Chromium content of total parenteral nutrition solutions

Chromium (Cr) present as contaminant was analyzed by flameless atomic absorption spectrometry in a variety of commercially produced solutions and additives commonly used in total parenteral nutrition (TPN) formulas. Total Cr likely to be administered unintentionally per day was estimated both by summing the Cr in appropriate volumes of each solution required for preparation of standard TPN formulas and by analyzing complete TPN solutions. Storage of TPN solutions in plastic bags for 14 days did not affect Cr concentrations. The amounts ranged from 2.4 to 8.1 micrograms/day for a high glucose formula and 2.6 to 10.5 micrograms for a high lipid formula. Amino acid solutions, especially when containing phosphate, or with phosphate salt additives and with lipid emulsions accounted for approximately 85 to 90% of the Cr found.     

Glutamine and smooth muscle morphology of the gut in rats on total parenteral nutrition

The purpose of this study was to assess the effects of addition of L-glutamine to an IV nutritional solution on the urinary excretion of 3-methylhistidine (3-MeH) and the morphology of the musculature of the gut in rats. Two experiments were run. In experiment 1 glutamine was added to a mildly hypocaloric IV solution which contained no other amino acids. For experiment 2 glutamine was added to an isocaloric balanced amino acid mixture. In both experiments L-alanine was added in equimolar amounts in place of the L-glutamine for the control groups. Providing glutamine in an IV diet without other amino acids significantly decreased urinary 3-MeH excretion (p less than 0.05). Electron microscopy and morphometric analysis of the jejunum showed an approximate 50% loss of musculature from the gut wall in alanine-treated animals. Glutamine supplementation of a balanced amino acid regime had no effect on urinary 3-MeH excretion or the musculature of the jejunum. We concluded that (1) glutamine is a preferred fuel for jejunal smooth muscle as well as for mucosal cells of the jejunum and (2) only when amino acids are limiting does exogenous glutamine prevent atrophy of the gut musculature.     

A pregnant woman with active ulcerative colitis maintained on total parenteral nutrition

A 28-year-old woman was admitted to our hospital with complaints of mucosanguinous stool and low grade fever. She was diagnosed as a typical chronic continuous type of ulcerative colitis by the findings of barium enema and colonoscopy. Since she had an allergy to sulfasalazine, prednisolone was chosen. She became pregnant during an active stage while being treated with 20 mg of prednisolone a day. Prednisolone was withdrawn to avoid the side-effects of the medicine on the fetal outcome. This resulted in her symptoms becoming far worse and the oral ingestion being discontinued. Total parenteral nutrition (TPN) was required under careful nutritional management. The TPN consisted of glucose, electrolytes, amino acids, vitamins, trace elements and intravenous lipid preparation. Her total energy intake was 2320 kcal a day. Vitamins were administered to her on the bases of the guideline of the American medical association. Rapid turnover proteins, transferrin, vitamins, trace elements and amino acids in addition to routine laboratory tests were measured to estimate her nutritional condition. The data showed that biotin was 10 times lower than the expected value and that other factors were within normal limits. This is the first case in Japan where a woman suffering from an active ulcerative colitis was treated with TPN and delivered of a healthy baby. We concluded that TPN under careful control was useful in the nutritional management and therapy of the pregnant patient who suffered from severe colitis. We believe that the amount of biotin's supplementation should be increased in this type of case because it was 10 times lower than the normal value, although the deficiency symptoms did not develop.     

丙氨酰胺谷氨酰胺对烫伤大鼠的作用

目的研究添加丙氨酰谷氨酰胺(Ala-Gln)全胃肠外营养对烫伤大鼠的蛋白质代谢、肠粘膜形态学、创面肉芽组织的影响。方法将22只30%TBSAⅢ度烫伤SD大鼠行颈外静脉插管后,随机分为传统TPN组(传统组)和添加二肽TPN组(二伏组),每组各11例,两组接受等热量(780kg     

Effect of total parenteral nutrition with xylitol on protein and energy metabolism in thermally injured rats

The use of xylitol as an alternative carbohydrate calorie source in total parenteral nutrition may offer unique pharmacologic and nutritional properties in the therapy of the thermally injured. Male Sprague-Dawley rats (250 g) received a 15-second dorsal scald injury (25-30% BSA) and were parenterally fed isovolemic diets (60 ml/day) that provided 200 kcal/kg/d, 9.68 g of amino acids/kg/d, and 23.5% nonprotein calories (NPC) as fat for 3 days. The balance of NPC were provided as dextrose (Dex) or 50% xylitol:50% dextrose (Xyl/Dex). Rectus muscle and liver fractional protein synthetic rates (FSR, %/day), whole body leucine appearance (Flux), oxidation (OX), protein breakdown (PB), and synthesis (PS) were estimated using a 4-hour iv infusion of [1-14C]leucine on day 3. Mean values (+/- SE) for leucine kinetics (mumol leucine/hr/100 g), cumulative nitrogen balance (mg N) and plasma insulin concentration (Table I). (microU/mL). The partial replacement of dextrose calories with xylitol did not significantly alter whole body and tissue leucine kinetics, daily and cumulative nitrogen balance, insulin concentration, and energy expenditure (indirect calorimetry). These data indicate that xylitol may be useful as an alternative carbohydrate calorie source in parenteral nutrition to avoid possible deleterious side effects of glucose overfeeding in the critically ill but did not improve protein metabolism under the conditions of this study.     

Pattern of energy storage in the liver and muscle of rats submitted to total parenteral nutrition

TPN was administered to young male rats for 10 days at a low (270 kcal/kg/day) and a high (250 kcal/kg/day) energy level, with an isonitrogenous supply (0.9 g N/kg/day). The non-protein calories were divided into three energy substrate ratios: 0% Fat 100% Glucose , 6% Fat 94% Glucose , and 60% Fat 40% Glucose . Glycogen, acylglycerols and enzyme activities of the heart and some skeletal muscles (tib. anterior, ext. dig. longus and soleus) were unaffected by the various intravenous regimens. The glycogen content of the liver was significantly higher in both low fat groups. There was also a clear tendency in all groups to lower values of glycogen as the energy level of the TPN increased. The opposite trend was seen with acylglycerols, which were highest in the high glucose and high fat groups. The highest acylglycerol content was found in the high fat group at the high energy level. This study demonstrates that unbalanced intravenous regimens, without fat or with a fat overload (20 g/kg/day), seem to alter the storage pattern of glycogen and fat in the liver, particularly when hypercaloric regimens are given. The heart and skeletal muscles seemed to be protected from this effect.     

Economics of total parenteral nutrition

Better data on the effectiveness of TPN are required, along with good costing data on the procedure and its benefits. The Veterans Administration Cooperative Trial on Perioperative TPN will be collecting such data. In this randomized trial, data are being collected on both the effectiveness of the procedure and the costs, direct and indirect, of the procedure and its consequences. Similar studies for other indications will help to establish fully the economics of TPN. As Steinberg and Anderson point out, it is important to remember that the absence of evidence that a procedure is not cost-effective does not imply that it is not cost-effective. As this review has shown, the cost-effectiveness of TPN has been evaluated for only a few indications. The results of more extensive cost-effectiveness analyses remain to be seen.     

Energy expenditure and motor activity in rats receiving total parenteral nutrition

Rats with intravascular catheters connected to infusion systems are frequently used in the investigation of nutritional and metabolic problems. Although the animal is often referred to as "unrestrained," there is no information on the effect of the catheter assembly or total parenteral nutrition (TPN) on total (TEE), activity (AEE), and resting (REE) energy expenditure (TEE = REE + AEE). Male Fischer 344 rats were studied in an analytical respiration calorimeter. Normal unoperated rats, aseptically catheterized orally fed rats from postoperative day 1 to 7, and TPN rats were studied. Orally fed catheterized rats had weight loss, negative nitrogen balance, negative energy balance, elevated REE, and normal AEE during the first 4 postoperative days. Their weight gain, positive nitrogen balance, AEE, and REE were almost identical to those of normal rats over postoperative days 5 through 7. REE and AEE in TPN rats were similar to values in normal rats. These data indicate that catheter operation and TPN cause no abnormality in AEE and REE if adequate time is allowed for recovery from catheter operation and strict attention is given to asepsis.     

Leptin and insulin response to long-term total parenteral nutrition depends on body fat mass

BACKGROUND & AIMS: Circulating leptin and insulin concentrations are physiologically representing energy homeostasis. However, the artificial situation of long-term total parenteral nutrition (TPN) and its effects on serum leptin and insulin is not fully understood. METHODS: We studied 42 gastroenterological patients who received TPN for 19+/-11 days. Serum leptin and insulin levels as well as body composition assessed by bioelectrical impedance analysis were evaluated on days 0, 7 and 14. Insulin sensitivity was estimated by calculating the QUICKI. RESULTS: Before the start of TPN, leptin correlated positively with female gender (P<0.03), BMI (P<0.02), fat mass (P<0.02), insulin levels (P<0.001) and QUICKI (P<0.001). Within the first week of TPN, an increase of leptin levels was found only in patients with a body fat mass of >30% (P<0.02). As these were predominantly women, their leptin levels increased likewise (P<0.003). In regression analysis, fat mass (P<0.001), female gender (P<0.04), insulin levels (P<0.03), and i.v. glucose supply rates (P<0.05) were independently associated to leptin levels. CONCLUSIONS: TPN-especially glucose-induces a neurohumoral response as shown here for leptin and insulin that is mainly depending on the fat mass. Better understanding of this regulatory mechanism during artificial nutrition could offer a new approach to improve its therapeutic effects.     

Folic acid and total parenteral nutrition

The stability of folic acid in a variety of solutions used for parenteral nutrition has been determined over a 2-wk period. Provided that the acidity of the solution remains above pH 5.0 the folate, in the concentrations usually used for parenteral nutrition, will remain stable in solution, and all of the folate added to the solution will be delivered to the patient. The applicability of this in vitro work to a group of patients requiring parenteral nutrition was assessed, in order to determine a suitable dose. A dose of 0.2 mg of folic acid daily was inadequate to meet the requirements of these patients. In contrast a dose of 1.2 mg daily for 7 days was sufficient to cause an increase in the serum folate concentration.     

Carcass and organ composition of rats fed high fat total parenteral nutrition

Fat-based total parenteral nutrition (TPN) has been shown to maintain the host nutritionally equivalent to carbohydrate-based TPN in a rat model; however, data on body composition have not been obtained. This study compared the effects of a lipid-based TPN regimen to those of an isocaloric glucose-based regimen and an oral diet on the composition of the carcass and organs of tumor- and nontumor-bearing rats. Sprague-Dawley rats implanted with the Walker 256 carcinosarcoma were randomly assigned to either diet A, a glucose-based TPN regimen; B, a lipid-based TPN regimen; or C, a purified oral diet. Tumor-bearing rats infused with diet B had less protein and more fat in their carcasses than those in the other dietary groups. Organs of nontumor- and tumor-bearing rats fed diet B contained less protein and more fat and triglycerides than rats fed either diet A or C. Survival index and hematocrit values were lowest in rats infused with the parenteral lipid diet. These findings indicate an abnormal pathological response to a TPN diet formulated to deliver 67% of nonprotein kilocalories as lipid.     

Effect of glutamine-supplemented total parenteral nutrition on the small bowel of septic rats

In order to study the effect of total parenteral nutrition (TPN) with or without glutamine supplementation in septic rats, septic Wistar albino rats were randomly assigned to receive 0.23 g of nitrogen and 113 kJ (100 g BW)(-1) per day in the form of amino acids with (group 2) or without (group 1) glutamine supplementation or 10% (w/v) glucose only (group 3). After 4 days of TPN treatments, rats receiving glutamine-supplemented TPN had a cumulative nitrogen balance of -24.4 +/- 3.3 mg N, which was significantly (P < 0.001) better compared to other TPN-treated groups. Septic rats of group 2 survived sepsis significantly (P < 0.001) better than those in groups 1 and 3. Glutamine-supplemented TPN treatment resulted in significant increases in jejunal weight (P < 0.001), DNA and protein contents (P < 0.001), villous height (P < 0.001) and crypt depth (P < 0.001) when compared with septic rats of group 1. Septic rats of group 2 extracted and metabolised glutamine by the small bowel at higher rates (P < 0.001) than that observed in septic rats of group 1. Increases in jejunal glutaminase (38.2%, P < 0.001) and decreases in glutamine synthetase (41.7%, P < 0.001) activities were observed in response to glutamine-supplemented TPN treatment. It is concluded that the administration of glutamine-supplemented TPN is beneficial to the small bowel of septic rats.     

Efficacy and safety of total parenteral nutrition

Total parenteral nutrition has been widely available for almost 20 years. This therapy can demonstrably support growth in neonates and children and will maintain life in adults with an inadequate intestine. It may be beneficial in highly selected preoperative patients, and patients with head trauma. Otherwise, its role in specific disease states or pathologic conditions remains unclear. Whether its benefits outweigh its hazards is largely unknown. Crucial to the decision-making process for initiation of TPN is a knowledge of when starvation becomes detrimental to an individual and whether TPN can prevent or reverse any of starvation's detrimental effects; this information is unknown. Many potential complications exist, the frequency of which generally is dependent on the expertise of the user. Nutritional support teams appear to reduce septic, mechanical, and metabolic complications and may improve the clinical efficacy and decrease the cost of TPN care.     

Nutritional effects of branched-chain amino acids on injured rats in total parenteral nutrition

In this study, we investigated the optimal contents of branched-chain amino acids (BCAA) in a balanced amino acid infusion in laparotomized rats. The BCAA contents of four infusion solutions used were prepared to 22, 31, 40, and 49% of total amino acids, respectively. The amounts of essential amino acids except for BCAA were equal in all the solutions. Rats weighing about 240 g were infused with about 200 mg of nitrogen and 10 g of glucose daily for 7 days and evaluated for body weight change, nitrogen balance, plasma and urinary amino acid levels, and plasma constituent levels. The body weights of all the groups were approximately maintained during the infusion period. The nitrogen balance of the BCAA-31 group was more positive than that of the BCAA-22 group and was not different from those of the BCAA-40 and BCAA-49 groups. Plasma total-protein level of the BCAA-31 group was higher than that of the BCAA-22 group and was equal to those of the BCAA-40 and BCAA-49 groups. Even when the BCAA content in an amino acid infusion was increased, no abnormal elevation was observed in plasma BCAA levels. There were no differences in the other nutritional parameters among the four infusion groups. These results suggest that the BCAA contents in an amino acid infusion are enough at 31% of total amino acids for this injured rat model.     

Hepatic complications of total parenteral nutrition

Elevations in serum hepatic enzyme levels and alterations in hepatic morphology have been noted in patients on total parenteral nutrition, in some cases progressing to fatal hepatic failure. Various factors such as toxins, inappropriate substrates, overfeeding, deficiency states, and gut hormone alterations have been implicated. It would appear that the tailoring of nutritional support to meet patient needs and the maintenance of normal gut integrity will be of increasing importance in reducing the incidence of this potentially fatal complication.     

Plasma amino acids in total parenteral nutrition comparison of continuous and cyclic parenteral nutrition

Cyclic nocturnal total parenteral nutrition (TPN) is a widely used technique but its metabolic consequences have not been fully investigated. The aim of this work was to investigate the influence of infusion rhythm on the plasma amino-acid profile in 12 subjects. During two successive 7-day periods and in a randomly chosen order, they received either standard continuous TPN (TPN_Co), i.e., 24 h a day or cyclic TPN (TPN_Cy), i.e., between 5 p.m. and 9 a.m. Caloric and nitrogen supplies were identical in both periods. Plasma amino-acids were analysed at 8:30 a.m. and 4:30 p.m. on the last day of each infusion period. In contrast to the stability observed in TPN_Co, TPN_Cy led to considerable variations of plasma amino-acid concentrations, creating a profile close to that observed in normal oral feeding conditions. Total 24 h urinary amino-acid elimination and the nitrogen balance did not differ between the two types of TPN. These results show that TPN_Cy induces a metabolic profile close to physiological conditions.