Glucose in parenteral nutrition: a survey of U.S. medical centers.

Background: A previous report suggested that glucose administration in total parenteral nutrition (TPN) should not exceed 4 mg/kg/min with a respiratory quotient (RQ) >1.0. This rate would not be exceeded, in most patients, with a TPN glucose concentration of 15%.

Bowel necrosis caused by water in jejunal feeding.

Background: Fifteen reports of bowel necrosis in patients receiving jejunal feeding have been reported. Etiology remains unexplained.

Methods: A patient with a 60% burn receiving jejunostomy tube feeding developed hypernatremia and was given distilled water in the jejunum, 400 mL every 2 hours.

Electronic parenteral and enteral nutrition.

Background: With reports of deleterious effects of total parenteral nutrition (TPN) in adults in addition to our surveys, which indicated that 1/4, and as many as 1/2, of US academic medical centers were using excess glucose in TPN, our objective was to devise a computer program to optimize nutrients in parenteral and enteral nutrition in adult and pediatric patients.

Methods: From review of the literature, body composition, including total body water and body cell mass (BCM), were calculated from large published databases. A computer program, based on a previous algorithm, was developed to determine optimum parenteral and enteral nutritional support, based on calculated BCM as the reference.

Glutamine in the support of patients following bone marrow transplantation.

Bone marrow transplantation is being utilized with increasing frequency in the treatment of patients with malignancy; it is also being applied to the treatment of patients with genetic diseases and as an adjunct to solid organ transplantation. The high dose cytotoxic chemotherapy, often accompanied by total body irradiation, results in severe catabolism, disruption of the gastrointestinal mucosa and marked immunosuppression. A variety of studies show that the supplementation of the amino acid glutamine, by the enteral or parenteral route, as either the free or dipeptide form, appears safe and efficacious in patients undergoing bone marrow transplantation.

Oral and parenteral glutamine in bone marrow transplantation: a randomized, double-blind study.

Background: Total parenteral nutrition (TPN) supplemented with glutamine (GLN) has been reported to be effective for patients with bone marrow transplantation (BMT). Our aim was to evaluate enteral and parenteral glutamine in patients undergoing BMT.

Methods: For evaluation of GLN in BMT, 66 patients with 43 hematologic and 23 solid malignancies (21 breast carcinomas), were randomized, double-blinded, to either oral GLN (n = 35) or glycine-control (GLY) (n = 31), 10 g three times daily.

Patterns and problems of adult total parenteral nutrition use in US academic medical centers.

Objective: To determine the pattern of total parenteral nutrition (TPN) use in US academic medical centers because TPN in adults may be associated with complications related to excessive glucose (dextrose) administration and a respiratory quotient greater than 1.0.

Design: Two surveys of the University HealthSystems Consortium (n = 106, 74 members and 32 network partners using TPN) to determine TPN formulas and amounts of TPN nutrients given to 2 hypothetical abdominal trauma patients (1 man and 1 woman), each of whom weighed 70 kg.

Relative validity of clinical techniques for measuring the body composition of persons with amyotrophic lateral sclerosis.

Tracking body composition is necessary to understand how amyotrophic lateral sclerosis (ALS) is affecting a patient's morphology and to provide a basis for appropriate nutritional advice throughout disease progression. Dual X-ray absorptiometry (DEXA) has been shown to reliably detect body composition changes in persons with ALS. However, this procedure is expensive and available primarily for research.

Bioelectrical impedance in the clinical evaluation of liver disease.

Liver disease is often characterized by an accumulation of excess body water as ascites, edema, or both. It was our purpose, using bioelectrical impedance analysis (BIA), to measure total body water (TBW) and extracellular water (ECW) in 35 patients with end-stage liver disease, including those undergoing orthotopic liver transplantation and, in 15 of these patients, to compare these values with measurements of TBW by deuterium oxide and of ECW by bromide dilutions. Poor correlation of TBW derived from BIA with TBW by deuterium dilution was found (r = 0.

Total parenteral nutrition with glutamine in bone marrow transplantation and other clinical applications (a randomized, double-blind study).

In a paper by Ziegler et al (Ann Intern Med 116: 821-828, 1992), total parenteral nutrition supplemented with L-glutamine (TPN/GLN) was reported beneficial in patients receiving bone marrow transplantation (BMT) for hematologic malignancies. By using a similar protocol, we studied 29 patients with both hematologic malignancies and solid tumors, and with both allogeneic and autologous BMTs. In a double-blind, randomized approach, patients were given isocaloric, isonitrogenous TPN after BMT until they consumed 50% of their required diet orally.

Liver test alterations with total parenteral nutrition and nutritional status.

Liver test abnormalities are a well-recognized complication in the parenterally fed population. Numerous etiologies for the development of elevated liver tests have been suggested. However, the etiology and clinical significance remain unclear.

Glutamine-enriched intravenous feedings attenuate extracellular fluid expansion after a standard stress.

A double-blind, randomized controlled trial was performed to determine the effect of glutamine (GLN)-enriched intravenous feedings on the volume and distribution of body fluids in catabolic patients. Subjects with hematologic malignancies in remission underwent a standard treatment of high-dose chemotherapy and total body irradiation before bone marrow transplantation. After completion of this regimen, they were randomized to receive either standard parenteral nutrition (STD, n = 10) or an isocaloric, isonitrogenous nutrient solution enriched with crystalline L-glutamine (0.

Optimum doses of deuterium oxide and sodium bromide for the determination of total body water and extracellular fluid.

A practical approach for determining optimum tracer doses is described for measurements of total body water (TBW) and extracellular water (ECW) based on dilution of deuterium oxide and sodium bromide with respective analyses by nuclear magnetic resonance and anion-exchange chromatography. Using these techniques and plasma concentrations corresponding to adult doses up to 1.5 g kg-1 body weight of deuterium oxide and 0.

Cardiopulmonary response of the rat to gram-negative bacteremia.

Hemodynamic and respiratory effects of a continuous 5-h intravenous infusion of live Escherichia coli were studied in rats. Control animals were infused with saline. Rats infused with 1.

Liver adenosine triphosphate (ATP) in hypoxia and hemorrhagic shock.

Reduction of liver ATP in proportion to the severity of shock and hypoxia is well known. We have studied the interrelationships among arterial oxygenation, arterial pH, and liver ATP in experimental hypoxia and in hemorrhagic shock in rats. No significant correlation was found between liver ATP and arterial pH in both hemorrhagic shock and hypoxia and between liver ATP and arterial PO2 in hypoxia.

Rapid computer prediction of total body water in fluid overload.

Using computer analysis of the early plasma arterial disappearance curve of tritiated water (HTO), we sought the fewest points and earliest times needed to predict the final volume of dilution, total body water (TBW). In ten anesthetized adult female dogs weighing 19.1 +/- 0.