Total parenteral nutrition. Conquering the complexities

Delivery of total parenteral nutrition (TPN) is a complex procedure requiring a basic knowledge of nutritional physiology and an understanding of the impact of various disease states on utilization of nutrient substrates. The goals of TPN are to reverse catabolism, promote anabolism, and build structural protein. It is important to infuse an adequate amount of calories and protein but to avoid the stress of overfeeding. Various laboratory values may be monitored to ensure that each of the nutrients administered is being adequately tolerated by the patient. Keeping these principles in mind, primary care physicians can deliver a TPN regimen specifically suited for individual patients and can anticipate and prevent any potential complications.     

腹腔感染后维生素A、E、C代谢障碍的防治

目的观察完全胃肠外营养(TPN)添加维生素A、E、C对腹腔感染后抗氧化能力的影响。方法采用盲肠结扎加穿孔(CLP)模型,将SD大鼠随机分为对照组(CLP TPN)、治疗组(CLP TPN 维生素A、E、C)、延迟治疗组(CLP TPN 延迟应用维生素A、E、C),于术后当天以及第1、3、5天观察血浆及肝组织中维生素含量及丙二醛(MDA)、还原型谷胱甘肽(GSH)的变化。结果 CLP对照组维生素A、E、 C及GSH明显低于正常对照,MDA显著高于正常对照;治疗组和延迟治疗组维生素A、E、C及GSH显著高于对照组,但延迟治疗组低于治疗组;治疗组和延迟治疗组MDA明显低于对照组,但延迟治疗组高于治疗组。结论 TPN添加维生素A、E、C能改善腹腔感染后机体的抗氧化能力,减轻脂质过氧化损伤。     

Meeting exceptional nutritional needs. 1. Total parenteral nutrition.

The provision of adequate nutrition to hospitalized patients with exceptional caloric requirements has been a problem until the recent advent of intravenous hyperalimentation. With total parenteral nutrition (TPN), the nutritional needs of any patient can be met by infusion. TPN solution is hypertonic, and administration requires central venous cannulation. The subclavian vein is usually chosen as route of access to the superior vena cava. Strict aseptic technique must be used in inserting the catheter and making up and administering the solution. TPN is not without risk. Infection is always a possibility, as are metabolic alterations, such as electrolyte imbalance, fluid overload, osmotic dehydration, and essential fatty acid deficiency.     

Sonographic findings in gallbladder ascariasis.

Invasion of the adult roundworm, Ascaris lumbricoides, into the gallbladder is rare and was seen in 14(2.1%) of the 665 cases with hepatobiliary ascariasis. The diagnosis was suggested in all 13 cases in which sonography was performed and in 5 of the 11 cases at endoscopic retrograde cholangiography. Sonographic findings included a nonshadowing, long, echogenic structure in the form of a coil, an echogenic strip with central anechoic tube, an echogenic structure extending across the gallbladder giving it a septate appearance, and characteristic erratic, nondirectional, zig-zag movements of these echogenic structures in the gallbladder. Serial sonograms accurately predicted spontaneous exit of the worm. Pregnancy and anomalous origin of the cystic duct directly from the papilla of Vater facilitated worm invasion into the gallbladder. We conclude that real-time sonography offers a simple, rapid approach for the diagnosis and follow-up of patients, whereas endoscopic retrograde cholangiography has limited diagnostic value in this disorder.     

肠外肠内营养学临床指南系列一——住院患者肠外营养支持的适应证(草案)

背景 临床营养支持（clinical nutrition support）一般认为可以通过经口、经肠道或经肠外途径为患者提供较全面的营养素。目前临床上包括肠内营养（enteral nutrition，EN）和肠外营养（parenteral nutrition，PN）。     

Zinc and total parenteral nutrition.

Present knowledge of trace element nutritional requirements and the effects of TPN solutions unsupplemented with zinc indicate that zinc supplementation must be considered for any patient receiving prolonged TPN. Zinc sulfate appears to be the supplement of choice, and infusions of freeze-dried plasma appear to be an unsatisfactory method for supplying zinc, even during short-term therapy. As long as accepted dosage regimens are followed, there appears to be little risk of toxicity when TPN solutions are supplemented with zinc.     

Total parenteral nutrition infusate. An approach to its optimal composition in post-trauma acute renal failure

A study on 46 patients suffering from acute post-traumatic oliguric renal failure was carried out in order to provide adequate nutritional support. It was found that a high nitrogen intake was achieved by combined infusion of essential (EAA) and non-essential (NEAA) free amino acids; the essential amino acid/total ($\text{E}\text{T}$) nitrogen ratio had to be higher than four for the improvement of nitrogen balance and protein metabolism.     

Sonographic analysis of gallbladder findings in Salmonella enteric fever.

The purpose of this study was to analyze gallbladder sonographic findings associated with Salmonella typhi enteric fever. Sixty-two patients with culture positive Salmonella enteric fever were analyzed with serial sonography. The following gallbladder sonographic findings were noted: globular gallbladder distention (33 of 62 patients, 530%), positive sonographic Murphy sign (25 patients, 40%), pericholecystic edema or fluid (25 patients, 40%), gallbladder wall thickening > 4 mm (21 patients, 34%), low-level nonshadowing intraluminal echoes or sludge (nine patients, 15%), intramural linear sonolucency or striation (eight patients, 13%), and mucosal irregularity or sloughed membrane (four patients, 6%). Using the sonographic findings a gallbladder score was devised to assess the severity of gallbladder changes, and the score was correlated with the following clinical parameters--duration of fever, multidrug resistance, and clinical outcome. An abnormal gallbladder score was noted in 37 patients (60%), and multidrug resistance was noted in 35 of these patients (95%). The gallbladder scores showed a strong positive correlation with the duration of fever and the frequency of multidrug resistance. All 62 patients were treated with intensive antibiotic therapy without any deaths.