less than 175 milligrams per deciliter had excellent ability to predict risk in patients deficient in both proteins (PPA = 77%, s = 1.0, f = 0.88, % correctly classified = 91%). The delayed cutaneous hypersensitivity (DCH) test was not useful for identifying high‐risk patients (s = 0.44,f= 0.88). The four‐variable discriminant function which described our data (1.17 SA + 0.012 ST — 0.061 triceps skinfold (TSF) — 0.75 DCH — 4.33) was compared with a two‐variable function (1.20 SA + 0.013 ST — 6.43) generated from the same data. Either function correctly classified 88% of the patients (PPA = 79%, s = 0.94, f = 0.85). Multiple regression analysis showed that the four‐variable and two‐variable functions contributed 54 and 51%, respectively, to the outcome, indicating that, in the presence of SA and ST, TSF and DCH were, for practical purposes, redundant. Our results suggest that, of the commonly employed nutritional tests, only SA and ST, used in the context of the weighted index, have sufficient discriminating ability to justify their use in nutritional evaluation.

ISSN:0148-6071    

DOI:10.1177/014860718300700115

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

In order to assess the metabolic efficacy of cyclic nocturnal parenteral nutrition (C‐TPN) in hospitalized patients, a prospective study was carried out with 14 patients having a protein calorie malnutrition due to severe gastrointestinal diseases. Patients population was divided into two groups: one group received 1 milligram per kilogram per day of prednisolone with induced hypercatabolism (n = 4); the second group was not under corticosteroid therapy (n = 10). Patients selected for the study were unaffected by cardiac, hepatic, renal or pulmonary failure, diabetes or bacteriemia. C‐TPN was compared to standard or continuous TPN (S‐TPN) and each type of TPN was 1 week with 24 hours between change over. During C‐TPN, parenteral perfusion was discontinued for 9.1 ± 0.4 hours per day (mean ± SEM). Intravenous regimens were strictly the same during C‐TPN and S‐TPN and provided 192 ± 10 milligram nitrogen per kilogram per day plus mixed energy‐sources equivalent to 50 ± 2 kilocalories per kilogram per day with a glucose‐fat emulsion ratio of 50 ± 5%. Metabolic data for each period included weight, serum albumin and transferrin changes, protein breakdown as estimated by measurement of urea production rate and lean body mass gain estimated from determination of total nitrogen balance. In corticosteroid‐induced hypercatabolic patients, C‐TPN provides visceral protein gain equal to S‐TPN and halves the water‐energy deposits observed during S‐TPN, but is less effective than S‐TPN for decreasing protein breakdown and achieving lean body mass gain. Inversely, in mildly catabolic patients, C‐TPN provides visceral protein and lean body mass gains which are similar to those achieved with S‐TPN; C‐TPN, however, halves the water‐energy deposits when compared to S‐TPN. From these data, C‐TPN can be proposed as an optimal therapy in mildly or uncatabolic patients who do not have severe energy depletion.

ISSN:0148-6071    

DOI:10.1177/014860718300700121

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

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.

ISSN:0148-6071    

DOI:10.1177/014860718300700126

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

Long‐term administration of Intralipid to infants raises the potential risk of cumulative hyperlipemia. The elimination of lipoproteins from the blood during 3 hours of Intralipid infusion (0.33 grams per kilogram per hour) was investigated in five term infants during two infusion periods without and with heparin. A single intravenous injection of heparin (100 micron per kilogram) preceded the period of Intralipid infusion. During the nonheparin periods levels of triglycerides (L‐particles) rose progressively to 1320±133 milligrams per 100 milliliters plasma, whereas during the heparin periods levels rose more moderately and peaked at 636±107 milligrams per 100 milliliter plasma (p<0.001–0.05). The study suggests that the heparin effect is still apparent for a period of 6 hours and repeated bolus injections may keep triglyceride levels at approximately normal concentrations during constant Intralipid infusion (0.166 grams per kilograms per hour).

ISSN:0148-6071    

DOI:10.1177/014860718300700137

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

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 with51Cr EDTA. Sodium flux was determined by radioactive22Na 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.

ISSN:0148-6071    

DOI:10.1177/014860718300700140

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

The effects of total parenteral nutrition were studied in two anuric neonates and an anuric infant. Based on the observations of urea production, nitrogen balance, and serum osmolality, the bulk of the infused nitrogen appeared to be incorporated into the body proteins. The need for potassium, calcium, phosphorous, and magnesium substitution was also indicative of net anabolism. Despite effective utilization of the amino acids, high plasma levels of phenylalanine and methionine, and extremely low levels of the urea cycle intermediates were measured. We conclude that the application of carefully planned parenteral nutrition may aid in the management of newborns with failing kidneys and that it influences considerably the indications of dialysis in early infancy.

ISSN:0148-6071    

DOI:10.1177/014860718300700145

出版商:SAGE Publications    

年代:1983

数据来源: WILEY

摘要:

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.

ISSN:0148-6071    

DOI:10.1177/014860718300700150

出版商:SAGE Publications    

年代:1983

数据来源: WILEY