Gallbladder contraction after administration of intravenous amino acids and long-chain triacylglycerols in humans.

We examined the possible physiologic effects of intravenous (IV) amino acids (AAs) and long-chain triacylglycerols (LCTs) on gallbladder (GB) motility and release of cholecystokinin (CCK) on humans. GB contraction was studied in normal volunteers after administration of a fatty meal and IV infusion of AA and LCT. The GB contraction volume was calculated with ultrasound. Cholecystokinin-8 (CCK-8) and cholecystokinin-33/39 (CCK-33/39) were measured by radio-immunoassay. Administration of a fatty meal resulted in GB contraction by 60% of its basal volume and was accompanied by an increase in the serum levels of both CCK-8 and CCK-33/39. Administration of IV AA and LCT resulted in GB contraction by 17 and 37%, respectively, of its basal volume. The latter contractions were accompanied by increased levels of CCK-8 only. We conclude that IV administration of AA and LCT can result in human GB contraction and induce the release of only CCK-8. Continuous IV administration of AA and LCT for greater than 2h causes exhaustion of CCK-8 release, so that the GB returns to its initial volume.     

Serum levels of coenzyme Q10 and lipids in patients during total parenteral nutrition

Serum levels of coenzyme Q10 (CoQ10) as well as lipids were determined in patients during total parenteral nutrition (TPN). The mean CoQ10 levels (M +/- SD) were 0.77 +/- 0.30 microgram/ml for 108 normal subjects and 0.59 +/- 0.35 microgram/ml for 95 patients before TPN. The mean CoQ10 level of the patients decreased significantly to 0.35 +/- 0.23 microgram/ml one week after the start of TPN, and then remained almost unchanged during TPN for up to 6 weeks. When the patients receiving TPN (TPN patients) were grouped according to their clinical diagnoses, the mean CoQ10 level of patients with cancer was significantly lower than that of the other patients without cancer in 4 week therapy, but there was no difference in the levels between the patients with and without diseases of the gastrointestinal tract. Serum levels of total cholesterol (T-Chol) and esterified cholesterol in TPN patients also declined below their respective normal ranges, but not to the same extent in comparison to CoQ10. The levels of triglycerides (TG), phospholipids (PL), non-esterified fatty acids, low density lipoproteins, very low density lipoproteins, chylomicrons, and cholesterol in the high density lipoprotein fraction in serum of TPN patients were within their normal ranges. The levels of CoQ10 in TPN patients were correlative to those of T-Chol, TG, and PL, and decreased rapidly prior to the latter levels.     

脂肪乳剂对完全胃肠外营养大鼠血清游离脂肪酸谱的影响

为研究脂肪乳剂对机体脂肪代谢的影响，用气相色谱法观测了完全胃肠外营养（ＴＰＮ）大鼠血清游离脂肪酸（ＦＦＡ）谱的变化。将４０只雄性Ｗｉｓｔａｒ大鼠随机分成５组，每组８只：（１）ＳＨ（Ｓｈａｍｏｐｅｒａｔｉｏｎ）组，仅进行颈外静脉结扎，正常饲养；（２）ＮＳ（Ｎｏｔｍａｌｓａｌｉｎｅ）组：正常饲养，输入生理盐水；（３）ＧＳ（Ｇｌｕｃｏｓｅ）组：全部能量由葡萄糖提供，即不含脂肪乳剂ＴＰＮ组；（４）ＬＣＴ（Ｌｏｎｇｃｈａｉｎｔｒｉｇｌｙｃｅｒｉｄｅ）组：含１０％Ｉｎｔｒａｌｉｐｉｄ脂肪轧的ＴＰＮ组；（５）ＭＣＴ（Ｍｅｄｉｕｍｃｈａｉｎｔｒｉｇｌｙｃｅｒｉｄｅ）组：含１０％Ｌｉｐｏｆｕｎｄｉｎ脂肪乳ＴＰＮ组。ＴＰＮ各组大鼠等能量等氮量等液量匀速连续输入“生合一”营养液（即将所有营养物混合在一个溶器内）。于第７天取血标本进行血清ＦＦＡ测定。结果表明：不含脂肪乳的ＴＰＮ大鼠血清各种ＦＦＡ下降，并出现必需脂肪酸缺乏（ＥＦＡＤ）症状，如精神不振活动少，毛发无光泽、脱落等；脂肪乳剂的使用，使大鼠血清各种ＦＦＡ升高，对机体的代谢和功能有着不同的生理、药理作用。     

Hypermanganesemia in patients receiving total parenteral nutrition

BACKGROUND: Manganese is one of the trace elements that is routinely administered to total parenteral nutrition (TPN) patients. The recommended daily IV dosage ranges from 100 to 800 MICROg. We have used 500 microg daily. Recent reports have suggested neurologic symptoms seen in some patients receiving home parenteral nutrition (HPN) may be due to hypermanganesemia. Therefore, HPN patients and some short-term inpatients receiving TPN were studied to ascertain the relationship between dose and blood levels. METHODS: Red blood cell manganese levels were obtained by atomic absorptiometry. RESULTS: The levels in 36 hospitalized, short-term patients obtained within 48 hours of initiating TPN were all normal. The 30 patients receiving TPN from 3 to 30 days had levels that ranged from 4.8 to 28 microg/L (normal, 11 to 23 microg/L). Two patients had abnormal levels, at days 14 and 18. Fifteen of the 21 patients receiving inpatient TPN or HPN for 36 to 5075 days had elevated Mn levels. Only one patient with hypermanganesemia, an inpatient, had abnormal biochemical liver tests (bilirubin and alkaline phosphatase). One of the patients with a high level had some vestibular symptoms attributed to aminoglycoside use and had increased signal density in the globus pallidus on T1-weighted images on magnetic resonance imaging (MRI). A second patient with Mn levels twice normal had no neurologic symptoms, but had similar MRI findings. A third had some basal ganglia symptoms, confirmed by a neurologic evaluation, seizures, and very high Mn levels. The MRI showed no signal enhancement, but motion artifacts limited the study technically. CONCLUSIONS: Hypermanganesemia is seen in HPN patients receiving 500 microg manganese daily and may have resulted in some neurologic damage in three patients. Hypermanganesemia is sometimes seen after a short course of TPN in inpatients, as early as 14 days. Patients should be monitored for hypermanganesemia if they receive Mn in their TPN for >30 days. A 500 microg/d dose of Mn is probably excessive, and 100 microg/d should probably never be exceeded. Mn should be eliminated from the solution if the Mn level is elevated and should not be readministered unless the level returns to normal or subnormal. Mn should not be supplemented if the patient has liver disease with an elevated bilirubin.     

不同配方TPN对胆源性胰腺炎胆囊收缩及胆汁酸成分的影响

目的：探讨各种完全胃肠外营养（TPN）对胆源性胰腺炎胆囊收缩及胆汁酸成分改变的作用。方法：选择胆源性胰腺炎住院病人共86例,在常规治疗相同的基础上,随机分成四组,TPN支持分别为仅用糖盐水（GNS组）、糖盐水加用7％凡命（VM组）、糖盐水加用20％英脱利匹特（IL组）、糖盐水加用7％凡命及20％英脱利匹特（VM＋IL组）。B超测量胆囊体积及计算最大胆囊排空率（MGER）,气相色谱法检测胆汁游离脂肪酸（FFA）。结果：发现VM＋IL组及VM组与GNS及IL组比较MGER显著升高,差异显著（P＜0．05）;VM＋IL组及IL组与GNS组比较,各种胆汁FAA构成比较差异显著（P＜0．05）。结论：TPN中加入VM＋IL或VM会促进胆囊排空,加入VM＋IL或IL会减轻胆汁FFA变化程度,均对胆石形成或增大可能有预防作用。     

Total parenteral nutrition decreases liver oxidative metabolism and antioxidant defenses in healthy rats: comparative effect of dietary olive and soybean oil

BACKGROUND: Total parenteral nutrition (TPN) is used for critically ill patients undergoing surgery, after trauma, or during disease conditions that favor oxidative stress. We studied the effect of TPN on liver oxidative metabolism and antioxidant defenses in rats, and we compared the effect of soybean oil- and olive oil-based diets. METHODS: Seven-week-old rats (n = 28) were divided into four groups. Two experimental groups received a TPN solution containing soybean oil (TPN-S) or a mixture of olive/soybean oil, 80/20 (TPN-O), IV for 6 days. Orally fed animals received a solid diet including soybean oil (Oral-S) or olive/soybean oil, 80/20 (Oral-O). The following parameters were measured: DL-alpha-tocopherol, vitamin A, malondialdehyde and thiobarbituric acid reactive substances (MDA-TBARS), and total radical-trapping antioxidant parameter (TRAP) in serum; DL-alpha-tocopherol, vitamin A, glutathione (GSH), and catalase (Cat) activity in liver homogenate; fatty acids from phospholipid, cytochrome P-450 content, NADPH-cytochrome c2 reductase activity in liver microsomes; superoxide dismutase (SOD), glutathione peroxidase (Gpx), glutathione reductase (GR), glutathione transferase (GST), and glucose-6-phosphate dehydrogenase (G6PD) in liver cytosol. RESULTS: The soybean or olive oil diets modified the liver microsomal fatty acid phospholipid composition, but the unsaturation index remained unchanged. TPN specifically increased the saturation of the membrane. The cytochrome P-450 level and the NADPH-cytochrome c2 reductase, SOD, Gpx, Cat, and GST activities were unchanged by soybean oil or olive oil diet but decreased receiving TPN. CONCLUSIONS: In rats, TPN decreased the liver oxidative metabolism and enzymatic antioxidant defenses. This may be related to saturation of the liver microsomal fatty acids.     

急性胰腺炎的全肠外营养与生长抑素治疗

目的 :观察在禁食、胃肠减压和预防感染的基础上 ,加用生长抑素和全肠外营养对胰腺炎非手术治疗的影响。　方法 :将 1990年 1月至 1994年 12月底收治的急性胰腺炎 2 6例 ,归为A组。自 1995年以来收治的急性胰腺炎 2 8例 ,归为B组。两组胰腺炎的病因和严重程度无明显差别。B组病人采用全肠外营养支持和生长抑素治疗。　结果 :A组病人入院时血清白蛋白为 (30 .0± 1.2 ) g/L ,治疗 15天后 ,白蛋白仍在 (30 .4± 0 .8) g/L。B组病人于入院后即行全肠外营养支持 ,时间为 (17± 6 )天 ,施他宁使用时间为 (7± 2 )天。其血清白蛋白入院时为 (2 9.0±1.3)g/L ,治疗 15天后 ,白蛋白上升至 (35 .7± 0 .9) g/L ,明显高于入院时 (P <0 .0 1)。B组病人的病死率及住院日、中转手术率、淀粉酶的恢复天数较A组病人有明显改善 ,并发症发生率明显减少。　结论 :在急性胰腺炎非手术治疗原则的基础上 ,通过加用全肠外营养和生长抑素可最大程度地抑制胰腺的分泌 ,改善病人的营养状态 ,减少并发症的发生率与病死率 ,缩短住院时间。     

Weight change and peptide hormone responses in patients receiving interferon

The purpose of this pilot study was to describe body weight status and peptide hormone responses in patients receiving interferon (IFN) therapy for renal cell carcinoma. Eighteen patients were on therapy for approximately two to three months. Mean weight loss of the patients was 2.2 +/- 0.9 kg (mean +/- SEM) or 4.9 +/- 0.9% of prestudy weight. Of the 18 patients, 6 were further evaluated for peptide hormone responses to meal stimulation before and after treatment (mean: 1.5 months). These subjects had a mean weight loss of 4.3 +/- 1.6 kg or 7.0 +/- 3.5% of prestudy weight. Blood was drawn from subjects before and six times after they had consumed a defined formula liquid meal to provoke enteroinsular peptide release. It was discovered that one-half of this group (n = 3; Group A) had some glucose intolerance following IFN therapy, despite increased response of insulin, gastric inhibitory polypeptide (GIP), and pancreatic polypeptide (PP) to meal stimulation. Further, patients in Group A had a weight loss of -11.7 +/- 2.7% of prestudy weight, whereas the other three patients (Group B) experienced a mean loss of -2.3 +/- 1.2% (p less than 0.04). The three subjects characterized by the smaller loss of prestudy weight (Group B) had decreased glucose response to meal stimulation, despite decreased responses of insulin and GIP. Response of PP was slightly increased with treatment in group B, but the increase was not as large as that in Group A. These data may suggest that extreme weight loss and altered peptide hormone response occur in a subset of cancer patients receiving interferon therapy.     

Weight change and peptide hormone responses in patients receiving interferon

The purpose of this pilot study was to describe body weight status and peptide hormone responses in patients receiving interferon (IFN) therapy for renal cell carcinoma. Eighteen patients were on therapy for approximately two to three months. Mean weight loss of the patients was 2.2 ± 0.9 kg (mean ± SEM) or 4.9± 0.9% of prestudy weight. Of the 18 patients, 6 were further evaluated for peptide hormone responses to meal stimulation before and after treatment (mean: 1.5 months). These subjects had a mean weight loss of 4.3 ± 1.6 kg or 7.0 ±3.5% of prestudy weight. Blood was drawn from subjects before and six times after they had consumed a defined formula liquid meal to provoke enteroinsular peptide release. It was discovered that one‐half of this group (n = 3; Group A) had some glucose intolerance following IFN therapy, despite increased response of insulin, gastric inhibitory polypeptide (GIP), and pancreatic polypeptide (PP) to meal stimulation. Further, patients in Group A had a weight loss of — 11.7 ± 2.7% of prestudy weight, whereas the other three patients (Group B) experienced a mean loss of ‐ 2.3 ± 1.2% (p < 0.04). The three subjects characterized by the smaller loss of prestudy weight (Group B) had decreased glucose response to meal stimulation, despite decreased responses of insulin and GIP. Response of PP was slightly increased with treatment in group B, but the increase was not as large as that in Group A. These data may suggest that extreme weigh t loss and altered peptide hormone response occur in a subset of cancer patients receiving interferon therapy.     

Does the route of feeding modify gastric emptying in rats?

BACKGROUND: It has been shown that the pattern of previous nutrient intake can influence gastric emptying. However, the effect of the absence of enteral stimulation in the setting of a normal energy supply on gastric emptying has not been examined. The aim of this study was to determine whether the absence of enteral stimulation during total parenteral nutrition (TPN) could modify gastric emptying in rats. METHODS: Two experiments were performed. First, gastric emptying of a peptone meal was compared between rats receiving TPN, oral liquid diet (same solution as TPN), or regular diet (control group) for 10 days. In the second experiment, gastric emptying of two test meals (40% peptone and 25% glucose) was studied before and after rats received TPN or intragastric nutrition (same solution as TPN) for 10 to 12 days. RESULTS: In experiment 1, gastric emptying of 40% peptone in the TPN and liquid diet groups was slower than that in the control group. This difference was significant between the TPN group and the control group (p < .01) but not between the liquid diet and control groups (p = .076). Gastric emptying of this meal in the TPN and liquid diet groups was similar. In experiment 2, no difference in gastric emptying of 40% peptone or 25% glucose was found between rats receiving TPN and those receiving intragastric nutrition for 10 to 12 days. CONCLUSIONS: The composition of diet not the route of feeding is important in the modification of gastric emptying by the pattern of previous nutrient intake.     

Clinical studies on zinc metabolism during total parenteral nutrition as related to zinc deficiency

In 99 adult patients receiving controlled total parenteral nutrition (TPN), a study was made on the time course of concentrations of zinc in plasma, erythrocyte and urine in relation to the development of zinc deficiency. Zinc deficiency developed in 11 cases receiving TPN solutions not containing zinc. The plasma zinc level was significantly lower at the time of onset of zinc deficiency than in normal subjects, before the procedure of TPN, or at the time of symptomatic relief achieved by administration of zinc. The erythrocyte zinc level was slightly but not significantly lower at time of onset of zinc deficiency than in normal subjects, before TPN or at time of symptomatic relief. The urinary zinc level at time of onset of zinc deficiency was significantly lower than that in normal subjects or at the time of symptomatic relief but not significantly lower than that before TPN. A comparison between patients developing and those not developing zinc deficiency within 4 wk of the outset of TPN showed that only the plasma zinc level was significantly lower in the former than the latter group. The urinary zinc level also tended to be lower, although not significantly, in the former than the latter group but varied widely. No difference was present between the groups as to the erythrocyte zinc level. Zinc deficiency developed in none of those patients who had a plasma zinc level of 50 micrograms/dl or more but in five of 10 (50%) patients with less than 50 micrograms/dl and in all three with less than 30 micrograms/dl of zinc in plasma.(ABSTRACT TRUNCATED AT 250 WORDS)     

不同脂肪乳剂对阻塞性黄疸大鼠肝脏功能和形态学的影响

目的：比较不同脂肪酸来源的全胃肠外营养（TPN）对胆总管结扎大鼠肝脏功能和形态学的影响。观察不同脂肪酸对阻塞性黄疸大鼠受损肝脏的作用,为临床阻塞性黄疸患应用TPN提供实验依据。方法：采用SD大鼠36只,随机分4组,每组9只,其中A组为假手术＋经口饮食对照组;余3组均行胆总管结扎术：B组为经口饮食对照组,C,D组分别给予以长链（LCT）或中长链脂肪酸（MCT／LCT）为脂肪来源的TPN。结果：应用长链脂肪酸大鼠的血清AKP,g-GT,血清总胆红素,直接胆红素和胆汁酸水平均高于应用中长链脂肪酸大鼠。对实验大鼠肝脏形态学观察发现,应用LCT的大鼠肝细胞损害较经口饮食对照大鼠有所加重,而应用MCT／LCT的大鼠肝细胞损害未见加重。结论：短期应用合理糖脂比,热氮比和合适脂肪来源的TPN并不加重阻塞性黄疸大鼠的肝脏损害和胆红素代谢紊乱。     

Polymyxin B reduces total parenteral nutrition-associated hepatic steatosis by its antibacterial activity and by blocking deleterious effects of lipopolysaccharide.

Overgrowth of Gram-negative bacteria as a result of total parenteral nutrition (TPN) and bowel rest could be responsible for the release of a variety of hepatotoxic substances such as endotoxin or tumor necrosis factor (TNF) and the ensuing TPN-associated liver function derangements. Polymyxin B is an effective antimicrobial agent as well as a blocking agent for endotoxin (lipopolysaccharide) activity and TNF production. In the present study we compared the oral and intravenous effects of polymyxin in rats receiving TPN in an attempt to define these two possible mechanisms of action of polymyxin on TPN-associated hepatic steatosis. Both oral, as well as intravenous polymyxin B, significantly reduced total hepatic fat and triglyceride accumulation in TPN rats, more so in the intravenous group exhibiting close to control levels. Both polymyxin-treated groups exhibited significantly lower Gram-negative bacterial counts in the cecum, with the oral group exhibiting a lower count than the IV group. The spontaneous production of TNF by peritoneal macrophages was markedly increased in rats receiving TPN and very close to being undetected in both groups receiving TPN and polymyxin. We believe polymyxin B protects the liver during TPN by both its antimicrobial effect which prevents overgrowth of gut Gram-negative bacteria and the subsequent translocation of endotoxin, and by its specific antilipopolysaccharide activity which, in the present study, completely abolished hepatic steatosis and TNF production during TPN.     

Total parenteral nutrition in surgical illness: how much? How good?

Using primed constant infusions of isotopes and indirect calorimetry, we assessed protein, glucose, and fat kinetics in severely ill surgical patients suffering from sepsis, major trauma, gastrointestinal cancer, or nutritional depletion from benign disease. We also assessed the effect of 5 days of total parenteral nutrition (TPN) on abnormal metabolism in these states. In the basal state, patients with sepsis, trauma, or cancer had an elevated rate of net protein catabolism due to an increased rate of whole-body protein catabolism, whereas whole-body protein synthesis was not impaired. TPN had no impact on the elevated rate of whole-body protein catabolism in these conditions but decreased the rate of net protein catabolism, suggesting that increased substrate availability optimizes whole-body protein synthesis. Consequently, few surgical patients became anabolic while receiving TPN. In contrast, patients with nutritional depletion from benign disease had a decreased rate of net protein loss compared with volunteers and could be made anabolic with the administration of TPN. All patients studied had an elevated rate of plasma glucose production, impaired glucose oxidation, and an increased rate of Cori cycling in the basal state. After 5 days of TPN, most surgical patients showed improved ability to oxidize glucose, but the high rates of glucose recycling to lactate persisted. Patients suffering from sepsis, trauma, or cancer had an enhanced rate of lipolysis in the basal state associated with an increased rate of whole body-fat oxidation compared with healthy volunteers. After administration of TPN, whole-body fat oxidation was significantly decreased in patients with trauma but increased in patients with sepsis or cancer.(ABSTRACT TRUNCATED AT 250 WORDS)     

THE THYROTROPIN RELEASING HORMONE STIMULATION TEST IN ALCOHOLISM

The mechanism for a blunted thyroid stimulating hormone (TSH)response to thyrotropin releasing hormone (TRH) in alcoholicsis not known. We performed a combined TRH and gonadolibenn stimulationtest on three well-defined groups of nondepressed alcoholicmen, Group A comprised patients with acute withdrawal symptoms(n = 28), group B patients abstinent for 5–8 weeks (n= 29) and group C patients who had been abstinent for > 2years (n – 16). Twenty-two healthy male volunteers wereused for comparison. A blunted TSH response to TRH (delta TSH< 5 µU/l) occurred only in groups A (39%) and B (17%).In group A delta TSH showed a significant negative correlationwith the severity of withdrawal symptoms and a significant positivecorrelation with serum magnesium levels. In group B, patientswith a family history of alcoholism had significantly lowerdelta TSH levels than those without such a family history. Groupsdid not differ with respect to basal and delta prolactin, andTSH responses were not significantly associated with vitamindeficiency, cortisol levels or free thyroid hormone levels.We conclude that TRH stimulation test blunting appears to berelated to factors operating in the withdrawal state and improveswith continued abstinence. A possible role of genetic factorsand serum magnesium needs to be further explored.     

Effect of energy substrate manipulation on tumour cell proliferation in parenterally fed cancer patients

The effects of isocaloric carbohydrate-based vs. fat-based total parenteral nutrition (TPN) regimens on cancer cell proliferation and host nutritional status were evaluated in 27 patients with tumours of the gastro intestinal tract consecutively assigned to receive for 14 days: a glucose-based (A) or a lipid-based (B) TPN formula, or an oral diet (C) isocaloric and isonitrogenous to A and B. Cancer cell replication rate was evaluated by thymidine labelling index (LI) on tumour samples before and at the end of each nutritional regimen. The number of replicating cells increased by 32.2% in patients receiving regimen A. LI decreased by 24.3% in patients given regimen B. LI values were slightly increased (+15%) in patients maintained on regimen C. Nutritional status remained within normal limits. None of the LI changes observed between and within the three arms of the trial were found to be statistically significant. Thus we failed to prove that glucose consistently stimulates or lipids inhibit tumour proliferation despite a trend in this sense.     

Metronidazole prevention of serum liver enzyme abnormalities during total parenteral nutrition

Abnormal serum liver enzymes are common in adults receiving total parenteral nutrition (TPN). The mechanism(s) responsible for these changes is unclear. One hypothesis is that there is overgrowth of intestinal anaerobic bacteria with subsequent toxic effects on the liver from endotoxins and/or bile acids. A retrospective survey of patients receiving TPN was undertaken. The patients were divided into two matched groups. One group had received metronidazole, a drug that suppresses anaerobic bacteria, while the other group had not. The administration of metronidazole during TPN was associated with prevention of the expected rise of serum alkaline phosphatase, gamma glutamyl transpeptidase, and aspartate amino-transferase. This study supports the concept that anerobic intestinal bacteria may be involved in the pathogenesis of liver changes commonly observed during TPN.     

Water-soluble vitamins in cancer patients on parenteral nutrition: a prospective study

Forty-three patients with mild weight loss were studied prospectively to determine whether the parenteral water-soluble vitamin doses in a commercially available preparation (MVI concentrate; USV Laboratories, Tarrytown, NY) maintained serum, red blood cell (RBC), and urinary concentrations of water-soluble vitamins in stressed cancer patients receiving total parenteral nutrition (TPN). Patients were divided into three groups: (1) oral diet, no intravenous vitamins given; (2) TPN plus 5 ml MVI; and (3) TPN plus 10 ml MVI. Vitamins C, B1, B2, B3, B6, and niacin were measured initially and weekly during a 6-week study period. Caloric and nitrogen balances were quantified. Most of the patients in all three groups had normal blood or urine levels of all water-soluble vitamins. No clinical evidence of vitamin deficiency or MVI toxicity was detected. The recommended parenteral dosages of vitamin C (100 mg/day) and B3 (15 mg/day) provided measurably adequate levels in all patients. Levels of vitamins B1, B2, B6, and niacin that were less than the normal range were noted in 4-40% of patients receiving the recommended daily dosages of 3 mg, 3.6 mg, 4 mg, and 40 mg, respectively. These deficiencies appeared to improve in group III patients who received twice the recommended parenteral vitamin dosages, although they did not completely disappear. Niacin deficiency appeared to be the most prevalent, occurring in 40% of patients studied. Since intravenous doses of B1, B2, B6, and niacin are safe and well tolerated, it appears that increased daily amounts of these vitamins should be given to cancer patients on parenteral nutrition.     

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%. Our previous survey of hospitals, 7 years ago, of TPN composition revealed use of excessive glucose. Our purpose was to reevaluate glucose usage in TPN. METHODS: A subset of data from 45 hospitals participating in Novation's Medication Use Evaluation program, "Parenteral Nutrition for Adults and Neonates" study, was analyzed to document glucose administration in TPN. RESULTS: Data of 629 adult patients from 44 hospitals receiving TPN were analyzed. Of these, 30 hospitals with 478 patients had 100 patients (15.9% of the total) with TPN glucose infusion rates >4 mg/kg/min, whereas 27 hospitals, or 61%, had average TPN glucose concentrations above 15%. This could be associated with an RQ >1.0, implying increased net lipogenesis. CONCLUSIONS: The majority of hospitals surveyed were found, as in a previous survey, to be using amounts of glucose in TPN which would be expected to be associated with an RQ >1.0, implying increased net lipogenesis.     

Total parenteral nutrition in severe acute pancreatitis.

The influence of total parenteral nutrition (TPN) was studied in 67 patients with severe acute pancreatitis having three or more criteria according to Ranson (mean +/? SD = 3.8 +/? 0.21). Although TPN has been reported to not be of benefit in the progress and severity of the disease, we have found that the time TPN is started is important in influencing the course of the disease and in the development of local complications, as well as in the mortality rate. Patients whose TPN was started within the first 72 hours of the disease had a 23.6% complication rate and 13% mortality, in comparison with patients whose TPN was started later in the course of the disease, who had a 95.6% complication rate (p less than 0.01) and a mortality rate of 38% (p less than 0.03). The nutritional status of the patients during TPN administration of 28.4 days was maintained either steady or was improved, as assessed by nitrogen balance, serum levels of transferrin (p less than 0.05), and albumin (p less than 0.05). The administration of fat solution, either to prevent essential fatty acid deficiency or to provide part of the caloric requirements, was found to cause neither clinical nor laboratory worsening of the disease. All pancreatic fistulae that developed during the course of the disease spontaneously closed in patients receiving TPN without operation in a mean period of 33.3 days, and all pseudocysts subsided in an average of 18.3 days. Those who died (overall mortality rate 24%) had had uncontrollable sepsis, which resulted in hypercatabolism and multiple system organ failure.(ABSTRACT TRUNCATED AT 250 WORDS)