Parenteral nutrition in pediatric patients

Protein, calorie, fluid, fat, and micronutrient requirements of pediatric patients are reviewed, as are methods of nutritional assessment and complications associated with the use of parenteral nutrition in these patients. In general, preterm infants and neonates require greater per-kilogram amounts of protein, calories, fluid, and micronutrients than older children. In addition, preterm infants and neonates have deficiencies in enzymes that metabolize certain amino acids, making otherwise nonessential amino acids essential. These unique protein needs have been addressed in amino acid formulations designed specifically for this group of patients. Supplying the neonate with the calcium and phosphorus needed for bone growth can be difficult because of solubility limitations in parenteral nutrient solutions. The use of intravenous fat emulsion in infants with hyperbilirubinemia or pulmonary complications is controversial. However, only rarely does fat emulsion have to be completely withheld. Complications associated with parenteral nutrition in pediatric patients include infection, metabolic disorders (cholestasis, bone demineralization), and mechanical problems. Cholestasis induced by parenteral nutrition has been shown to be more common in low-birth-weight infants; however, the precise etiology is unknown and may be multifactorial. Basic requirements necessary to promote growth while pediatric patients are receiving parenteral nutrition have been determined. However, current studies are challenging what were thought to be standards of pediatric parenteral nutrition therapy.     

Parenteral nutrition in the critically ill patient

The metabolic alterations, nutritional and metabolic assessment, and nutritional requirements of critically ill patients are discussed, and parenteral nutrition support therapies are reviewed. Physiological alterations in the metabolism of the injured or septic patient are mediated through the interactions of neuroendocrine, cardiovascular, toxic, and starvation responses. These responses cause mobilization of nutritional substrates in an effort to maintain vital organ function and immune defenses. A patient's nutritional status can be determined from anthropometric measurements, creatinine excretion rate, and evaluations of protein stores and immune reserves and function; body weight is a poor indicator. Nitrogen-balance calculations are also useful for determining the adequacy of nutritional intake and the degree of metabolic stress. Early assessments of nutritional status may assist in identifying those patients for whom nutritional support interventions are needed. Nutritional requirements are altered by the metabolic responses to injury and sepsis. Studies suggest that use of nutrient solutions enriched for branched-chain amino acids may enhance nitrogen retention and that energy expenditures in injured or septic patients are only moderately elevated. Most nonprotein calories in parenteral nutrient solutions are provided as glucose, but lipids are an important source of energy in the critically ill patient who has high energy requirements or carbohydrate intolerance; however, clearance of lipids may be decreased. Fluid, electrolyte, and mineral status must be evaluated frequently. Critically ill patients have unique nutritional requirements, and parenteral nutrition support therapies for these patients are being investigated and refined.     

Parenteral nutrition support in patients with cancer.

In the patient with cancer, malnutrition may result from the disease itself or from its treatment. Total parenteral nutrition (TPN) has been used for many years to treat or prevent malnutrition in the patient with cancer. There have been few studies, however, that demonstrate significant benefit from TPN therapy in these patients. Patients receiving high-dose chemotherapy (as in bone marrow transplantation), and patients with solid tumors who have documented malnutrition (cachexia, weight loss) prior to cancer surgery, may benefit from TPN. No other groups of patients with cancer appear to derive significant benefit from TPN, and some groups may actually be harmed by its use. Practical considerations in the use of TPN include periodic calorie-protein assessment, electrolyte management, and monitoring for drug-TPN interactions.     

肠外营养液致右侧肢体肌力下降1例

肠外营养液输注速度过快导致患者出现右侧肢体肌力下降     

重度烧伤婴儿的肠外营养平衡的护理

目的 探讨适合婴儿重度烧伤后保护性代谢改变特点的肠外营养平衡护理方法,减少传统高热量肠外营养支持、胰岛素严格控制血糖疗法治疗重度烧伤婴儿的并发症.方法 介绍我们科室制定的低热量摄入、安全使用胰岛素的肠外营养护理方法治疗60例重度烧伤婴儿的疗效.结果 60例婴儿都抢救成功,并且并发症明显减少.结论 婴儿合成、分泌和利用胰岛素的能力较成年人差,烧伤应激时比成年人更加容易出现高血糖.高热量肠外营养（葡萄糖、氨基酸、脂肪乳等）在体内代谢时要消耗体内极其大量的氧气,加重重度烧伤婴儿的缺氧症状.婴儿胰岛素代谢障碍,胰岛素蓄积容易出现延迟的致命的低血糖.我们科室制定的所有重度烧伤婴儿的肠外营养平衡支持治疗及护理方法是根据重度烧伤后婴儿的保护性代谢改变特点来制定的.     

基于处方前置审核系统的肠外营养审核与点评实践

目的 通过优化肠外营养审核与点评模式,规范我院肠外营养处方,促进合理用药,降低医疗风险.方法 分别调取我院开展处方前置审核前后接受肠外营养治疗的患者用药信息,综合点评,比较优化审核规则和审核模式前后肠外营养处方合格率.结果 药师通过对处方前置审核系统规则库进行维护,使我院全肠外营养、补充性肠外营养处方整体不合理比例均有...     

Alcohol intake and nutrition]

This article contains summaries of our studies carried out at the society of the research "alcohol and health" with discussions on some related studies. Items included: (1) Discussions on "could alcoholic beverage regard as a nutrient?". (2) Nutrients in alcoholic bevarages. Distilled alcoholic beverages contain little nutrients except energy, while brewered alcoholic beverages contains nutritionally significant amounts of magnesium, niacin, and vitamin B2. (3) Dietary habits and alcoholics. Survey studies on researchers working at a brewing industry revieled that positive correlations were observed between intakes amounts of alcoholic beverages and intakes amounts of pulses, fishes, eggs, and seasonings and spices. While, negative correlations were observed between intake amount of confectioneries, fruits and daily products, and intake amount of alcohol. As nutrients, intakes of energy and sodium increased and intakes of dietary fibers, niacin, vitamin C, carotene, and zinc decreased in proportion to increase in alcoholic intakes. (4) Effect of alcohol intake on metabolism of nutrients. To clarify the influence of alcohol intake on nutrients metabolism, our research group carried out several animal experiments. Thiamin status evaluated by blood thiamin level and erythrocyte transketolase activity a thiamin dependent enzyme, decreased significantly by excess administration of alcohol. Effect of alcohol on metabolism of zinc, a cofactor of alcohol dehydrogenase, was not significant in our experiments, although other researchers reported that zinc metabolism was influenced by alcohol intake. In addition, we found that copper concentration in liver decreased significantly in alcohol administered rats as compared to control rats. The mechanisms concerning alcohol intakes on copper metabolism remains to be clarified.     

PICC管在肿瘤化疗患者胃肠外营养中的应用与护理

目的为肿瘤化疗患者推广使用PICC管,建立胃肠外营养支持,总结应用效果及护理方法。方法对37例化疗患者采用经外周静脉置人中心静脉管,简称PICC,应用化疗后的胃肠外营养。结果37例患者均顺利通过PICC管顺利完成胃肠外营养的治疗。结论PICC运用于肿瘤患者化疗后的胃肠外营养,解决了患者反复穿刺的痛苦,药物外渗的后顾之忧及高渗药物对外周血管的损害,提高了患者的生活质量。减轻了护士的工作量。值得推广。     

Parenteral nutrition in the management of gastrointestinal Kaposi's sarcoma in a patient with AIDS

A patient with acquired immunodeficiency syndrome (AIDS) who required aggressive nutritional intervention via home parenteral nutrition therapy is described, and nutritional status, etiology and therapeutic management of AIDS-associated malnutrition, role of nutrition support, and factors for consideration in using parenteral nutrition in AIDS patients are discussed. Parenteral nutrition therapy was initiated in a 30-year-old AIDS patient with Kaposi's sarcoma lesions of the gastrointestinal tract because of rapid weight loss, low serum protein levels, and malnutrition. He had previously undergone a small-bowel resection and a jejunojejunostomy, and radiation and antineoplastic-drug therapy was planned. During parenteral nutrition therapy, the patient demonstrated increased physical strength and was able to care for himself during most of the time spent at home or in a long-term-care facility. Aggressive measures, including parenteral nutrition therapy, were discontinued 11 days before the patient's death. Complications of therapy included one episode of sepsis and a tear in the external catheter tubing. Malabsorption and diarrhea mainly caused by gastrointestinal disease, reduced food intake because of oral and esophageal infections, adverse effects from medication, and depression are factors that can contribute to AIDS-associated malnutrition. Also, hypermetabolism resulting from infections and fevers may contribute to malnutrition in AIDS. The extent to which this malnutrition affects the underlying immune dysfunction occurring in the syndrome and the response to other more direct drug therapies in AIDS is not known. Available methods for nutritional intervention are based on clinical experience and anecdotal reports. Because of gastrointestinal disease, an oral diet, supplements, and enteral tube feedings may not meet nutritional goals for an AIDS patient.(ABSTRACT TRUNCATED AT 250 WORDS)     

Parenteral nutrition decreases hepatic dihydropyrimidine dehydrogenase activity and modulates catabolism of 5-fluorouracil in rats

BACKGROUND: Dihydropyrimidine dehydrogenase (DPD) is a rate-limiting enzyme in the catabolism of 5-fluorouracil (5-FU). The effect of parenteral nutrition (PN) on hepatic DPD activity and metabolism of 5-FU remains unknown. MATERIALS AND METHODS: Rats were divided into two groups: a sham-operated oral feeding group (FED) and a PN group. After 7-day PN infusion, hepatic DPD activity, serum 5-FU levels and thymidylate synthase (TS) levels in the jejunum and tumor were measured. RESULTS: PN administration significantly decreased hepatic DPD activities. After infusion of 5-FU (40 mg/kg body), the serum 5-FU concentration and 5-fluoro-2'-deoxyuridine-5'-monophosphate (FdUMP)-bound TS levels in the jejunum were significantly higher in the PN group than the FED group (156.8 +/- 51.9 vs 100.5 +/- 51.9 ng/ml, p < 0.001 and 38.55 +/- 7.61 vs 22.89 +/- 4.46 pmol/g of tissue, p < 0.01, respectively). In Yoshida sarcoma-bearing rats, the FdUMP-bound TS level in the tumor did not differ significantly between the PN and FED rats. CONCLUSION: PN decreases hepatic DPD activity, which may lead to increased toxicity of 5-FU.