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Sample records for parenteral solutions supplemented

  1. Compatibility considerations in parenteral nutrient solutions.

    PubMed

    Niemiec, P W; Vanderveen, T W

    1984-05-01

    Information on compatibility of nutrients and drugs with parenteral nutrient (PN) solutions is reviewed and evaluated. Precipitation of calcium phosphate when calcium and phosphate salts are added can be affected by pH, amino acid concentration, amino acid product, temperature, sequence of additives, specific salt used, and time since admixture; precipitate formation can occur gradually over 24 hours. Insulin is chemically stable in PN solutions, but adsorption to the infusion system can cause decreased availability. Poor delivery of vitamin A via PN solutions has been reported. The sodium bisulfite content of amino acid injections may cause degradation of thiamine, but studies simulating clinical use are needed. Folic acid stability in PN solutions has been demonstrated, and phytonadione appears to be stable. Drug administration via PN solutions may be advantageous when fluid intake is restricted or peripheral vein access is limited and in home PN therapy. Summarized are results of studies involving heparin, cimetidine hydrochloride, aminophylline, amphotericin B, iron dextran, hydrochloric acid, corticosteroids, narcotics, metoclopramide, digoxin, and fluorouracil. Many antibiotics are probably stable, especially when administered by co-infusion rather than by direct mixture in the PN solution container. When lipids are mixed in the same container with amino acid-dextrose solutions, compatibility and stability of electrolytes, vitamins, and trace elements must be reassessed. Practical research is needed, and availability of additives should be studied in specific patient populations and for specific PN formulations. Valid conclusions are dependent on careful study design. PMID:6328980

  2. A review of 5-hydroxymethylfurfural (HMF) in parenteral solutions.

    PubMed

    Ulbricht, R J; Northup, S J; Thomas, J A

    1984-10-01

    The chemical formation, toxicity, and pharmacokinetics of 5-hydroxymethylfurfural (HMF) and certain other decomposition products found in parenteral solutions are reviewed. Heat sterilization-induced hexose decomposition to furan derivatives is promoted at low pH. Based upon infusion studies with rats and dogs, HMF does not appear to be acutely toxic at concentrations ordinarily encountered in parenteral infusion solutions (e.g., 10 mg/liter). Dosages of parenterally administered HMF exceeding 75 mg/kg body wt have led to some toxic effects, including increased activity of hepatic enzymes, altered serum-protein fractions, increased relative spleen weight, and hepatic fatty degeneration. Approximately 50% of parenterally administered HMF is oxidized and eliminated by the kidneys. From a clinical standpoint, the amount of HMF formed as a result of the heat sterilization of parenteral solutions containing hexoses does not seem to pose any significant toxicologic problem. PMID:6391997

  3. Quantitative high-performance liquid chromatography-tandem mass spectrometry impurity profiling methods for the analysis of parenteral infusion solutions for amino acid supplementation containing L-alanyl-L-glutamine.

    PubMed

    Schiesel, Simone; Lämmerhofer, Michael; Leitner, Alexander; Lindner, Wolfgang

    2012-10-12

    Potential impurities in a parenteral infusion solution for amino acid supplementation containing alanylglutamine (AlaGln) and glycyltyrosine (GlyTyr) as peptide constituents have been determined. Such complex multicomponent pharmaceutical formulations with reactive ingredients may yield a multitude of impurities in stress testing samples. Thus, three stability indicating LC-ESI-MS/MS methods were developed for the establishment of quantitative impurity profiles employing a Chiralpak QN-AX and a Polysulfoethyl A stationary phase in HILIC mode as well as a Gemini C18 stationary phase in gradient RPLC mode. The primary goal was to separate isobaric compounds (stereoisomers, constitutional isomers, retro-peptides) and to provide quantitative data of impurities identified in stressed nutritional infusion solutions. The optimized methods were calibrated by standard addition in the samples and validated according to ICH guidelines. The methods were then applied for the analysis of stressed sample solutions stored under different conditions. Major peptide impurities found in concentrations above the qualification threshold in stressed solutions stored at 40 °C for 6 months comprised cyclo(AlaGln) 808 μg/mL, pyroGluAla 122 μg/mL, AlaGlu 117 μg/mL, cycloGlyTyr 60 μg/mL, AlaGln epimers (DL+LD) 38 μg/mL, and TyrGly 27 μg/mL. A number of impurities above the reporting threshold were also detected including AlaAlaGln 18 μg/mL, cyclo(AlaGlu) 16 μg/mL, AlaGlu(AlaGln) 17 μg/mL, and AlaGlu(His) 12 μg/mL. The study showed that bioactive peptides may be formed in amino acid infusion solutions by condensation of amino acids and a careful control of these impurities is mandatory. PMID:22305362

  4. Colorimetric determination of tobramycin in parenteral solutions.

    PubMed

    Das Gupta, V

    1988-06-01

    A colorimetric method based on a reaction between tobramycin and alkaline copper sulphate solution has been proposed to quantify tobramycin in injections. The excipients present and normal saline did not interfere with the assay procedure. A tobramycin sample which was decomposed using either sulphuric acid or sodium hydroxide solution indicated fairly good stability on both sides of the pH scale. PMID:3209627

  5. Effect of parenteral amino acid supplementation in preterm low birth weight newborn.

    PubMed

    Alo, D; Shahidullah, M; Mannan, M A; Noor, K

    2010-07-01

    This interventional study was done to determine the effect of parenteral amino acid supplementation on weight change, biochemical effect and incidence of sepsis in preterm low birth weight newborns during their hospital stay. It was carried out during the period of June 2006-May 2007 in the Newborn unit of a tertiary care hospital of Bangladesh. Sixty preterm (28-34weeks), low birth weight (1000-1800g) AGA (appropriate for gestational age) newborns were enrolled within 24 hours of birth. Intervention and control newborns were matched in terms of birth weight and gestational age. Samples were volunteers. Parenteral amino acid (5%) supplementation in addition to usual nutritional management until enteral feeding reached three fourth of total calorie intake. Usual nutritional management was 10% intravenous dextrose and subsequent enteral feeding. Main outcome measured with weight change, biochemical effect and incidence of sepsis. Weight change was observed by two parameters such as mean percentage of maximum postnatal weight loss and mean days to reach birth weight, both were significantly lower in intervention than control group (p<0.05). Biochemical effect of parenteral amino acid supplementation investigated in this study has been shown to have no effect. There was no difference in incidence of sepsis between intervention and control group (p>0.05). Improved nutritional supplementation with parenteral amino acids resulted in better growth as evident by lesser degree of weight loss and earlier regaining of birth weight in the early neonatal period. Biochemical parameters are not affected by parenteral amino acid supplementation. PMID:20639832

  6. Selected ultratrace elements in total parenteral nutrition solutions

    SciTech Connect

    Berner, Y.N.; Shuler, T.R.; Nielsen, F.H.; Flombaum, C.; Farkouh, S.A.; Shike, M. )

    1989-11-01

    Ultratrace elements are potentially essential (eg. boron, molybdenum, nickel, and vanadium) or toxic (eg, aluminum and cadmium) in humans. Long-term total parenteral nutrition (TPN) patients can inadvertently receive significant amounts of ultratrace elements present as contaminants in TPN solutions. We determined the intake of selected ultratrace elements from a standard TPN solution and compared it with the amount reported to be absorbed from food in normal subjects. Contamination of TPN solutions with ultratrace elements was widespread and variable. The daily intakes of Mo, Ni, V. and Cd from this contamination were comparable to the amounts reported to be absorbed through the gastrointestinal tract in normal subjects. Al intake was high; B intake was low, approximately 10% of the amount absorbed by normal subjects. Thus, TPN solutions are contaminated with significant amounts of ultratrace elements. The biological significance of the intravenous infusion of these ultratrace elements is unclear and requires further investigation, particularly in home TPN patients.

  7. The interaction of dopexamine with various drugs and excipients in parenteral solutions.

    PubMed

    Pereira-Rosario, R; Utamura, T; Perrin, J H

    1988-11-01

    The interaction of dopexamine hydrochloride with various excipients and other drugs in parenteral solutions has been investigated by microcalorimetry. The interaction with heparin sodium, in particular, is significant. The interaction is strongest in parenterals containing glucose and is eliminated in normal saline. Divalent cations are more effective than monovalent ones in eliminating the reaction, which is apparently ionic in nature. PMID:2907551

  8. Timing of (supplemental) parenteral nutrition in critically ill patients: a systematic review

    PubMed Central

    2014-01-01

    Supplemental parenteral nutrition (SPN) is used in a step-up approach when full enteral support is contraindicated or fails to reach caloric targets. Recent nutrition guidelines present divergent advices regarding timing of SPN in critically ill patients ranging from early SPN (<48 h after admission; EPN) to postponing initiation of SPN until day 8 after Intensive Care Unit (ICU) admission (LPN). This systematic review summarizes results of prospective studies among adult ICU patients addressing the best timing of (supplemental) parenteral nutrition (S)PN. A structured PubMed search was conducted to identify eligible articles. Articles were screened and selected using predetermined criteria and appraised for relevance and validity. After critical appraisal, four randomized controlled trials (RCTs) and two prospective observational studies remained. One RCT found a higher percentage of alive discharge from the ICU at day 8 in the LPN group compared to EPN group (p = 0.007) but no differences in ICU and in-hospital mortality. None of the other RCTs found differences in ICU or in-hospital mortality rates. Contradicting or divergent results on other secondary outcomes were found for ICU length of stay, hospital length of stay, infection rates, nutrition targets, duration of mechanical ventilation, glucose control, duration of renal replacement therapy, muscle wasting and fat loss. Although the heterogeneity in quality and design of relevant studies precludes firm conclusions, it is reasonable to assume that in adult critically ill patients, there are no clinically relevant benefits of EPN compared with LPN with respect to morbidity or mortality end points, when full enteral support is contraindicated or fails to reach caloric targets. However, considering that infectious morbidity and resolution of organ failure may be negatively affected through mechanisms not yet clearly understood and acquisition costs of parenteral nutrition are higher, the early

  9. Impact of glutathione supplementation of parenteral nutrition on hepatic methionine adenosyltransferase activity

    PubMed Central

    Elremaly, Wesam; Mohamed, Ibrahim; Rouleau, Thérèse; Lavoie, Jean-Claude

    2015-01-01

    Background The oxidation of the methionine adenosyltransferase (MAT) by the combined impact of peroxides contaminating parenteral nutrition (PN) and oxidized redox potential of glutathione is suspected to explain its inhibition observed in animals. A modification of MAT activity is suspected to be at origin of the PN-associated liver disease as observed in newborns. We hypothesized that the correction of redox potential of glutathione by adding glutathione in PN protects the MAT activity. Aim To investigate whether the addition of glutathione to PN can reverse the inhibition of MAT observed in animal on PN. Methods Three days old guinea pigs received through a jugular vein catheter 2 series of solutions. First with methionine supplement, (1) Sham (no infusion); (2) PN: amino acids, dextrose, lipids and vitamins; (3) PN-GSSG: PN+10 μM GSSG. Second without methionine, (4) D: dextrose; (5) D+180 μM ascorbylperoxide; (6) D+350 μM H2O2. Four days later, liver was sampled for determination of redox potential of glutathione and MAT activity in the presence or absence of 1 mM DTT. Data were compared by ANOVA, p<0.05. Results MAT activity was 45±4% lower in animal infused with PN and 23±7% with peroxides generated in PN. The inhibition by peroxides was associated with oxidized redox potential and was reversible by DTT. Correction of redox potential (PN+GSSG) or DTT was without effect on the inhibition of MAT by PN. The slope of the linear relation between MAT activity and redox potential was two fold lower in animal infused with PN than in others groups. Conclusion The present study suggests that prevention of peroxide generation in PN and/or correction of the redox potential by adding glutathione in PN are not sufficient, at least in newborn guinea pigs, to restore normal MAT activity. PMID:26722840

  10. Glutamine-supplemented tube feedings versus total parenteral nutrition in children receiving intensive chemotherapy.

    PubMed

    Ford, C; Whitlock, J A; Pietsch, J B

    1997-04-01

    Although enteral nutrition is generally advocated in the care of children with cancer, those patients receiving intensive chemotherapy alone or in combination with bone marrow transplantation often require total parenteral nutrition (TPN). Two patients are presented illustrating some differences between enteral and parenteral feedings in children receiving intensive chemotherapy. Nasogastric glutamine-supplemented tube feedings were well tolerated both in the hospital and at home. The cost of care for the enterally supported child was less than one third of the TPN-supported child. Although TPN appears to be beneficial in some patients with cancer, it is expensive and is associated with several significant disadvantages. Among these are an increased incidence of both gram-positive and gram-negative infections and an increased incidence of gastrointestinal symptoms. Enteral nutrition is less costly than TPN and maintains the structural and functional integrity of the intestinal mucosa. The addition of certain substrates such as glutamine, arginine and omega-3 fatty acids may improve the body's immune response as well. We hypothesize that early glutamine supplemented tube feedings in children receiving intensive chemotherapy alone or in combination with bone marrow transplantation will result in improved nutrition with fewer infections and lower cost than TPN-supplemented patients. In addition, a shorter hospital stay and improved quality of life are anticipated. PMID:9144976

  11. Glutamine-Supplemented Parenteral Nutrition and Probiotics in Four Adult Autoimmune Enteropathy Patients

    PubMed Central

    Xu, Ren-Ying; Zhou, Yi-Quan; Lu, Li-Ping; Chen, Zhi-Qi; Wu, Ying-Jie; Cai, Wei

    2014-01-01

    To evaluate the effects of glutamine-supplemented parenteral nutrition (PN) and probiotics in adult autoimmune enteropathy (AIE) patients. Four adult AIE patients were identified from April 2006 to January 2012. Clinical and nutritional data were obtained from the patients' medical records. Glutamine-supplemented PN started immediately when the AIE diagnosis was confirmed. The total PN duration was 351 days. According to the PN prescription, the average caloric intake ranged from 20 to 25 kcal/kg/day, and the protein intake ranged from 1.2 to 1.5 g/kg/day. Alanyl-glutamine (20 g/day) was administered to AIE patients for 4 weeks followed by a 2-week break, and this treatment schedule was repeated when PN lasted for more than 6 weeks. Body weight gain and an increased serum albumin level were achieved after PN, and defecation frequency and quality also improved. Each patient received oral supplements, 250 mL of Ensure and two probiotics capsules (each capsule containing 0.5×108 colonies) three times a day when enteral nutrition started. Three AIE patients were successfully weaned off PN, and one patient died of pneumonia. Glutamine-supplemented PN and probiotics show promise in managing patients with AIE and related malnutrition. PMID:24827631

  12. Supplemental Parenteral Nutrition Is the Key to Prevent Energy Deficits in Critically Ill Patients.

    PubMed

    Oshima, Taku; Heidegger, Claudia-Paula; Pichard, Claude

    2016-08-01

    This review emphasizes the role of a timely supplemental parenteral nutrition (PN) for critically ill patients. It contradicts the recommendations of current guidelines to avoid the use of PN, as it is associated with risk. Critical illness results in severe metabolic stress. During the early phase, inflammatory cytokines and mediators induce catabolism to meet the increased body energy demands by endogenous sources. This response is not suppressed by exogenous energy administration, and the early use of PN to reach the energy target leads to overfeeding. On the other hand, early and progressive enteral nutrition (EN) is less likely to cause overfeeding because of variable gastrointestinal tolerance, a factor frequently associated with significant energy deficit. Recent studies demonstrate that adequate feeding is beneficial during and after the intensive care unit (ICU) stay. Supplemental PN allows for timely adequate feeding, if sufficient precautions are taken to avoid overfeeding. Indirect calorimetry can precisely define the adequate energy prescription. Our pragmatic approach is to start early EN to progressively test the gut tolerance and add supplemental PN on day 3 or 4 after ICU admission, only if EN does not meet the measured energy target. We believe that supplemental PN plays a pivotal role in the achievement of adequate feeding in critically ill patients with intolerance to EN and does not cause harm if overfeeding is avoided by careful prescription, ideally based on energy expenditure measured by indirect calorimetry. PMID:27256992

  13. System for creating on site, remote from a sterile environment, parenteral solutions

    NASA Technical Reports Server (NTRS)

    Finley, Mike (Inventor); Scharf, Mike (Inventor); Packard, Jeff (Inventor); Kipp, Jim (Inventor); Dudar, Tom (Inventor); Owens, Jim (Inventor); Bindokas, Al (Inventor)

    1996-01-01

    The present invention provides a system and method for creating on site, remote from a sterile environment, parenteral solutions in large volume parenteral containers for intravenous administration to a patient. In an embodiment, this system comprises an empty large volume container including at least one port for accessing an interior of the container. The port includes a sterilizing filter for sterilizing a fluid fed through the port into the container. A second container is provided including a solute and having means for coupling the second container to the large volume container and thereby providing fluid communication therebetween allowing the solute to be received within the interior of the container. A sterile water source is also provided including means for placing the sterile water source in fluid communication with the port and allowing water to flow from the sterile water source into the interior of the container. This allows the solute, and sterile water that has been fed through the filter, to create a parenteral solution in the large volume parenteral container.

  14. System for creating at a site, remote from a sterile environment, a parenteral solution

    NASA Technical Reports Server (NTRS)

    Scharf, Mike (Inventor); Finley, Mike (Inventor); Veillon, Joe (Inventor); Kipp, Jim (Inventor); Dudar, Tom (Inventor); Owens, Jim (Inventor); Ogle, Jim (Inventor)

    1996-01-01

    The present invention relates to a container, system, and method for creating parenteral solutions at a site, remote from sterile environments. The system includes a flexible container that is empty except for a prepackaged amount of a solute that is housed in the interior of the container. The container includes at least one port and a sterilizing filter in communication with an interior of the port. The container is so constructed and arranged that a fluid flow path is created from the port through the filter and into the interior of the container. A sterile water source including means for establishing fluid flow from the sterile water source into the port is provided. Accordingly, sterile water can flow from the sterile water source through the filter into the container where it is mixed with the solute to create a parenteral solution that can then be infused into a patient. A method and container are also provided.

  15. Toxicity potential of compounds found in parenteral solutions with rubber stoppers

    SciTech Connect

    Danielson, J.W. )

    1992-03-01

    Leached stopper components found in parenteral solutions produced by several manufacturers were identified and quantitated. Their toxicity potential was determined by comparing the types and quantities of the leached components with known toxicity levels and/or harmful effects. Toxicity potentials for benzaldehyde, 2-butoxyethanol, cyclohexanone, ethylbenzene, 1,1,2,2-tetrachloroethane, and tetrachloroethylene are listed. Breakdown products of dextrose (furfural and 5-hydroxymethylfurfural), which may also have harmful effects, were quantitated.

  16. Pleural effusion with parenteral nutrition solution: an unusual complication of an "appropriately" placed umbilical venous catheter.

    PubMed

    Pabalan, Maria Janina U; Wynn, Ralph J; Reynolds, Anne Marie; Ryan, Rita M; Youssfi, Mostafa; Manja, Veena; Lakshminrusimha, Satyan

    2007-11-01

    Pleural effusion is not an uncommon complication of percutaneous intravenous catheters in neonates. Umbilical venous catheters (UVCs) are associated with pleural effusion following abnormal placement in the left atrium or pulmonary veins due to venous obstruction. We report for the first time a case of right-sided pleural effusion with parenteral nutrition solution following a UVC that appeared to be positioned appropriately in the inferior vena cava. PMID:17972230

  17. Effect of phosphate buffer concentration on the heat resistance of Bacillus stearothermophilus spores suspended in parenteral solutions.

    PubMed

    Gauthier, C A; Smith, G M; Pflug, I J

    1978-09-01

    The effect of various quantities of Butterfield phosphate buffer added to four parenteral solutions on the survival of Bacillus stearothermophilus spores heated at 121 degrees C was determined. The effect of the addition of phosphate buffer on spore survival varied with the parenteral solution. Spore survival was increased or decreased, depending upon the composition of the parenteral solution and the buffer concentration. The results obtained in these experiments attest to the fact that environmental factors, including the type of ions present and ionic concentration, affect the heat destruction rate of B. stearothermophilus spores. Therefore, the sterilization requirements of a product such as a parenteral solution may be affected by small changes in formulation. PMID:727778

  18. Effect of phosphate buffer concentration on the heat resistance of Bacillus stearothermophilus spores suspended in parenteral solutions.

    PubMed Central

    Gauthier, C A; Smith, G M; Pflug, I J

    1978-01-01

    The effect of various quantities of Butterfield phosphate buffer added to four parenteral solutions on the survival of Bacillus stearothermophilus spores heated at 121 degrees C was determined. The effect of the addition of phosphate buffer on spore survival varied with the parenteral solution. Spore survival was increased or decreased, depending upon the composition of the parenteral solution and the buffer concentration. The results obtained in these experiments attest to the fact that environmental factors, including the type of ions present and ionic concentration, affect the heat destruction rate of B. stearothermophilus spores. Therefore, the sterilization requirements of a product such as a parenteral solution may be affected by small changes in formulation. PMID:727778

  19. Effect of parenterally l-arginine supplementation on the respiratory distress syndrome in preterm newborns.

    PubMed

    Cansever, Murat; Akin, Mustafa Ali; Akcakus, Mustafa; Ozcan, Alper; Gunes, Tamer; Ozturk, Adnan; Kurtoglu, Selim

    2016-07-01

    l-Arginine (l-Arg) is the precursor of nitric oxide which plays an important role on pulmonary circulation and pulmonary vascular tone. Earlier studies suggested that l-Arg levels in preterm newborns with respiratory distress syndrome (RDS) were low due to its consumption and l-Arg supplementation may reduce the severity of RDS. Our aim was detect the effect of the parenterally l-Arg supplementation on RDS severity. The subjects were chosen between preterm newborns (gestational age <34 weeks) (n = 30). Twenty of the subjects were diagnosed with permaturity and RDS, and 10 of the subjects were healthy preterm newborns. Ten of the subjects was taken l-Arg (1.5 mmol/kg/d) in addition to routine RDS treatment and assumed as "Group 1". In this group, daily l-Arg supplementation was started end of the first day, and continued at end of fifth day. The others of the subjects diagnosed with RDS was take routine RDS treatment and assumed as "Group 2". Healthy preterm newbors assumed as "Group 3". Blood collections for l-Arg levels via tandem mass spectrometry were made in first day and repeated on the seventh days. Oxygenation index was used to determine severity of RDS. l-Arg consentrations in Group 1 were 8.7 ± 4.1 μM/L and 11.9 ± 5.0 μM/L in first and seventh day, respectively. l-Arg consentrations were 12.6±4.5 μM/Land 10.9 ± 5.4 μM/L in Group 2 and 8.6 ± 5.1 μM/L and 9.4 ± 4.1 μM/L in Group 3. There is no correlation between l-Arg concentrations and OI also duration of the mechanical ventilation of the subjects in patient groups (Group 1 and 2). PMID:26365434

  20. [Levels of contaminant zinc in solutions routinely used in rehydration and/or parenteral feeding].

    PubMed

    Hering, S E; Cupo, P; Trivelato, T M; Ottoboni, M A; Franco, L M

    1986-01-01

    With the objective to evaluate the zinc needs of children submitted to rehydration and/or parenteral nutrition, the content of contaminating zinc was determined in intravenous solutions utilized at University Hospital of Ribeirão Preto, SP, Brazil. Zinc was measured in 40 bottles containing deionized water and submitted to the routine treatment for industrialization of serum for parenteral use, according to the standards of the University Hospital of Ribeirão Preto, Industrial Pharmacy. The effect of the sealing material employed (polished red stopper and unpolished black stopper) was observed, as well as time of contact between the solutions and rubber stoppers and latex slides, and the method of bottle conditioning (vertical or horizontal position) which permits contact of the solutions with the rubber stoppers. The gluco-saline solutions prepared in our Hospital and stored in glass bottles with unpolished black rubber stoppers and latex slide showed substantial zinc levels (1,220 to 4,860 micrograms/ml, n = 30). The same solutions kept in glass vials or plastic bottles were zinc free. The highest zinc levels were observed in the amino acid solutions placed in sealed bottles with unpolished black rubber stoppers (11,690 to 24,310 micrograms/ml, n = 20). It is important to be aware of these contaminating zinc levels to provide proper treatment involving this micronutrient. PMID:3098212

  1. Determination of solute-polymer interaction properties and their application to parenteral product container compatibility evaluations.

    PubMed

    Kenley, R A; Jenke, D R

    1990-09-01

    Kinetic and thermodynamic interaction properties between dialkyl phthalate test compounds and a polyolefin polymer were examined via a permeation-cell experimental design. Disappearance and appearance rates of solute in the receptor and donor solutions, as well as the equilibrium composition of the test system, are used to determine sorption and diffusion coefficients and the solute/polymer equilibrium binding constant. Sorption rate constants and diffusion coefficients exhibit Arrenhius-type behavior. The binding constants obtained correlate well with the solute's octanol-water partition coefficient. The kinetic and thermodynamic data generated combine with proposed interaction models to identify solute/polymer interactions (binding and leaching) pertinent to evaluating container/solution compatibility for parenteral products. PMID:2235889

  2. Assessment of vitamin and trace element supplementation in severely burned patients undergoing long-term parenteral and enteral nutrition.

    PubMed

    Perro, G; Bourdarias, B; Cutillas, M; Higueret, D; Sanchez, R; Iron, A

    1995-10-01

    The efficacy of an oral supplement of vitamins and trace elements during a longterm artificial parenteral and enteral nutrition was investigated for 3 months in patients with extensive burns. Thirty severely burned patients (22 male, 8 female, age 41 +/- 18 years, range 23-59 years, 33 +/- 12% total body surface area burn, 22% +/- 8 full thickness burn surface area) were included. Every 10 days, from day 10 until day 90, we determined serum levels of: *vitamins B1, B12, A, E, *folic acid, *copper, zinc, iron, *transferrin, albumin, prealbumin, total proteins, *fibronectin, retinol binding protein (RBP), *calcium, *phosphorus, *triglycerides, *total cholesterol, *C reactive protein (CRP), *erythrocyte folic acid. The mean daily nutritional support was 60 Kcals and 0.4 g N per kg of body weight, 70% enterally and 30% parenterally administered, with enteral vitamin and trace element supplementation. On day 10, there was a decrease of the serum level of 19/20 parameters. For 8 parameters (vitamin A, total cholesterol, iron, transferrin, fibronectin, phosphorus, RBP, total proteins), the level was lower than usual. Between day 10 and day 20, a significant normalization of 6 of them was noted, the average levels of transferrin and iron remaining below normal values until day 50. There was a significant decrease in C-reactive protein levels, however above normal limits. No deficiency in vitamins or trace elements was found. Cyclic variations of serum levels occurred which may be more related to volemic, hydroelectrolytic, endocrine and inflammatory disorders than to nutritional problems. PMID:16843945

  3. Effect of Ginkgo leaf parenteral solution on blood and cochlea antioxidant and immunity indexes in OM rats.

    PubMed

    Zhao, Jiandong; Su, Yu; Chen, Aiting; Yuan, Hu; Liu, Liangfa; Wu, Wenming

    2011-01-01

    Oxidative stress is involved in the development and progression of otitis media (OM). In this study, we investigated the effect of Ginkgo leaf parenteral solution on blood and cochlea antioxidant and immunity indexs in OM rats. In OM model rats, blood and cochlea malondialdehyde (MDA), nitric oxide (NO), tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8) and interleukin-10 (IL-10) levels were significantly increased, whereas antioxidant enzymes activities (superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) and glutathione reductase (GR)) were significantly decreased compared with normal rats. Treatment with Ginkgo leaf parenteral solution restored the altered parameters in a dose-dependent manner. We conclude that Ginkgo leaf parenteral solution confers protection against oxidative injuries in OM rats by increasing activities of antioxidants and immunity, suggesting a potential drug for the prevention and therapy of OM. PMID:22173336

  4. Capillary GC analysis of compounds leached into parenteral solutions packaged in plastic bags

    SciTech Connect

    Snell, R.P. )

    1989-09-01

    A number of investigators have reported finding the plasticizer di(2-ethylhexyl)phthalate in plasma, urine, and parenteral solutions. These findings have been associated with the use of polyvinyl chloride packaging materials. Capillary gas chromatography--mass spectrometry, packed column gas chromatography, and high-performance liquid chromatography were used for the analyses. The screening procedure described herein accurately and quantitatively analyzes the plasticizers di(2-ethylhexyl)phthalate and dibutylphthalate and some of the degradation products plus 2,6-di-tert-butyl-p-cresol and cyclohexanone. Liquid--liquid extraction followed by capillary gas chromatography is used. Linear regression analysis of standard solutions gives correlation coefficients from 0.99963 to 0.99989 for six compounds. Recoveries for these compounds vary from 84.9% to 114% with relative standard deviations ranging from 2.51% to 6.33%.

  5. Parenteral approaches in malabsorption: Home parenteral nutrition.

    PubMed

    Wanten, Geert J A

    2016-04-01

    Severe malabsorption of fluids and nutrients leads to intestinal failure (IF) where intravenous supplementation of nutrients and fluids is necessary to maintain health and/or growth. Long-term treatment of IF implies the start of intravenous support in the outpatient setting (home parenteral nutrition, HPN). Although HPN has proven lifesaving for many patients for more than four decades this strategy remains associated with complications that compromise the quality of life. Many problems relate to the presence of the venous access device and concern infections or vascular occlusion due to thrombosis. Patient training remains key to prevent these complications. Also metabolic problems may arise that involve liver function or composition or bone mineralization. While intestinal transplantation remains inferior to HPN as alternative treatment strategy in terms of survival, promising developments include the introduction of hormones that promote intestinal adaptation, mixed lipid emulsions that decrease liver problems and catheter lock solutions that prevent infections. PMID:27086893

  6. Parenteral Nutrition Supplementation in Biliary Atresia Patients Listed for Liver Transplantation”

    PubMed Central

    Sullivan, Jillian S; Sundaram, Shikha S; Pan, Zhaoxing; Sokol, Ronald J

    2011-01-01

    Objective To determine the impact of parenteral nutrition (PN) on outcomes in biliary atresia (BA) patients listed for liver transplantation (LTx). Study Design We retrospectively reviewed charts of all BA patients from 1990 through 2010 at our institution, s/p hepatoportoenterostomy, ≤ 36 months old, and listed for LTx. Initiation of PN was based on clinical indications. Results 25 PN and 22 non-PN subjects (74% female) were studied. Median PN initiation age was 7.7 months, mean duration 86 days, and mean PN energy supplied 77 kcal/kg/day. Prior to PN, triceps skinfold thickness (TSF) and mid-arm circumference (MAC) Z-scores were decreasing. After PN, TSF (p=0.003) and MAC (p<0.0001) improved significantly. The PN group had lower MAC and TSF than non-PN at time of LTx listing. Between listing and LTx, MAC and TSF improved in PN and worsened in non-PN such that both groups had the same Z-scores at LTx. PN group had a higher incidence of GI bleeding and ascites pre-LTx, but there was no difference in pre-LTx bacteremia, and post-LTx days in ICU and patient or graft survival. Conclusions PN improves nutritional status in malnourished BA patients awaiting LTx, which is associated with post-LTx outcomes comparable to those not requiring PN. PMID:21987426

  7. Moist-heat sterilization and the chemical stability of heat-labile parenteral solutions.

    PubMed

    Li, L C; Parasrampuria, J; Bommireddi, A; Pec, E; Dudleston, A; Mayoral, J

    1998-01-01

    The impact of moist-heat sterilization (autoclaving) on the chemical stability of parenteral solutions was examined using two heat-labile products, clindamycin phosphate and succinylcholine chloride injections, as examples. A nonisothermal kinetic model was used to predict the extent of product degradation during autoclaving. The predicted results were found to be in close agreement with the experimental data. For the same peak temperature, a greater loss of product was shown by using a cycle with a higher F0. On the other hand, a higher peak-temperature cycle resulted in less product degradation for the same F0 value. The benefit of a high-temperature cycle was further illustrated by the fact that less chemical degradation for both products was produced by a 122 degrees C cycle with an F0 of 11 as compared to that which occurred during a 116.5 degrees C cycle with an F0 of 8. Although clindamycin phosphate was found to be highly unstable during a conventional autoclaving process, predicted data indicate that a UHT (Ultra-High Temperature) process may be used to sterilize this product with acceptable degradation. PMID:15605602

  8. Evaluation of official instrumental methods for the determination of particulate matter contamination in large volume parenteral solutions.

    PubMed

    Montanari, L; Pavanetto, F; Conti, B; Ponci, R; Grassi, M

    1986-11-01

    The distribution pattern of particle contamination in nine different types of LV parenteral solutions and the possibility of correlating the counts made with two official instruments (Coulter Counter and HIAC) were studied. Two hundred containers of LV parenteral solutions (corresponding to 40 batches) produced in Italy, were sampled. Each bottle was submitted to HIAC and Coulter Counter countings, for particle sizes ranging between 2 and 25 micron. For about 50% of the products, the two straight lines that represent the distribution of particle contamination obtained with the two methods did not cross-over within the studied size range, the Coulter Counter counts always proving higher than the HIAC ones. In the other cases, the cross-over point of the two lines occurred at varying size levels. Statistical analysis of the results pointed to a relationship between the contamination values obtained with the two counting methods for sizes ranging between 2 and 5 micron, but there was no correlation for sizes equal to, or higher than, 10 micron. From the maximum contamination levels established by the BP and the FU IX for the HIAC method, the corresponding values were calculated for the Coulter Counter method. Similarly the values were calculated the HIAC method based on the maximum values set for the Coulter Counter. PMID:2879006

  9. Stability-indicating HPLC method for the determination of the stability of oxytocin parenteral solutions prepared in polyolefin bags.

    PubMed

    Kaushal, G; Sayre, B E; Prettyman, T

    2012-02-01

    Oxytocin is very commonly used in clinical settings and is a nonapeptide hormone that stimulates the contraction of uterine smooth muscles. In this study the stability of extemporaneously compounded oxytocin solutions was investigated in polyolefin bags. The sterile preparations of oxytocin were compounded to the strength of 0.02 U/mL in accordance with United States Pharmacopeia (USP) <797> standards. In order to carry out the stability testing of these parenteral products, the solutions were stored under three different temperature conditions of -20°C (frozen), 2-6°C (refrigerated), and 22-25°C (room temperature). Three solutions from each temperature were withdrawn and were assessed for stability on days 0, 7, 15, 21, and 30 as per the USP guidelines. The assay of oxytocin was examined by an HPLC method at each time point. No precipitation, cloudiness or color change was observed during this study at all temperatures. The assay content by HPLC revealed that oxytocin retains greater than at least 90% of the initial concentrations for 21 days. There was no significant change in pH and absorbance values for 21 days under all the conditions of storage. Oxytocin parenteral solutions in the final concentration of 0.02 U/mL and diluted in normal saline are stable for at least 30 days under frozen and refrigerated conditions for 30 days. At the room temperature, the oxytocin solutions were stable for at least 21 days. The stability analysis results show that the shelf-life of 21 days observed in this study was far better than their recommended expiration dates. PMID:22460429

  10. The Technical and Financial Effects of Parenteral Supplementation with Selenium and Vitamin E during Late Pregnancy and the Early Lactation Period on the Productivity of Dairy Cattle.

    PubMed

    Bayril, T; Yildiz, A S; Akdemir, F; Yalcin, C; Köse, M; Yilmaz, O

    2015-08-01

    This study aimed to determine the effects of parenteral selenium (Se) and vitamin E supplementation on economic impact, milk yield, and some reproductive parameters in high-yield dairy cows in the dry period and in those at the beginning of lactation. At the beginning of the dry period, cows (n = 323) were randomly divided into three groups as follows: Treatment 1 (T1), Treatment 2 (T2), and Control (C). Cows in group T1 received this preparation 21 days before calving and on calving day, and cows in group T2 received it only on calving day. The cows in the control group did not receive this preparation. Supplementation with Se increased Se serum levels of cows treated at calving day (p<0.05). Differences in milk yield at all weeks and the electrical conductivity values at the 8th and 12th weeks were significant (p<0.05). Supplementation with Se and Vitamin E decreased the incidence of metritis, the number of services per conception and the service period, but had no effects on the incidence of retained fetal membrane. A partial budgeting analysis indicated that Se supplementation was economically profitable; cows in group T1 averaged 240.6$ per cow, those in group T2 averaged 224.6$ per cow. Supplementation with Se and Vitamin E has been found to increase serum Se levels, milk yield, and has positive effects on udder health by decreasing milk conductivity values and incidence of sub-clinical mastitis. PMID:26104521

  11. The Technical and Financial Effects of Parenteral Supplementation with Selenium and Vitamin E during Late Pregnancy and the Early Lactation Period on the Productivity of Dairy Cattle

    PubMed Central

    Bayril, T.; Yildiz, A. S.; Akdemir, F.; Yalcin, C.; Köse, M.; Yilmaz, O.

    2015-01-01

    This study aimed to determine the effects of parenteral selenium (Se) and vitamin E supplementation on economic impact, milk yield, and some reproductive parameters in high-yield dairy cows in the dry period and in those at the beginning of lactation. At the beginning of the dry period, cows (n = 323) were randomly divided into three groups as follows: Treatment 1 (T1), Treatment 2 (T2), and Control (C). Cows in group T1 received this preparation 21 days before calving and on calving day, and cows in group T2 received it only on calving day. The cows in the control group did not receive this preparation. Supplementation with Se increased Se serum levels of cows treated at calving day (p<0.05). Differences in milk yield at all weeks and the electrical conductivity values at the 8th and 12th weeks were significant (p<0.05). Supplementation with Se and Vitamin E decreased the incidence of metritis, the number of services per conception and the service period, but had no effects on the incidence of retained fetal membrane. A partial budgeting analysis indicated that Se supplementation was economically profitable; cows in group T1 averaged 240.6$ per cow, those in group T2 averaged 224.6$ per cow. Supplementation with Se and Vitamin E has been found to increase serum Se levels, milk yield, and has positive effects on udder health by decreasing milk conductivity values and incidence of sub-clinical mastitis. PMID:26104521

  12. Parenteral nutrition.

    PubMed

    Thibault, Ronan; Pichard, Claude

    2013-01-01

    Parenteral nutrition (PN) is a technique of nutritional support, which consists of intravenous administration of macronutrients (glucose, amino acids, and triglycerides), micronutrients (vitamins and trace elements), water, and electrolytes. Early studies indicate that the use of total PN was associated with increased mortality and infectious morbidity. These detrimental effects of PN were related to hyperglycemia and overfeeding at a period when PN was administered according to the principle that the higher calories the patients received, the better their outcome would be. Enteral nutrition (EN) then replaced PN as the gold standard of nutritional care in the intensive care unit (ICU). However, EN alone is frequently associated with insufficient energy coverage, and subsequent protein-energy deficit is correlated with a worse clinical outcome. Infectious and metabolic complications of PN could be prevented if PN is used by a trained team using a validated protocol, only when indicated, not within the first 2 days following ICU admission, and limited through the time. In addition, energy delivery has to be matched to the energy target, and adapted glucose control should be obtained. In patients with significant energy deficit (>40%), the combination of PN and EN, i.e. supplemental PN, from day 4 of the ICU stay, could improve the clinical outcome of ICU patients as compared with EN alone. Therefore, PN should be integrated in the management of ICU patients with the aim of prevent the worsening of energy deficits, allowing the preservation of lean body mass loss, and reducing the risk of undernutrition-related complications. PMID:23075587

  13. Parenteral nutrition.

    PubMed

    Inayet, N; Neild, P

    2015-03-01

    Over the last 50 years, parenteral nutrition has been recognised as an invaluable and potentially lifesaving tool in the physician's arsenal in the management of patients with intestinal failure or inaccessibility; however, it may also be associated with a number of potentially life-threatening complications. A recent NCEPOD report (2010) identified a number of inadequacies in the overall provision and management of parenteral nutrition and recommendations were made with the aim of improving clinical practice in the future. This paper focuses on the practical aspects relating to parenteral nutrition for adults, including important concepts, such as patient selection, as well as general management. We also explore the various pitfalls and potential complications and how these may be minimised. PMID:25874831

  14. Multiparametric Flow System for the Automated Determination of Sodium, Potassium, Calcium, and Magnesium in Large-Volume Parenteral Solutions and Concentrated Hemodialysis Solutions

    PubMed Central

    Pistón, Mariela; Dol, Isabel

    2006-01-01

    A multiparametric flow system based on multicommutation and binary sampling has been designed for the automated determination of sodium, potassium, calcium, and magnesium in large-volume parenteral solutions and hemodialysis concentrated solutions. The goal was to obtain a computer-controlled system capable of determining the four metals without extensive modifications. The system involved the use of five solenoid valves under software control, allowing the establishment of the appropriate flow conditions for each analyte, that is, sample size, dilution, reagent addition, and so forth. Detection was carried out by either flame atomic emission spectrometry (sodium, potassium) or flame atomic absorption spectrometry (calcium, magnesium). The influence of several operating parameters was studied. Validation was carried out by analyzing artificial samples. Figures of merit obtained include linearity, accuracy, precision, and sampling frequency. Linearity was satisfactory: sodium, r 2 >0.999 ( 0.5 – 3.5 g/L), potassium, r 2 >0.996 (50–150 mg/L), calcium, r 2 >0.999 (30–120 mg/L), and magnesium, r 2 >0.999 (20–40 mg/L). Precision ( s r , %, n=5 ) was better than 2.1 %, and accuracy (evaluated through recovery assays) was in the range of 99.8 %– 101.0 % (sodium), 100.8 – 102.5 % (potassium), 97.3 %– 101.3 % (calcium), and 97.1 %– 99.8 % (magnesium). Sampling frequencies ( h −1 ) were 70 (sodium), 75 (potassium), 70 (calcium), and 58 (magnesium). According to the results obtained, the use of an automated multiparametric system based on multicommutation offers several advantages for the quality control of large-volume parenteral solutions and hemodialysis concentrated solutions. PMID:17671619

  15. Cloud point extraction of vanadium in parenteral solutions using a nonionic surfactant (PONPE 5.0) and determination by flow injection-inductively coupled plasma optical emission spectrometry.

    PubMed

    Wuilloud, Gustavo M; de Wuilloud, Jorgelina C A; Wuilloud, Rodolfo G; Silva, Maria F; Olsina, Roberto A; Martinez, Luis D

    2002-10-16

    A preconcentration and determination methodology for vanadium at trace levels in parenteral solutions was developed. Cloud point extraction was successfully employed for the preconcentration of vanadium prior to inductively coupled plasma atomic optical emission spectrometry (ICP-OES) coupled to a flow injection (FI) system. The vanadium was extracted as vanadium-2-(5-bromo-2-pyridylazo)-5-diethylaminophenol [V-(5-Br-PADAP)] complex, at pH 3.7 mediated by micelles of the nonionic surfactant polyoxyethylene (5.0) nonylphenol (PONPE 5.0). The extracted surfactant-rich phase (100 mul) was mixed with 100 mul of ethanol and this final volume injected into ICP-OES for the vanadium determination. Under these conditions, the 50 ml sample solution preconcentration allowed raising an enrichment factor of 250-fold; however, it was possible to obtain a theoretical enrichment factor of 500-fold. The lower limit of detection (LOD) obtained under the optimal conditions was 16 ng l(-1). The precision for 10 replicate determinations at the 2.0 mug l(-1) V level was 2.3% relative standard deviation (RSD), calculated with the peak heights. The calibration graph using the preconcentration system for vanadium was linear with a correlation coefficient of 0.9996 at levels near the detection limits up to at least 50 mug l(-1). The method was successfully applied to the determination of vanadium in parenteral solution samples. PMID:18968790

  16. Parenteral drug products containing aluminum as an ingredient or a contaminant: Response to Food and Drug Administration notice of intent and request for information. ASCN/A. S. P. E. N. Working Group on Standards for Aluminum Content of Parenteral Nutrition Solutions

    SciTech Connect

    Not Available

    1991-03-01

    Aluminum remains a significant contaminant of total parenteral nutrition (TPN) solutions and may be elevated in bone, urine, and plasma of infants receiving TPN. Aluminum accumulation in tissues of uremic patients and adult TPN patients has been associated with low-turnover bone disease. Furthermore, aluminum has also been linked with encephalopathy and anemia in uremic patients and with hepatic cholestasis in experimental animals. Because of the toxic effects of aluminum, the Food and Drug Administration (FDA) recently published a notice of intent to set an upper limit of 25 micrograms/L for aluminum in large-volume parenterals and to require manufacturers of small-volume parenterals, such as calcium and phosphate salts, to measure aluminum content and note this content on the package label. The ASCN/A.S.P.E.N. Working Group on Standards for Aluminum Content of Parenteral Nutrition Solutions supports these intentions and further urges the FDA to require that cumulative aluminum intake in terms of safe, unsafe, and toxic quantities of aluminum per kilogram be made known to physicians and pharmacists preparing the TPN solutions, to ensure that manufacturers use appropriate control procedures in aluminum measurements, and to employ a standard unit of aluminum measurement.

  17. Glutamine supplementation.

    PubMed

    Wernerman, Jan

    2011-01-01

    Intravenous glutamine supplementation is standard care when parenteral nutrition is given for critical illness. There are data of a reduced mortality when glutamine supplementation is given. In addition, standard commercial products for parenteral nutrition do not contain any glutamine due to glutamine instability in aqueous solutions. For the majority of critical ill patients who are fed enterally, the available evidence is insufficient to recommend glutamine supplementation. Standard formulation of enteral nutrition contains some glutamine: 2-4 g/L. However, this dose is insufficient to normalize glutamine plasma concentration.Plasma concentration of glutamine is low in many patients with critical illness and a low level is an independent risk factor for mortality. A low plasma glutamine concentration is the best indicator of glutamine depletion. Data are emerging about how the endogenous production of glutamine is regulated. We know that skeletal muscle is the major producer of glutamine and that a part of the profound depletion of skeletal muscle seen in critical illness is a reflection of the need to produce glutamine.Glutamine is utilized in rapidly dividing cells in the splanchnic area. Quantitatively most glutamine is oxidized, but the availability of glutamine in surplus is important for the de novo synthesis of nucleotides and necessary for cell division and protein synthesis. More knowledge about the regulation of the endogenous production of glutamine is needed to outline better guidelines for glutamine supplementation in the future. PMID:21906372

  18. Evaluation of a simple method for visual detection of microprecipitates in blends of parenteral drug solutions using a focused (tyndall) light beam.

    PubMed

    Veggeland, Turid; Brandl, Martin

    2010-01-01

    The formation of microprecipitates (sub visible particles) is a critical factor when blending parenteral drug solutions prior to or during intravenous administration to a patient. In cases where compatibility is not documented, analytical screening of such mixtures for physical incompatibility would give a safer foundation for secure administration of such blends to patients. The aim of this article is to report our experiences with visual screening using a focused (Tyndall) light beam for the detection of micro precipitates within blends of drug solutions, a method which may be used in any hospital pharmacy without use of advanced analytical instrumentation. A selection of clinically applied drug solutions was tested for precipitation upon blending in a proportion of 1:1. In order to reduce potential background particle burden, the solutions were filtered through 0.2 micrometer pore size filters prior to mixing. To detect potential precipitation, the solutions were visually inspected using two different types of focused light beams, a 75-watt white, focused light source and a HeNe pocket laser-pointer, for light scattering. For comparison, a light obscuration particle counter test was performed as described in the European Pharmacopeia. An experimental set-up is described, and a detailed protocol is suggested for a method able to detect micro precipitates in drug solution blends by using focused (Tyndall) light. The performance of this method for selected blends is reported in comparison to the Pharmacopeial light obscuration particle count test. Despite the fact that visual inspection using Tyndall light is a simple and low-cost method, it was found sensitive for detecting minute amounts of sub visible particles with detection sensitivity close to the light obscuration particle counting limits stated by the European Pharmacopeia. In cases where an electronic particle counter is not accessible, a sensitive warning signal may be obtained from this approach

  19. 78 FR 40474 - Sustaining Power Solutions LLC; Supplemental Notice That Initial Market-Based Rate Filing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-05

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Sustaining Power Solutions LLC; Supplemental Notice That Initial Market... in the above-referenced proceeding, of Sustaining Power Solutions LLC's application for...

  20. Total parenteral nutrition - infants

    MedlinePlus

    Total parenteral nutrition (TPN) is a method of feeding that bypasses the gastrointestinal tract. Fluids are given into a vein to ... babies. It can provide a better level of nutrition than regular intravenous (IV) feedings, which provide only ...

  1. Total parenteral nutrition

    MedlinePlus

    Total parenteral nutrition (TPN) will help you or your child get nutrition from a special formula through a vein in the ... you can also eat and drink while getting nutrition from TPN. Your nurse will teach you how ...

  2. The effect of oral and parenteral vitamin D supplementation in the elderly: a prospective, double-blinded, randomized, placebo-controlled study.

    PubMed

    Sakalli, Hakan; Arslan, Didem; Yucel, Ahmet Eftal

    2012-08-01

    Hypovitaminosis D in the elderly causes falls and fractures as a result of impaired neuromuscular functions and also may be a reason for nonspecific musculosceletal pain. The aim of this study is to investigate the benefits of a single dose per os or parenterally administrated vitamin D on increasing the quality of life and functional mobility and decreasing the pain in the elderly. The community-dwelling elderly subjects over 65 years age were included in the study. The subjects were given 300.000 IU Vitamin D via per os and parenteral route and assessed after 4 weeks. The serum creatinine, calcium, phosphorous, ALT, ALP, 24-h urine calcium excretion, PTH, and vitamin D levels, as well as VAS (visual analog scale) for pain assessment, functional mobility with TUG (timed up and go test) and quality of life with SF-36 before and after the treatment were evaluated. The serum vitamin D levels were measured by the RIA method. The subjects were divided into four groups each consisting of 30 subjects. The 1st group took i.m. vitamin D, the 2nd group took i.m. placebo, the 3rd group took p.o. vitamin D, and the 4th group took p.o. placebo. The mean age of all the participants was 70.1 ± 4.3 years. There was no difference in the age and gender between the groups (P > 0.05). After treatment, the PTH level of first group was decreased (P = 0.0001) and the vitamin D level increased (P = 0.0001) significantly. In the third group, the PTH level of first group was decreased (P = 0.0001) and the vitamin D level increased (P = 0.004) and the 24-h calcium excretion in urine (P = 0.015) increased significantly. When the pain, the functional mobility, and the quality of life were evaluated, in the first group, the TUG (P = 0.0001) and the VAS (P = 0.0001) decreased significantly, whereas the SF-36 subtitles: physical functioning (P = 0.0001), role physical (0.006), bodily pain (P = 0.0001), general health (P = 0.007), social functioning (P = 0.05), and mental health (P = 0

  3. Dietary supplements in the Department of Defense: possible solutions to optimizing force readiness.

    PubMed

    Gonsalves, Stephen; Stavinoha, Trisha; Hite, Linda; Costa, Janelle; Dilly, George; Deuster, Patricia A

    2012-12-01

    Dietary supplement use is common among military service members; approximately 17 to 20% report using high-risk weight-loss, performance-enhancing, and bodybuilding supplements. To date, no overarching policy or program has been approved or implemented to inform service members or educate health care providers on the potential adverse consequences of using multiple combinations of supplements or the pros and cons of supplements per se. A review of regulations, concerns, and possible solutions is provided. Importantly, the role of third-party certification and education is emphasized. PMID:23397690

  4. Iodine Deficiency in a Parenteral Nutrition-Dependent Adolescent With Intestinal Pseudo-Obstruction.

    PubMed

    Mortensen, Melissa; Williamson, Nila; Davis, Cheryl; Kanyu Hsu, Evelyn; Javid, Patrick J; Horslen, Simon

    2016-07-01

    Routine supplementation of iodine in parenteral nutrition (PN) solutions is not current practice in the United States. In this case study, we describe an incidental finding of goiter in a long-term PN-dependent adolescent. With increased iodine screening, we then identified additional patients with undetectable urinary iodine concentrations in our population of children with short bowel receiving long-term PN. We hypothesize that 2 practice changes are possibly reducing iodine provision to long-term PN-dependent patients: transition to alcohol-based skin preparations and lipid minimization. PMID:25261415

  5. Modular Building Supplement: A Quick, Quality Solution for Schools.

    ERIC Educational Resources Information Center

    Goodmiller, Brian D.; Schendell, Derek G.

    2003-01-01

    This supplement presents three articles on modular construction that look at: "Fast Track Expansion for a New Jersey School" (involving a modular addition); "Precast Construction Helps Schools Meet Attendance Boom" (precast concrete components are quick, durable, and flexible); and "Airing HVAC Concerns" (poor indoor air quality in prefabricated…

  6. Vitamin K in parenteral nutrition.

    PubMed

    Shearer, Martin J

    2009-11-01

    Vitamin K (as phylloquinone and menaquinones) is an essential cofactor for the conversion of peptide-bound glutamate to gamma-carboxy glutamic acid (Gla) residues in a number of specialized Gla-containing proteins. The only unequivocal deficiency outcome is a bleeding syndrome caused by an inability to synthesize active coagulation factors II, VII, IX, and X, although there is growing evidence for roles for vitamin K in bone and vascular health. An adult daily intake of about 100 microg of phylloquinone is recommended for the maintenance of hemostasis. Traditional coagulation tests for assessing vitamin K status are nonspecific and insensitive. Better tests include measurements of circulating vitamin K and inactive proteins such as undercarboxylated forms of factor II and osteocalcin to assess tissue and functional status, respectively. Common risk factors for vitamin K deficiency in the hospitalized patient include inadequate dietary intakes, malabsorption syndromes (especially owing to cholestatic liver disease), antibiotic therapy, and renal insufficiency. Pregnant women and their newborns present a special risk category because of poor placental transport and low concentrations of vitamin K in breast milk. Since 2000, the Food and Drug Administration has mandated that adult parenteral preparations should provide a supplemental amount of 150 microg phylloquinone per day in addition to that present naturally, in variable amounts, in the lipid emulsion. Although this supplemental daily amount is probably beneficial in preventing vitamin K deficiency, it may be excessive for patients taking vitamin K antagonists, such as warfarin, and jeopardize their anticoagulant control. Natural forms of vitamin K have no proven toxicity. PMID:19874942

  7. Parenteral nutrition: never say never

    PubMed Central

    2015-01-01

    This review emphasizes the benefits of parenteral nutrition (PN) in critically ill patients, when prescribed for relevant indications, in adequate quantities, and in due time. Critically ill patients are at risk of energy deficit during their ICU stay, a condition which leads to unfavorable outcomes, due to hypercatabolism secondary to the stress response and the difficulty to optimize feeding. Indirect calorimetry is recommended to define the energy target, since no single predictive equation accurately estimates energy expenditure. Energy metabolism is intimately associated with protein metabolism. Recent evidence calls for adequate protein provision, but there is no accurate method to estimate the protein requirements, and recommendations are probably suboptimal. Enteral nutrition (EN) is the preferred route of feeding, but gastrointestinal intolerance limits its efficacy and PN allows for full coverage of energy needs. Seven recent articles concerning PN for critically ill patients were identified and carefully reviewed for the clinical and scientific relevance of their conclusions. One article addressed the unfavorable effects of early PN, although this result should be more correctly regarded as a consequence of glucose load and hypercaloric feeding. The six other articles were either in favor of PN or concluded that there was no difference in the outcome compared with EN. Hypercaloric feeding was not observed in these studies. Hypocaloric feeding led to unfavorable outcomes. This further demonstrates the beneficial effects of an early and adequate feeding with full EN, or in case of failure of EN with exclusive or supplemental PN. EN is the first choice for critically ill patients, but difficulties providing optimal nutrition through exclusive EN are frequently encountered. In cases of insufficient EN, individualized supplemental PN should be administered to reduce the infection rate and the duration of mechanical ventilation. PN is a safe therapeutic option

  8. Protective effect of polysaccharides on the stability of parenteral emulsions.

    PubMed

    Chai, Guihong; Sun, Feng; Shi, Jianli; Tian, Bin; Tang, Xing

    2013-05-01

    The main purpose of this study is to investigate the influence of two polysaccharides (dextran, hydroxyethyl starch) on the stability of parenteral emulsions. All parenteral emulsions were prepared by high-pressure homogenization. The influence of polysaccharides concentration was studied. The stabilities of autoclaving sterilization, centrifugation and freeze-thawing process were investigated extensively. Following the addition of polysaccharides, the stabilities of the parenteral emulsions were improved. A high-concentration polysaccharides solution (13%, w/v) produced better protection than a low one (1.3%, w/v), especially during freeze-thawing process. The protective mechanisms of polysaccharides were attributed to increasing systematic viscosity, non-frozen water absorbed by polysaccharides, formation of a linear bead-like structure and thicker mixed emulsifier film. Overall, polysaccharides can offer greatly increased protection for parenteral emulsions, and represent a novel protective strategy for improving the stability of this delivery system. PMID:22583006

  9. Design Solutions: Supplement to the Curriculum Guide for Art in the Secondary Schools. Field Test.

    ERIC Educational Resources Information Center

    Chicago Board of Education, IL.

    Intended to clarify the elements and principles of design as stated in the "Curriculum Guide for Art in the Secondary Schools," this illustrated supplement presents 15 design units with step-by-step instructions for clarifying design problems and providing solutions. Each unit is presented in three stages, each of which is a complete lesson in…

  10. Metabolic acidosis during parenteral nutrition: Pathophysiological mechanisms

    PubMed Central

    Dounousi, Evangelia; Zikou, Xanthi; Koulouras, Vasilis; Katopodis, Kostas

    2015-01-01

    Total parenteral nutrition (TPN) is associated with metabolic complications including metabolic acidosis (MA), one of the main disorders of acid-base balance. The main causes involved in the appearance of MA during TPN administration are the metabolism of cationic amino acids and amino acids containing sulfuric acid (exogenous addition), the titratable acidity of the infused parenteral solution, the addition of acidificant agents (hydrochloric acid, acetic acid), thiamine deficiency, disruption of carbohydrate and lipid metabolic pathways and D-fructose administration. Moreover, hypophosphatemia that appears during TPN therapy contributes significantly to the maintenance of MA. This review describes in a comprehensive way the pathophysiological mechanisms involved in the appearance of MA induced by intravenous administration of TPN products most commonly used in critically ill-patients. PMID:25983433

  11. Glutamine: An Obligatory Parenteral Nutrition Substrate in Critical Care Therapy

    PubMed Central

    Stehle, Peter; Kuhn, Katharina S.

    2015-01-01

    Critical illness is characterized by glutamine depletion owing to increased metabolic demand. Glutamine is essential to maintain intestinal integrity and function, sustain immunologic response, and maintain antioxidative balance. Insufficient endogenous availability of glutamine may impair outcome in critically ill patients. Consequently, glutamine has been considered to be a conditionally essential amino acid and a necessary component to complete any parenteral nutrition regimen. Recently, this scientifically sound recommendation has been questioned, primarily based on controversial findings from a large multicentre study published in 2013 that evoked considerable uncertainty among clinicians. The present review was conceived to clarify the most important questions surrounding glutamine supplementation in critical care. This was achieved by addressing the role of glutamine in the pathophysiology of critical illness, summarizing recent clinical studies in patients receiving parenteral nutrition with intravenous glutamine, and describing practical concepts for providing parenteral glutamine in critical care. PMID:26495301

  12. Hazards of parenteral treatment: do particles count?

    PubMed Central

    Puntis, J W; Wilkins, K M; Ball, P A; Rushton, D I; Booth, I W

    1992-01-01

    After prolonged parenteral nutrition a 12 month old infant died with pulmonary hypertension and granulomatous pulmonary arteritis. A review of necropsy findings in 41 infants who had been fed parenterally showed that two of these also had pulmonary artery granulomata, while none of 32 control patients who died from sudden infant death syndrome had similar findings. Particulate contaminants have been implicated in the pathogenesis of such lesions and these were quantified in amino acid/dextrose solutions and fat emulsions using automated particle counting and optical microscope counting respectively. Parenteral feed infusions compounded for a 3000 g infant according to standard nutritional regimens were found to include approximately 37,000 particles between 2 and 100 microns in size in one day's feed, of which 80% were derived from the fat emulsion. In-line end filtration of intravenous infusions may reduce the risk of particle associated complications. A suitable particle filter is required for use with lipid. Images p1476-a PMID:1489228

  13. Compatibility: drugs and parenteral nutrition.

    PubMed

    Miranda, Talita Muniz Maloni; Ferraresi, Andressa de Abreu

    2016-03-01

    Objective Standardization and systematization of data to provide quick access to compatibility of leading injectable drugs used in hospitals for parenteral nutrition. Methods We selected 55 injectable drugs analyzed individually with two types of parenteral nutrition: 2-in-1 and 3-in-1. The following variables were considered: active ingredient, compatibility of drugs with the parenteral nutrition with or without lipids, and maximum drug concentration after dilution for the drugs compatible with parenteral nutrition. Drugs were classified as compatible, incompatible and untested. Results After analysis, relevant information to the product's compatibility with parental nutrition was summarized in a table. Conclusion Systematization of compatibility data provided quick and easy access, and enabled standardizing pharmacists work. PMID:27074235

  14. Thiamine Deficiency in a Developed Country: Acute Lactic Acidosis in Two Neonates Due to Unsupplemented Parenteral Nutrition.

    PubMed

    Salvatori, Guglielmo; Mondì, Vito; Piersigilli, Fiammetta; Capolupo, Irma; Pannone, Veronica; Vici, Carlo Dionisi; Rizzo, Cristiano; Dotta, Andrea

    2016-08-01

    Thiamine is a water-soluble vitamin implicated in several metabolic processes. Its deficiency, due to prolonged parenteral nutrition without adequate vitamin supplementation, can lead to multiorgan failure characterized by cardiovascular impairment and metabolic acidosis refractory to bicarbonate administration. Only thiamine administration allows the remission of symptoms. We report 2 preterm infants with acute thiamine deficiency due to prolonged parenteral nutrition without adequate vitamin supplementation. PMID:25591974

  15. Supplemental Report: Technetium-99 On-Line Monitoring by Beta Counting for Hanford Supernate Waste Solutions

    SciTech Connect

    Sigg, R.A.

    2000-08-23

    SRTC is investigating approaches for near-real-time monitoring of 99Tc at selected points in the proposed pretreatment process for Hanford supernate waste solutions. The desired monitoring points include both the feed to and decontaminated product from a technetium-removal column. A Cs-removal column precedes technetium decontamination in the proposed process. Our earlier report (Ref. 1) showed that a simple flow-through beta counting system can easily meet 99Tc detection limit goals for solutions that do not contain interfering radionuclides; however, concentrations of residual interferences were too high in process solutions at the desired monitoring points. That is, technetium can not be measured without additional purification. In this supplement, ADS evaluated ion exchange cartridges to remove radionuclides that interfere with 99Tc beta measurements. Tests on radioactive standard solutions and on Hanford Envelope B (AZ-102) pretreated process solutions show that 99Tc passes through the cation removal cartridge to an on-line beta counter, and that interfering radionuclides were nearly totally removed. Envelope B solutions included both the process's Cs-removed feed to the Tc-removal column and product from the column. Analyses of these solutions before and after the cation exchange cartridge show that the concentration of the primary interference, 137Cs, was reduced to about 1/250th of the feed concentration.

  16. Total Parenteral Nutrition-Induced Cholestasis: Prevention and Management.

    PubMed

    Beath, Sue V; Kelly, Deirdre A

    2016-02-01

    When cholestasis occurs in patients receiving total parenteral nutrition, it is the result of many pathogenic pathways converging on the hepatic acinus. The result may be a temporary rise in liver function tests. The resulting fibrosis, portal hypertension, and jaundice are hallmarks of type 3 intestinal-associated liver disease to which children are more susceptible than adults. The key to prevention is in identifying high-risk scenarios, meticulous monitoring, and personalized prescription of parenteral nutrition solutions combined with an active approach in reducing the impact of inflammatory events when they occur by prompt use of antibiotics and line locks. PMID:26593297

  17. Parenteral opioids for labor analgesia.

    PubMed

    Campbell, David C

    2003-09-01

    Labor pain relief is an important aspect of women's health that has historically been neglected. Epidural analgesia is the only consistently effective method of labor pain relief and has recently undergone substantial improvements to address the concerns of both parturients and obstetric care providers. With increased physician awareness, these recent advances are becoming more widely accepted and routinely available for all laboring parturients. Unfortunately, an increasing number of women are presenting to maternity wards with an absolute contraindication to epidural labor analgesia. The present review will provide an outline of the recent developments in parenteral analgesic options which complement modern epidural analgesic techniques. Protocols for the initiation of "state-of-the-art" parenteral analgesic techniques are provided as a guide to facilitate effective, modern, parenteral labor analgesia. PMID:12972743

  18. Improved preservation of warm ischemic livers by hypothermic machine perfusion with supplemented University of Wisconsin solution.

    PubMed

    Jain, Shailendra; Lee, Sang Ho; Korneszczuk, Katarzyna; Culberson, Catherine R; Southard, James H; Berthiaume, François; Zhang, Jian X; Clemens, Mark G; Lee, Charles Y

    2008-01-01

    Hypothermic machine perfusion (HMP) has the potential to improve recovery and preservation of Donation after Cardiac Death (DCD) livers, including uncontrolled DCD livers. However, current perfusion solutions lack the needed substrates to improve energy recovery and minimize hepatic injury, if warm ischemic time (WIT) is extended. This proof-of-concept study tested the hypothesis that the University of Wisconsin (UW) solution supplemented with anaplerotic substrates, calcium chloride, thromboxane A2 inhibitor, and antioxidants could improve HMP preservation and minimize reperfusion injury of warm ischemic livers. Preflushed rat livers subjected to 60 min WIT were preserved for 5 h with standard UW or supplemented UW (SUW) solution. Post preservation hepatic functions and viability were assessed during isolated perfusion with Krebs-Henseleit solution. Livers preserved with SUW showed significantly (p < .001) improved recovery of tissue ATP levels (micromol/g liver), 2.06 +/- 0.10 (mean +/- SE), as compared to the UW group, 0.70 +/- 0.10, and the level was 80% of that of fresh control livers (2.60 +/- 0.13). At the end of 1 h of rewarming, lactate dehydrogenase (U/L) in the perfusate was significantly (p < .05) lower in the SUW group (429 +/- 58) as compared to ischemia-reperfusion (IR) (781 +/- 12) and the UW group (1151 +/- 83). Bile production (microg/min/g liver) was significantly (p < .05) higher in the SUW group (280 +/- 13) as compared to the IR (224 +/- 24) and the UW group (114 +/- 14). The tissue edema formation assessed by tissue wet-dry ratio was significantly (p < .05) higher in UW group. Histology showed well-preserved hepatic structure in the SUW group. In conclusion, this study suggests that HMP with SUW solution has the potential to restore and preserve livers with extended WIT. PMID:18340625

  19. Minimizing systemic infection during complete parenteral alimentation of small infants

    PubMed Central

    Nelson, R.

    1974-01-01

    A regimen of parenteral alimentation for infants was designed to eliminate as many factors responsible for infection as possible. The most important features of the feeding regimen were as follows. (1) Infants were fed via indwelling silastic catheters inserted into the superior vena cava or the right atrium by a cutdown operation. (2) The parenteral feeding was fat free to simplify the administration system. Y connectors and 2- or 3-way taps were avoided. (3) Extreme care was taken of junctions within the infusion system. Only certain members of the hospital staff were allowed to break such junctions, e.g. during the changing of packs of solution or of the giving sets. These junctions were sprayed with antibacterial aerosols. (4) The hypertonic solutions of nutrients were prepared in plastic packs, which do not require ventilation. The infusion system was therefore not contaminated by the entry of unsterile outside air. (5) The infused solutions were passed through 0·22 μm millipore filters before entering the patient's blood stream. There was an infection rate of 9% which was less than the 25 to 45% infection rate previously reported during parenteral feeding through indwelling venous catheters, and is also less than that associated with ventriculoatrial shunts for hydrocephalus. There was no case of systemic candidiasis, which is the most frequent and most serious infection associated with parenteral feeding. PMID:4206445

  20. 77 FR 28594 - Southern Energy Solution Group, LLC; Supplemental Notice That Initial Market-Based Rate Filing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-15

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Southern Energy Solution Group, LLC; Supplemental Notice That Initial Market... in the above-referenced proceeding of Southern Energy Solution Group, LLC's application for...

  1. 77 FR 64980 - Noble Americas Energy Solutions LLC; Supplemental Notice That Initial Market-Based Rate Filing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-24

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Noble Americas Energy Solutions LLC; Supplemental Notice That Initial Market... in the above-referenced proceeding of Noble Americas Energy Solutions LLC's application for...

  2. 78 FR 75560 - Green Current Solutions, LLC; Supplemental Notice That Initial Market-Based Rate Filing Includes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-12

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Green Current Solutions, LLC; Supplemental Notice That Initial Market-Based... above-referenced proceeding, of Green Current Solutions, LLC's application for market-based...

  3. Biodegradable microspheres for parenteral delivery.

    PubMed

    Sinha, V R; Trehan, A

    2005-01-01

    Nowadays, emphasis is being laid to development of controlled release dosage forms. Interest in this technology has increased steadily over the past few years. Although oral administration of drugs is a widely accepted route of drug delivery, bioavailability of drug often varies as a result of gastrointestinal absorption, degradation by first-pass effect, and hostile environment of gastrointestinal tract. Transdermal administration for percutaneous absorption of drug is limited by the impermeable nature of the stratum corneum. Ocular and nasal delivery is also unfavorable because of degradation by enzymes present in eye tissues and nasal mucosa. Hence, the parenteral route is the most viable approach in such cases. Of the various ways of achieving long-term parenteral drug delivery, biodegradable microspheres are one of the better means of controlling the release of drug over a long time. Because of the lipidic nature of liposomes, problems such as limited physical stability and difficulty of freeze-drying are encountered. Similarly, for emulsions, stability on long-term basis and in suspensions, rheological changes during filling, injecting, and storage poses limitation. Also, in all these systems, the release rate cannot be tailored to the needs of the patient. Parenteral controlled-release formulations based on biodegradable microspheres can overcome these problems and can control the release of drug over a predetermined time span, usually in the order of days to weeks to months. Various FDA-approved controlled-release parenteral formulations based on these biodegradable microspheres are available on the market, including Lupron Depot Nutropin Depot and Zoladex. This review covers various molecules encapsulated in biodegradable microspheres for parenteral delivery. PMID:16566705

  4. Metabolic bone disease and parenteral nutrition.

    PubMed

    Hamilton, Cynthia; Seidner, Douglas L

    2004-08-01

    Metabolic bone disease (MBD) is abnormal bone metabolism and includes the common disorders of osteoporosis and osteomalacia, which can develop in patients receiving long-term parenteral nutrition (PN). Patients who require long-term PN have significant gastrointestinal failure and malabsorption, which is generally caused by severe inflammatory bowel disease, intestinal ischemia, or malignancy. The exact cause of MBD in long-term PN patients is unknown, but its origin is thought to be multifactorial, with factors including underlying disease, effect of medications used to treat this disease (eg, corticosteroids), and various components of the PN solution. Caring for patients on long-term PN requires routine assessment and monitoring for MBD. Appropriate adjustments of the PN solution can help reduce the risk for developing PN-associated MBD and in some instances improve bone mineral density. Recent developments in pharmacologic treatment for osteoporosis show promise for patients with MBD receiving PN. PMID:15245704

  5. Do surface active parenteral formulations cause inflammation?

    PubMed

    Söderberg, Lars; Engblom, Johan; Lanbeck, Peter; Wahlgren, Marie

    2015-04-30

    Local irritation and inflammation at the site of administration are a common side effect following administration of parenteral formulations. Biological effects of surface (interfacial) activity in solutions are less well investigated than effects caused by other physico-chemical parameters such as pH and osmolality. The interfacial activity in different systems, including human plasma, typical amphiphilic substances with fundamental biological relevance such as free fatty acids, anesthetic depot formulations and six different antibiotics was measured. The relative interfacial pressure, and/or concentration of active substance, required to obtain 50% of the maximal attainable effect in terms of interfacial pressure were calculated. The aim was to test the hypothesis that these parameters would allow comparison to biological effects reported in in vivo studies on the investigated substances. The highest interfacial activity was found in a triglyceride/plasma system. Among the antibiotic tested, the highest interfacial activities were found in erythromycin and dicloxacillin, which is in accordance with previous clinical findings of a high tendency of infusion phlebitis and cell toxicity. Independently of investigated system, biological effects were minimal below a 15% relative increase of interfacial activity. Above 35-45% the effects were severe. Interfacial activity in parenteral formulations may well cause damages to tissues followed by inflammation. PMID:25708007

  6. Hydroxypropyl cellulose as an option for supplementation of cryoprotectant solutions for embryo vitrification in human assisted reproductive technologies.

    PubMed

    Mori, Chiemi; Yabuuchi, Akiko; Ezoe, Kenji; Murata, Nana; Takayama, Yuko; Okimura, Tadashi; Uchiyama, Kazuo; Takakura, Kei; Abe, Hiroyuki; Wada, Keiko; Okuno, Takashi; Kobayashi, Tamotsu; Kato, Keiichi

    2015-06-01

    Hydroxypropyl cellulose (HPC) was investigated as a replacement for serum substitute supplement (SSS) for use in cryoprotectant solutions for embryo vitrification. Mouse blastocysts from inbred (n = 1056), hybrid (n = 128) strains, and 121 vitrified blastocysts donated by infertile patients (n = 102) were used. Mouse and human blastocysts, with or without zona pellucida, were vitrified and warmed in either 1% or 5% HPC or in 5% or 20% SSS-supplemented media using the Cryotop (Kitazato BioPharma Co. Ltd, Fuji, Japan) method, and the survival and oxygen consumption rates were assessed. Viscosity of each vitrification solution was compared. Survival rates of mouse hybrid blastocysts and human zona pellucida-intact blastocysts were comparable among the groups. Mouse and human zona pellucida-free blastocysts, which normally exhibit poor cryoresistance, showed significantly higher survival rates in 5% HPC than 5% SSS (P < 0.05). The 5% HPC-supplemented vitrification solution showed a significantly higher viscosity (P < 0.05). The blastocysts were easily detached from the Cryotop strip during warming when HPC-supplemented vitrification solution was used. The oxygen consumption rates were similar between non-vitrified and 5% HPC groups. The results suggest possible use of HPC for supplementation of cryoprotectant solutions and provide useful information to improve vitrification protocols. PMID:25892497

  7. [Insulin therapy and parenteral nutrition in intensive care: practical aspects].

    PubMed

    Limonta, A; Gastaldi, G; Heidegger, C P; Pichard, C

    2015-03-25

    Critically ill patients are hypercatabolic due to stress and inflammation. This condition induces hyperglycemia. Muscle wasting is intense during critical illness. Its prevention is essential. This is possible by early and appropriate nutritional support. Preserving the function of the gastrointestinal tract with enteral nutrition is the gold standard. However, when targeted protein-caloric intake is not met through enteral nutrition within the first three days in the intensive care unit (ICU), supplemental parenteral nutrition is administered to reduce morbidity and mortality. In addition, in order to limit metabolic imbalance and reduce mortality, glycemic control using insulin therapy is mandatory. This article reviews the current understanding of parenteral nutrition and insulin therapy in ICU patients, and provides the decision model applied in our institution. PMID:26027204

  8. [Clinical importance of hypocaloric parenteral feeding].

    PubMed

    Behrendt, W; Kunitz, O; Kauhl, W; Lade, R

    1994-01-01

    Hypocaloric parenteral nutrition (HPN) is mainly and frequently used in surgical medicine since it allows a reliable and standardized supply of nutrients. Ready-mix solutions which are suitable for peripheral venous nutrition generally contain about 50 g carbohydrates (glucose and/or xylitol), 25 g amino acids and electrolytes per liter. The osmolarity of the solutions averages between 600 and 800 mosmol/l. HPN has two distinct advantages: firstly the minimal effects on carbohydrate metabolism and secondly the good improvement in nitrogen balance. If 2 g/kg and day glucose are administered, even postoperatively, the mean blood sugar levels are only just above the normal range and an amino acid dosage of 1 g/kg and day, compared with liquid substitution alone or the administration of small amounts of carbohydrates, leads to an approximately 60% improvement in postoperative N-balance. Experience gained with HPN in surgical medicine to date permits the following recommendation: 1. HPN should not be used after small and moderate interventions with short nutritional abstinence; it is not necessary to administer nutrients in such cases. 2. HPN may be used after moderate to serious surgical interventions; e.g. after gastrointestinal resections in the case of elective surgery on patients with a normal nutritional status. However, studies have yet to prove the clinical efficacy of HPN, e.g. as evidenced by shorter hospitalization or a reduced perioperative morbidity or mortality, although this reservation equally applies to the routinely administered complete parenteral or enteral nutrition.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7975956

  9. A Call to Action to Bring Safer Parenteral Micronutrient Products to the U.S. Market.

    PubMed

    Vanek, Vincent W; Borum, Peggy; Buchman, Alan; Fessler, Theresa A; Howard, Lyn; Shenkin, Alan; Valentine, Christina J

    2015-08-01

    The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) started an intensive review of commercially available parenteral vitamin and trace element (TE) products in 2009. The chief findings were that adult multi-TE products currently available in the United States (U.S.) provide potentially toxic amounts of manganese, copper, and chromium, and neonatal/pediatric multi-TE products provide potentially toxic amounts of manganese and chromium. The multivitamin products appeared safe and effective; however, a separate parenteral vitamin D product is needed for those patients on standard therapy who continue to be vitamin D depleted and are unresponsive to oral supplements. The review process also extended to parenteral choline and carnitine. Although choline and carnitine are not technically vitamins or trace elements, choline is an essential nutrient in all age groups, and carnitine is an essential nutrient in infants, according to the Food and Nutrition Board of the Institute of Medicine. A parenteral choline product needs to be developed and available. Efforts are currently under way to engage the U.S. Food and Drug Administration (FDA) and the parenteral nutrient industry so A.S.P.E.N.'s recommendations can become a commercial reality. PMID:26113560

  10. [Review and prospect of parenteral nutrition support for burn patients in China].

    PubMed

    Deng, Shi-lin

    2008-10-01

    Parenteral nutrition support for burn injury in China began to develop in 1970s along with improvement in burn foundational research of burn injury and the marketing of parenteral nutrition solutions manufactured by Chinese amino acids pharmaceutical industry. Up to 1980s many kinds of parenteral nutrition products were used in clinical therapy, and they were proved to be effective and safe. Meanwhile the guide for parenteral nutrition support of China was drafted to ensure standardized administration. Some problems should be called for attention in present practice of parenteral nutrition support. First, immuno nutrients have been proved to possess synergistic effect on parenteral/enteral nutrition support. But for those critical patients in sepsis/MODS period, more attention should be paid to the use of immuno nutrients in time of administration and optimal dosage because of the complicate physiopathologic reactions. Secondly, the use of growth hormone has been proved to be effective for promoting healing in patients with burn in many cases. However, the indications of growth hormone should be strictly observed and the regime of a low dose and short course should be adopted 7 days after burn for ensuring safety. Thirdly, we should pay attention to the best path of giving nutrition, whether enteral or parenteral. Parenteral nutrition support should be adopted for critical burn patients in early period with intestinal dysfunction, and enteral nutrition support should be used when intestinal functions recover partially. For patients with burn hypermetabolism, the application of enteral and parenteral nutrition support is complimentary, and it is aptly called total nutrition. PMID:19103029

  11. Immunonutrition – the influence of early postoperative glutamine supplementation in enteral/parenteral nutrition on immune response, wound healing and length of hospital stay in multiple trauma patients and patients after extensive surgery

    PubMed Central

    Lorenz, Kai J.; Schallert, Reiner; Daniel, Volker

    2015-01-01

    Introduction: In the postoperative phase, the prognosis of multiple trauma patients with severe brain injuries as well as of patients with extensive head and neck surgery mainly depends on protein metabolism and the prevention of septic complications. Wound healing problems can also result in markedly longer stays in the intensive care unit and general wards. As a result, the immunostimulation of patients in the postoperative phase is expected to improve their immunological and overall health. Patients and methods: A study involving 15 patients with extensive ENT tumour surgery and 7 multiple-trauma patients investigated the effect of enteral glutamine supplementation on immune induction, wound healing and length of hospital stay. Half of the patients received a glutamine-supplemented diet. The control group received an isocaloric, isonitrogenous diet. Results: In summary, we found that total lymphocyte counts, the percentage of activated CD4+DR+ T helper lymphocytes, the in-vitro response of lymphocytes to mitogens, as well as IL-2 plasma levels normalised faster in patients who received glutamine-supplemented diets than in patients who received isocaloric, isonitrogenous diets and that these parameters were even above normal by the end of the second postoperative week. Summary: We believe that providing critically ill patients with a demand-oriented immunostimulating diet is fully justified as it reduces septic complications, accelerates wound healing, and shortens the length of ICU (intensive care unit) and general ward stays. PMID:26734536

  12. Zinc: physiology, deficiency, and parenteral nutrition.

    PubMed

    Livingstone, Callum

    2015-06-01

    The essential trace element zinc (Zn) has a large number of physiologic roles, in particular being required for growth and functioning of the immune system. Adaptive mechanisms enable the body to maintain normal total body Zn status over a wide range of intakes, but deficiency can occur because of reduced absorption or increased gastrointestinal losses. Deficiency impairs physiologic processes, leading to clinical consequences that include failure to thrive, skin rash, and impaired wound healing. Mild deficiency that is not clinically overt may still cause nonspecific consequences, such as susceptibility to infection and poor growth. The plasma Zn concentration has poor sensitivity and specificity as a test of deficiency. Consequently, diagnosis of deficiency requires a combination of clinical assessment and biochemical tests. Patients receiving parenteral nutrition (PN) are susceptible to Zn deficiency and its consequences. Nutrition support teams should have a strategy for assessing Zn status and optimizing this by appropriate supplementation. Nutrition guidelines recommend generous Zn provision from the start of PN. This review covers the physiology of Zn, the consequences of its deficiency, and the assessment of its status, before discussing its role in PN. PMID:25681484

  13. Stability assessment of o/w parenteral nutrition emulsions in the presence of high glucose and calcium concentrations.

    PubMed

    Télessy, I G; Balogh, J; Turmezei, J; Dredán, J; Zelkó, R

    2011-09-10

    The purpose of the present study was to examine how the colloid stability features of o/w parenteral nutrition emulsions made with SMOFlipid (lipid emulsion based on soybean oil, medium chain triglycerides, olive oil and fish oil) will change in the presence of high concentration of calcium and glucose if usual micronutrients are also present, according to the needs of the clinical nutrition patient. Particle size analysis, zeta potential, dynamic surface tension measurements and light microscopic screening were carried out to evaluate the possible changes in the kinetic stability of the emulsions. Our results indicate that the higher glucose concentration of 15 or 20% could not compensate the emulsion-destabilizing effect of higher (5 mM) calcium concentration even in the presence of a modern fat emulsion. Therefore calcium demand of undernourished patient requiring 5 mM or higher final Ca²⁺ content in nutrient solution should be supplemented in another way. PMID:21636233

  14. Total parenteral nutrition caused Wernicke’s encephalopathy accompanied by wet beriberi

    PubMed Central

    Long, Ling; Cai, Xiao-Dong; Bao, Jian; Wu, Ai-Min; Tian, Qing; Lu, Zheng-Qi

    2014-01-01

    Patient: Female, 17 Final Diagnosis: Wernicke’s encephalopathy Symptoms: Blurred vision • dizziness • nystygmus • tachycardia Medication: — Clinical Procedure: — Specialty: Neurology Objective: Mistake in diagnosis Background: Wernicke’s encephalopathy (WE) is an acute and life-threatening illness which is not only seen in alcoholics, but also in persons with poor nutrition lacking thiamine (vitamin B1). Case Report: Here, we presented a case of WE in a patient who received parenteral nutrition without complement of thiamine. Besides neuropsychiatric problems, she also manifested prominent cardiovascular abnormalities, which were consistent with wet beriberi. Conclusions: This case emphasizes the need for thiamine supplementation in prolonged total parenteral nutrition, and also highlights the awareness of WE in persons with parenteral nutrition lacking thiamine. More importantly, we call for attention to wet beriberi in such persons. PMID:24516692

  15. Parenteral nutrition in hospital pharmacies.

    PubMed

    Katoue, Maram Gamal; Al-Taweel, Dalal; Matar, Kamal Mohamed; Kombian, Samuel B

    2016-07-11

    Purpose - The purpose of this paper is to explore parenteral nutrition (PN) practices in hospital pharmacies of Kuwait and identify potential avenues for quality improvement in this service. Design/methodology/approach - A descriptive, qualitative study about PN practices was conducted from June 2012 to February 2013 in Kuwait. Data were collected via in-depth semi-structured interviews with the head total parenteral nutrition (TPN) pharmacists at seven hospitals using a developed questionnaire. The questionnaire obtained information about the PN service at each hospital including the existence of nutritional support teams (NSTs), PN preparation practices, quality controls and guidelines/protocols. The interviews were audio-recorded, transcribed verbatim and analyzed for content. Findings - Seven hospitals in Kuwait provided PN preparation service through TPN units within hospital pharmacies. Functional NSTs did not exist in any of these hospitals. All TPN units used paper-based standard PN order forms for requesting PN. The content of PN order forms and PN formulas labeling information were inconsistent across hospitals. Most of the prepared PN formulas were tailor-made and packed in single compartment bags. Quality controls used included gravimetric analysis and visual inspection of PN formulations, and less consistently reported periodic evaluation of the aseptic techniques. Six TPN units independently developed PN guidelines/protocols. Originality/value - This study revealed variations in many aspects of PN practices among the hospitals in Kuwait and provided recommendations to improve this service. Standardization of PN practices would enhance the quality of care provided to patients receiving PN and facilitate national monitoring. This can be accomplished through the involvement of healthcare professionals with expertise in nutrition support working within proactive NSTs. PMID:27298063

  16. Pancreatic exocrine response to parenteral nutrition.

    PubMed

    Bivins, B A; Bell, R M; Rapp, R P; Toedebusch, W H

    1984-01-01

    Animal experimental data concerning pancreatic exocrine secretory response to parenteral nutrition is contradictory. We have studied the pancreatic exocrine output in a patient with a pure pancreatic fistula. In this patient, parenteral nutrition with hypertonic glucose, amino acids and fat emulsion was not associated with increases in fistula volume or protein output. Enteral protein and fat in this patient caused rapid increases in both fistula volume and protein output. This study supports the use of parenteral nutrition as a means of maintaining the pancreas at rest. PMID:6321813

  17. 21 CFR 201.323 - Aluminum in large and small volume parenterals used in total parenteral nutrition.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... used in total parenteral nutrition. 201.323 Section 201.323 Food and Drugs FOOD AND DRUG ADMINISTRATION... parenteral nutrition. (a) The aluminum content of large volume parenteral (LVP) drug products used in total parenteral nutrition (TPN) therapy must not exceed 25 micrograms per liter (µg/L). (b) The package insert...

  18. 21 CFR 201.323 - Aluminum in large and small volume parenterals used in total parenteral nutrition.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... used in total parenteral nutrition. 201.323 Section 201.323 Food and Drugs FOOD AND DRUG ADMINISTRATION... parenteral nutrition. (a) The aluminum content of large volume parenteral (LVP) drug products used in total parenteral nutrition (TPN) therapy must not exceed 25 micrograms per liter (µg/L). (b) The package insert...

  19. 21 CFR 201.323 - Aluminum in large and small volume parenterals used in total parenteral nutrition.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... used in total parenteral nutrition. 201.323 Section 201.323 Food and Drugs FOOD AND DRUG ADMINISTRATION... parenteral nutrition. (a) The aluminum content of large volume parenteral (LVP) drug products used in total parenteral nutrition (TPN) therapy must not exceed 25 micrograms per liter (µg/L). (b) The package insert...

  20. 21 CFR 201.323 - Aluminum in large and small volume parenterals used in total parenteral nutrition.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... used in total parenteral nutrition. 201.323 Section 201.323 Food and Drugs FOOD AND DRUG ADMINISTRATION... parenteral nutrition. (a) The aluminum content of large volume parenteral (LVP) drug products used in total parenteral nutrition (TPN) therapy must not exceed 25 micrograms per liter (µg/L). (b) The package insert...

  1. 21 CFR 201.323 - Aluminum in large and small volume parenterals used in total parenteral nutrition.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... used in total parenteral nutrition. 201.323 Section 201.323 Food and Drugs FOOD AND DRUG ADMINISTRATION... parenteral nutrition. (a) The aluminum content of large volume parenteral (LVP) drug products used in total parenteral nutrition (TPN) therapy must not exceed 25 micrograms per liter (µg/L). (b) The package insert...

  2. [Pulmonary complications during parenteral feeding via percutaneous silicon catheters].

    PubMed

    Closa, R M; Coroleu, W; Natal, A; Gómez-Papí, A; Ainsa Abos, E; Sánchez Galiana, A

    1998-07-01

    Percutaneous fine bore silicone central catheters are frequently used in sick full term newborns and in low birth weight premature infants; although their use has some risks. We report two cases of pleural effusion in two prematures of 34 and 33 weeks gestation and birth weight of 1,510 and 1,650 g, respectively; and one case neumonitis in a newborn of a 38 weeks gestation and 2,730 g birth weight. All of them have in common same initial clinical sign: increase mucus secretion of the upper airway a few hours after the beginning of parenteral nutrition using the type of catheter mentioned with the tip abnormally located in pulmonary artery. These complications are probably related to endothelial injury of very slow flow vessels due to the high osmolarity and low pH of the parenteral solutions used; which probably, in turn, produce thrombosis and vascular perforation, and/or extravasation. We suggest to suspect a pulmonary artery abnormally located catheter in patients receiving parenteral nutrition who increase upper airway mucus secretion. The rapid correction of the position would prevent major complications. PMID:12602026

  3. American Society for Parenteral & Enteral Nutrition

    MedlinePlus

    ... Resources Continuing Education Certification Claim CE Credits Clinical Nutrition Week eLearning Center Professional Development Webinars Calendar of ... Guidelines Clinical Practice Library Standards Malnutrition Awareness Parenteral ... Resources Practice and Research Toolkits Online Store Research ...

  4. Parenteral nutrition: risks, complications, and management.

    PubMed

    Worthington, Patricia H; Gilbert, Karen A

    2012-01-01

    Parenteral nutrition is a life-saving modality, but one that also carries risks for potentially life-threatening complications. Comprehensive management of patients receiving parenteral nutrition includes careful selection of candidates, individualizing formulas to meet patients' unique needs, monitoring response to therapy, and implementing strategies designed to avoid complications. Measures to mitigate the risk of central line-associated bloodstream infections are particularly important. As with all complex therapies, a collaborative, multidisciplinary approach promotes optimal outcomes. PMID:22222292

  5. Basic rules of parenteral fluid therapy.

    PubMed

    Oh, M S; Kim, H-J

    2002-01-01

    The following basic rules of parenteral fluid therapy are formulated with the aim of alleviating concern and confusion about i.v. fluid orders that are experienced by most physicians: Don't be generous with fluid; in determining the water intake, one must know the usual water output through the kidney, skin and lung; one must know the quantities of the electrolytes and nutrients that are being given, and know the initial volume of distribution (usually the ECF); one must know the aim of fluid therapy; one must not give and remove the same substance at the same time; one must be aware that hypertonic saline contains less water for a given amount of Na than isotonic saline; one must be familiar with different i.v. solutions and i.v. additives; one must be aware that the kidney does not manufacture water or electrolytes except for bicarbonate; for short-term fluid therapy, divalent ions (Ca, Mg, and P) do not need replacement; one should think about COP-wedge gradient in determining the type of fluid to be given. PMID:12401938

  6. [Total parenteral nutrition. History. Present time. Future].

    PubMed

    Wretlind, A; Szczygieł, B

    1998-04-01

    Total parenteral nutrition (TPN) has been available for only 30 years. However, history in this field goes back more than 350 years with the first landmark being the description of general blood circulation by William Harvey in 1628. His discovery is the anatomical basis for intravenous infusions. Many investigations were performed during the following centuries showing that solutions containing electrolytes and glucose could be given intravenously in man. The accumulated knowledge of protein metabolism formed the basis for studies on intravenous nutrition with protein hydrolysates, peptides and amino acids. The observation in the late 30-s by Robert Elman that amino acids in the form of protein hydrolysate could be safely administered intravenously in man was the first major step toward TPN. During the following years, major efforts were made to find methods to prepare infusion solutions with a high energy content and low osmotic pressure. The most realistic alternative seemed to be fat in the form of an emulsion. Many studies of a large number of various fat emulsions were made however, all of these emulsions caused severe adverse reactions in man. The first safe fat emulsion, intralipid, was made available in the early 60s. This was the second major step toward TPN. It was then no problem to include vitamins, electrolytes and trace elements in the fat emulsions and the solutions of amino acids and glucose. A few years later it was shown that a central venous catheter could be used to administer the infusion fluid intravenously. Many clinical investigations and reports have shown that the newly developed intravenous nutritional regimens are adequate alternatives to the ordinary diet. In this way it has been possible to maintain or obtain a good nutritional condition in most situations when oral or tube feeding can not be used. TPN has been shown to be of very great clinical importance to prevent and treat starvation often related to high morbidity and mortality

  7. The parenteral toxicity of Cyclofem.

    PubMed

    Cookson, K M

    1994-04-01

    The intraperitoneal median lethal dose of Cyclofem [Cyclo-Provera, C-P; depot-medroxyprogesterone acetate (Depo-Provera, DMPA)+estradiol cypionate (EC)] in mice was greater than 2500 mg/kg. The subcutaneous median lethal dose in mice and rats was greater than 1000 mg/kg. The suspension containing 50 mg/ml DMPA and 10 mg/ml EC used in all toxicology studies was not irritating to rabbit muscle. Chronic parenteral toxicity studies of Cyclofem were conducted in mice, rats and monkeys for 18, 22 and 24 months, respectively. Monthly doses were 2.5, 7.5 and 25 mg/kg Cyclofem in all species, 25 mg/kg DMPA and 25 mg/kg EC. Cyclofem was nontoxic but produced hormonal effects in all species. Decreased survival noted in the rodent studies was likely due to excessive EC dose. Mammary gland adenocarcinomas and pituitary adenomas were increased in the chronic rat study. Literature indicates the tumors were likely the result of the excessive hormone dose and were specific to rodents. In monkeys, Cyclofem was nontoxic, hormonally active, and noncarcinogenic at all doses including 50 times the human dose. PMID:8013218

  8. Pediatric parenteral nutrition in India.

    PubMed

    Bhave, S; Bavdekar, A

    1999-01-01

    Nutritional support to patients in neonatal and pediatric intensive care units is critical not only to minimize negative nitrogen balance but also to promote growth and development. Continuous technological and logistical advances in the Western countries have improved the efficacy and reduced the complications of parenteral nutrition (PN) to the extent that despite the constraints of cost and infrastructure, PN is now fast growing in India. Although widespread availability is very much desired, it is important that the technique is developed with considerable expertise and used judiciously with full knowledge of its indications, limitations, dangers and benefits. Indications for PN include surgical conditions (short gut syndrome), very low birth weight infants (particularly with necrotizing enterocolitis and surgical anomalies), malabsorption syndromes, conditions requiring bowel rest (acute pancreatitis, severe ulcerative colitis and necrotizing enterocolitis) and several non-gastrointestinal indications (end stage liver disease, renal failure, multiple trauma and extensive burns). Provision of PN is associated with significant and sometimes life threatening complications. The possible complications are technical (thrombosis, perforation of vein, thrombophlebitis), infections, metabolic disturbances, hepatobiliary stenosis, cholestasis, fibrosis, cirrhosis or cholelithiasis and bone related complications like osteopenia and fractures. Meticulous monitoring is necessary not only to detect complications but also to document clinical benefit. PMID:11132460

  9. Access technique and its problems in parenteral nutrition – Guidelines on Parenteral Nutrition, Chapter 9

    PubMed Central

    Jauch, K. W.; Schregel, W.; Stanga, Z.; Bischoff, S. C.; Braß, P.; Hartl, W.; Muehlebach, S.; Pscheidl, E.; Thul, P.; Volk, O.

    2009-01-01

    Catheter type, access technique, and the catheter position should be selected considering to the anticipated duration of PN aiming at the lowest complication risks (infectious and non-infectious). Long-term (>7–10 days) parenteral nutrition (PN) requires central venous access whereas for PN <3 weeks percutaneously inserted catheters and for PN >3 weeks subcutaneous tunnelled catheters or port systems are appropriate. CVC (central venous catheter) should be flushed with isotonic NaCl solution before and after PN application and during CVC occlusions. Strict indications are required for central venous access placement and the catheter should be removed as soon as possible if not required any more. Blood samples should not to be taken from the CVC. If catheter infection is suspected, peripheral blood-culture samples and culture samples from each catheter lumen should be taken simultaneously. Removal of the CVC should be carried out immediately if there are pronounced signs of local infection at the insertion site and/or clinical suspicion of catheter-induced sepsis. In case PN is indicated for a short period (max. 7–10 days), a peripheral venous access can be used if no hyperosmolar solutions (>800 mosm/L) or solutions with a high titration acidity or alkalinity are used. A peripheral venous catheter (PVC) can remain in situ for as long as it is clinically required unless there are signs of inflammation at the insertion site. PMID:20049083

  10. The necessity of selenium substitution in total parenteral nutrition and artificial alimentation.

    PubMed

    Gramm, H J; Kopf, A; Brätter, P

    1995-03-01

    For the trace element selenium, in contrast to zinc, iron, copper, chromium, manganese and iodine, there is still no clear official recommendation with regard to routine substitution in artificial nutrition. An overview of the manifestations of selenium deficiency in humans during the period 1979-1995 shows that nutritive deficiencies are exclusively TPN-induced or the result of severe malnutrition. The pathology of TPN-induced selenium deficiency and the analytic assessment of selenium status are described. Patients undergoing long-term parenteral nutrition or suffering from an increased loss of intestinal secretions have to be characterized as being especially at risk for clinical selenium deficiency. The relationship of the serum selenium kinetics in pediatric and adult patients to the depletion of body compartments during the course of short-term and prolonged TPN is discussed. Because of the importance of the selenoproteins, the regularly occurring depletion during selenium-free TPN and the borderline supply of selenium in Germany the routine substitution of selenium in TPN is strongly recommended. The pharmaceutical industry should be encouraged to develop a trace element solution that includes selenium, so that the nutritive requirement of patients on TPN can be satisfied. Adequate intravenous dosage recommendations are based on maintenance of glutathione peroxidase homeostasis. The routine supplementation dosage may not meet the selenium requirements of intensive care patients under conditions of increased metabolic demands on their anti-oxidative system. PMID:8846151

  11. Evaluation of Bacillus oleronius as a Biological Indicator for Terminal Sterilization of Large-Volume Parenterals.

    PubMed

    Izumi, Masamitsu; Fujifuru, Masato; Okada, Aki; Takai, Katsuya; Takahashi, Kazuhiro; Udagawa, Takeshi; Miyake, Makoto; Naruyama, Shintaro; Tokuda, Hiroshi; Nishioka, Goro; Yoden, Hikaru; Aoki, Mitsuo

    2016-01-01

    In the production of large-volume parenterals in Japan, equipment and devices such as tanks, pipework, and filters used in production processes are exhaustively cleaned and sterilized, and the cleanliness of water for injection, drug materials, packaging materials, and manufacturing areas is well controlled. In this environment, the bioburden is relatively low, and less heat resistant compared with microorganisms frequently used as biological indicators such as Geobacillus stearothermophilus (ATCC 7953) and Bacillus subtilis 5230 (ATCC 35021). Consequently, the majority of large-volume parenteral solutions in Japan are manufactured under low-heat sterilization conditions of F0 <2 min, so that loss of clarity of solutions and formation of degradation products of constituents are minimized. Bacillus oleronius (ATCC 700005) is listed as a biological indicator in "Guidance on the Manufacture of Sterile Pharmaceutical Products Produced by Terminal Sterilization" (guidance in Japan, issued in 2012). In this study, we investigated whether B. oleronius is an appropriate biological indicator of the efficacy of low-heat, moist-heat sterilization of large-volume parenterals. Specifically, we investigated the spore-forming ability of this microorganism in various cultivation media and measured the D-values and z-values as parameters of heat resistance. The D-values and z-values changed depending on the constituents of large-volume parenteral products. Also, the spores from B. oleronius showed a moist-heat resistance that was similar to or greater than many of the spore-forming organisms isolated from Japanese parenteral manufacturing processes. Taken together, these results indicate that B. oleronius is suitable as a biological indicator for sterility assurance of large-volume parenteral solutions subjected to low-heat, moist-heat terminal sterilization. PMID:26889054

  12. Manganese in Human Parenteral Nutrition: Considerations for Toxicity and Biomonitoring

    PubMed Central

    Santos, Dinamene; Batoreu, Camila; Mateus, Luisa; dos Santos, AP Marreilha; Aschner, Michael

    2013-01-01

    The iatrogenic risks associated with excessive Mn administration in parenteral nutrition (PN) patients are well documented. Hypermanganesemia and neurotoxicity are associated with the duration of Mn supplementation, Mn dosage, as well as pathological conditions, such as anemia or cholestasis. Recent PN guidelines recommend the biomonitoring of patients if they receive Mn in their PN longer than 30 days. The data in the literature are conflicting about the method for assessing Mn stores in humans as a definitive biomarker of Mn exposure or induced-neurotoxicity has yet to be identified. The biomonitoring of Mn relies on the analysis of whole blood Mn (WB Mn) levels, which are highly variable among human population and are not strictly correlated with Mn-induced neurotoxicity. Alterations in dopaminergic (DAergic) and catecholaminergic metabolism have been studied as predictive biomarkers of Mn-induced neurotoxicity. Given these limitations, this review addresses various approaches for biomonitoring Mn exposure and neurotoxic risk. PMID:24184781

  13. Marchiafava: Bignami Disease Treated with Parenteral Thiamine.

    PubMed

    Nemlekar, Saumitra Shankar; Mehta, Ritambhara Yeshwant; Dave, Kamlesh Rushikray; Shah, Nilima Deepak

    2016-01-01

    Marchiafava - Bignami disease is rare sequelae of chronic alcohol use. We present a case with transient ischemic attack like presentation and its management with parenteral thiamine. A 53 year old male with history of country liquor use since 32 years was brought to hospital with acute onset of delirium & mild weakness involving motor functions of left side of the body, non-reactive planters and exaggerated tendon reflexes on left side. The MRI showed bilateral hyper intense signal on T2W and FLAIR images & Hypo intense lesion on T1W images involving body, genu and splenium of corpus callosum. The features are suggestive of Marchiafava - Bignami Disease. There have been few guidelines for management of MBD and literature supports use of parenteral thiamine 500mg leading to remission of symptoms and symptomatic improvement. It is advisable to use parenteral thiamine in all cases as it overlaps management of other co-morbidities of chronic alcoholism. PMID:27114628

  14. Marchiafava: Bignami Disease Treated with Parenteral Thiamine

    PubMed Central

    Nemlekar, Saumitra Shankar; Mehta, Ritambhara Yeshwant; Dave, Kamlesh Rushikray; Shah, Nilima Deepak

    2016-01-01

    Marchiafava - Bignami disease is rare sequelae of chronic alcohol use. We present a case with transient ischemic attack like presentation and its management with parenteral thiamine. A 53 year old male with history of country liquor use since 32 years was brought to hospital with acute onset of delirium & mild weakness involving motor functions of left side of the body, non-reactive planters and exaggerated tendon reflexes on left side. The MRI showed bilateral hyper intense signal on T2W and FLAIR images & Hypo intense lesion on T1W images involving body, genu and splenium of corpus callosum. The features are suggestive of Marchiafava - Bignami Disease. There have been few guidelines for management of MBD and literature supports use of parenteral thiamine 500mg leading to remission of symptoms and symptomatic improvement. It is advisable to use parenteral thiamine in all cases as it overlaps management of other co-morbidities of chronic alcoholism. PMID:27114628

  15. GLP-2 Prevents Intestinal Mucosal Atrophy and Improves Tissue Antioxidant Capacity in a Mouse Model of Total Parenteral Nutrition

    PubMed Central

    Lei, Qiucheng; Bi, Jingcheng; Wang, Xinying; Jiang, Tingting; Wu, Chao; Tian, Feng; Gao, Xuejin; Wan, Xiao; Zheng, Huijun

    2016-01-01

    We investigated the effects of exogenous glucagon-like peptide-2 (GLP-2) on mucosal atrophy and intestinal antioxidant capacity in a mouse model of total parenteral nutrition (TPN). Male mice (6–8 weeks old) were divided into three groups (n = 8 for each group): a control group fed a standard laboratory chow diet, and experimental TPN (received standard TPN solution) and TPN + GLP-2 groups (received TPN supplemented with 60 µg/day of GLP-2 for 5 days). Mice in the TPN group had lower body weight and reduced intestinal length, villus height, and crypt depth compared to the control group (all p < 0.05). GLP-2 supplementation increased all parameters compared to TPN only (all p < 0.05). Intestinal total superoxide dismutase activity and reduced-glutathione level in the TPN + GLP-2 group were also higher relative to the TPN group (all p < 0.05). GLP-2 administration significantly upregulated proliferating cell nuclear antigen expression and increased glucose-regulated protein (GRP78) abundance. Compared with the control and TPN + GLP-2 groups, intestinal cleaved caspase-3 was increased in the TPN group (all p < 0.05). This study shows GLP-2 reduces TPN-associated intestinal atrophy and improves tissue antioxidant capacity. This effect may be dependent on enhanced epithelial cell proliferation, reduced apoptosis, and upregulated GRP78 expression. PMID:26761030

  16. Parenteral amino acid intakes in critically ill children

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Parenteral amino acid formulas used in parenteral nutrition have a variable composition. To determine the amino acid intake of parenterally fed, critically ill children, and compare it with recommended dietary allowances (RDA) established by the Institute of Medicine (IOM), we retrospectively review...

  17. PARENTERAL NUTRITION INDICATIONS, ADMINISTRATION, AND MONITORING

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Parenteral nutrition (PN) can be lifesaving or life threatening, depending on when and how it is used. In infants and children who are unable to meet their nutritional requirements over extended periods, it can prevent death from malnutrition. On the other hand, if appropriate attention is not paid ...

  18. Pharmaceutical Point of View on Parenteral Nutrition

    PubMed Central

    Stawny, M.; Olijarczyk, R.; Jaroszkiewicz, E.; Jelińska, A.

    2013-01-01

    Parenteral nutrition—a form of administering nutrients, electrolytes, trace elements, vitamins, and water—is a widely used mode of therapy applied in many diseases, in patients of different ages both at home and in hospital. The success of nutritional therapy depends chiefly on proper determination of the patient's energetic and electrolytic needs as well as preparation and administration of a safe nutritional mixture. As a parenterally administered drug, it is expected to be microbiologically and physicochemically stable, with all of the components compatible with each other. It is very difficult to obtain a stable nutritional mixture due to the fact that it is a complex, two-phase drug. Also, the risk of incompatibility between mixture components and packaging should be taken into consideration and possibly eliminated. Since parenteral nutrition is a part of therapy, simultaneous use of drugs may cause pharmacokinetic and pharmacodynamic interactions as well as those with the pharmaceutical phase. The aim of this paper is to discuss such aspects of parenteral nutrition as mixture stability, methodology, and methods for determining the stability of nutritional mixtures and drugs added to them. PMID:24453847

  19. Parenteral nutrition in patients with renal failure – Guidelines on Parenteral Nutrition, Chapter 17

    PubMed Central

    Druml, W.; Kierdorf, H. P.

    2009-01-01

    Partial EN (enteral nutrition) should always be aimed for in patients with renal failure that require nutritional support. Nevertheless PN (parenteral nutrition) may be necessary in renal failure in patient groups with acute or chronic renal failure (ARF or CRF) and additional acute diseases but without extracorporeal renal replacement therapy, or in patients with ARF or CRF with additional acute diseases on extracorporeal renal replacement therapy, haemodialysis therapy (HD), peritoneal dialysis (PD) or continuous renal replacement therapy (CRRT), or in patients on HD therapy with intradialytic PN. Patients with renal failure who show marked metabolic derangements and changes in nutritional requirements require the use of specifically adapted nutrient solutions. The substrate requirements of acutely ill, non-hypercatabolic patients with CRF correspond to those of patients with ARF who are not receiving any renal replacement patients therapy (utilisation of the administered nutrients has to be monitored carefully). In ARF patients and acutely ill CRF patients on renal replacement therapy, substrate requirements depend on disease severity, type and extent/frequency of extracorporeal renal replacement therapy, nutritional status, underlying disease and complications occurring during the course of the disease. Patients under HD have a higher risk of developing malnutrition. Intradialytic PN (IDPN) should be used if causes of malnutrition cannot be eliminated and other interventions fail. IDPN should only be carried out when modifiable causes of malnutrition are excluded and enhanced oral (like i.e. additional energy drinks) or enteral supply is unsuccessful or cannot be carried out. PMID:20049069

  20. Stability-Indicating HPLC-UV Method for Vitamin D3 Determination in Solutions, Nutritional Supplements and Pharmaceuticals.

    PubMed

    Temova, Žane; Roškar, Robert

    2016-08-01

    A simple and fast high-performance liquid chromatography method with UV detection for determination of vitamin D3 in stability studies as well as in solutions, nutritional supplements and pharmaceuticals was developed. Successful separation of vitamin D3 from its degradation products was achieved on a Gemini C18 100 × 3.0 mm column using a mixture of acetonitrile and water (99:1, v/v) as а mobile phase. The method was successfully validated according to the ICH guidelines. The described reversed-phase HPLC method is favorable compared with other published HPLC-UV methods because of its stability-indicating nature, short run time (3.3 min) and wide analytical range with outstanding linearity, accuracy and precision. The method was further applied for quantification of vitamin D3 in selected liquid and solid nutritional supplements and prescription medicines, confirming its suitability for routine analysis. Degradation products, formed under stress conditions (hydrolysis, oxidation, photolysis and thermal degradation), were additionally elucidated by suitable equipment (LC-DAD-MS) to confirm the stability-indicating nature of the developed method. PMID:27048642

  1. Controversies in the Mechanism of Total Parenteral Nutrition Induced Pathology

    PubMed Central

    Kumar, Jain Ajay; Teckman, Jeffery H.

    2015-01-01

    Over 30,000 patients are permanently dependent on Total Parenteral Nutrition (TPN) for survival with several folds higher requiring TPN for a prolonged duration. Unfortunately, it can cause potentially fatal complications. TPN infusion results in impairment of gut mucosal integrity, enhanced inflammation, increased cytokine expression and trans-mucosal bacterial permeation. It also causes endotoxin associated down regulation of bile acid transporters and Parenteral Nutrition Associated Liver Disease (PNALD), which includes steatosis, disrupted glucose metabolism, disrupted lipid metabolism, cholestasis and liver failure. Despite multiple theories, its etiology and pathophysiology remains elusive and is likely multifactorial. An important cause for TPN related pathologies appears to be a disruption in the normal enterohepatic circulation due to a lack of feeding during such therapy. This is further validated by the fact that in clinical settings, once cholestasis sets in, its reversal occurs when a patient is receiving a major portion of calories enterally. There are several other postulated mechanisms including gut bacterial permeation predisposing to endotoxin associated down regulation of bile acid transporters. An additional potential mechanism includes toxicity of the TPN solution itself, such as lipid mediated hepatic toxicity. Prematurity, leading to a poor development of bile acid regulating nuclear receptors and transporters has also been implicated as a causative factor. This review presents the current controversies and research into mechanisms of TPN associated injury. PMID:27417369

  2. Effects of Formulation Variables and Storage Conditions on Light Protected Vitamin B12 Mixed Parenteral Formulations

    PubMed Central

    Monajjemzadeh, Farnaz; Ebrahimi, Fatemeh; Zakeri-Milani, Parvin; Valizadeh, Hadi

    2014-01-01

    Purpose: In this research the effect of vitamin B1 and B6 on cyanocobalamin stability in commercial light protected parenteral formulations and upon adding stabilizing agents will be investigated and best formulation composition and proper storage condition will be introduced. Methods: In this research some additives such as co solvents and tonicity adjusters, surfactants, antioxidants and chelating agents as well as buffer solutions, were used to improve the stability of the parenteral mixed formulations of B12 in the presence of other B vitamins (B1 and B6). Screening tests and accelerated stability tests were performed according to ICH guidelines Q1A (R2). Results: Shelf life evaluation revealed the best formulation and the proper storage condition. The results indicated the first kinetic models for all tested formulations and the optimum pH value was determined to be 5.8. There was no evidence of B12 loss when mixed with B1 and B6 in a medical syringe at room temperature for maximum of 8 hours. Conclusion: It is necessary to formulate vitamin B12 mixed parenteral solutions using proper phosphate buffers (pH=5.8) and to indicate “Store in refrigerator” on the mixed parenteral formulations of vitamin B12 with other B vitamins, which has not been expressed on the label of tested Brand formulations at the time of this study. PMID:25436187

  3. Hyaluronic Acid (800 kDa) Supplementation of University of Wisconsin Solution Improves Viability of Osteochondral Grafts and Reduces Matrix Metalloproteinase Expression during Cold Preservation

    PubMed Central

    Yamada, Takuya; Uchida, Kentaro; Onuma, Kenji; Inoue, Gen; Aikawa, Jun; Takano, Shotaro; Sekiguchi, Hiroyuki; Fujimaki, Hisako; Miyagi, Masayuki; Takaso, Masashi

    2015-01-01

    Osteochondral allografting is a promising option for the treatment of large cartilage defects. However, because the cell viability of osteochondral tissues (OCTs) gradually reduces during storage at 4°C, methods for maintaining the cell viability of fresh OCTs are needed to improve transplantation outcomes. Here, we evaluated whether the supplementation of preservation solution with one of three different molecular weight forms of hyaluronic acid (HA) improved the viability of rat OCTs during long-term cold storage. The supplementation of University of Wisconsin (UW) solution with 800 kDa significantly improved the cell viability of OCT after 14 days at 4°C compared to nonsupplemented UW solution. In contrast, UW solution supplemented with either 1900 or 6000 kDa HA did not markedly improve the cell viability of the OCT. Real-time PCR analysis revealed that the levels of matrix metalloproteinases 2, 3, and 9 were significantly decreased in OCT stored in UW solution supplemented with 800 kDa HA. Although further studies in human OCT are warranted, these findings demonstrate that the use of 800 kDa HA in place of serum may be a suitable approach for the long-term preservation of osteochondral allografts designated for the repair of large cartilage defects in the clinical setting. PMID:26199955

  4. Intravenous Lipid Emulsions in Parenteral Nutrition.

    PubMed

    Fell, Gillian L; Nandivada, Prathima; Gura, Kathleen M; Puder, Mark

    2015-09-01

    Fat is an important macronutrient in the human diet. For patients with intestinal failure who are unable to absorb nutrients via the enteral route, intravenous lipid emulsions play a critical role in providing an energy-dense source of calories and supplying the essential fatty acids that cannot be endogenously synthesized. Over the last 50 y, lipid emulsions have been an important component of parenteral nutrition (PN), and over the last 10-15 y many new lipid emulsions have been manufactured with the goal of improving safety and efficacy profiles and achieving physiologically optimal formulations. The purpose of this review is to provide a background on the components of lipid emulsions, their role in PN, and to discuss the lipid emulsions available for intravenous use. Finally, the role of parenteral fat emulsions in the pathogenesis and management of PN-associated liver disease in PN-dependent pediatric patients is reviewed. PMID:26374182

  5. In-vitro detection of mannan and galactomannan in components of total parenteral nutrition (TPN).

    PubMed

    Knoth, H; Maywald, D; Walter, W

    2016-05-01

    Detection of Candida mannan and Aspergillus galactomannan in serum with the Platelia enzyme immunoassay is applied for diagnosing invasive fungal infections. High risk patients for invasive fungal infections are often receiving parenteral nutrition. It is important to know whether false-positive Platelia test results occur during total parenteral nutrition. Studies to false-positivity in intravenous feeding solutions lack so that we start an in-vitro investigation. We used two different enzyme immunoassays to test the feeding solutions. We tested infusions (n = 19) which are applied for the production of individual parenteral nutrition in the University Hospital Carl Gustav Carus Dresden. We used the Platelia Aspergillus EIA to analyse the Aspergillus antigen galactomannan in the solutions. In addition, the Platelia Candida Ag plus was used to determine the concentration of the Candida antigen mannan. In summary, four solutions (21%) showed measurable concentrations of the Candida mannan. They were considered positive with a concentration > 0.125 ng/ ml mannan (Tracitrans infant, calcium gluconate solution) and borderline with a concentration between 0.0625 and 0.125 ng/ml mannan (Tracitrans plus, SMOFlipid). None of the analysed infusions contained the Aspergillus galactomannan. In conclusion, further investigations on the topic are necessary to determine their in-vivo impact. A positive Platelia test result can simulate the presence of invasive fungal infections. As a consequence the patient may be treated with expensive, systemic antimycotics with a high risk of adverse events. Therefore a definite diagnosis is important. PMID:27348965

  6. Steroidal Compounds in Commercial Parenteral Lipid Emulsions

    PubMed Central

    Xu, Zhidong; Harvey, Kevin A.; Pavlina, Thomas; Dutot, Guy; Hise, Mary; Zaloga, Gary P.; Siddiqui, Rafat A.

    2012-01-01

    Parenteral nutrition lipid emulsions made from various plant oils contain steroidal compounds, called phytosterols. During parenteral administration of lipid emulsions, phytosterols can reach levels in the blood that are many fold higher than during enteral administration. The elevated phytosterol levels have been associated with the development of liver dysfunction and the rare development of liver failure. There is limited information available in the literature related to phytosterol concentrations in lipid emulsions. The objective of the current study was to validate an assay for steroidal compounds found in lipid emulsions and to compare their concentrations in the most commonly used parenteral nutrition lipid emulsions: Liposyn® II, Liposyn® III, Lipofundin® MCT, Lipofundin® N, Structolipid®, Intralipid®, Ivelip® and ClinOleic®. Our data demonstrates that concentrations of the various steroidal compounds varied greatly between the eight lipid emulsions, with the olive oil-based lipid emulsion containing the lowest levels of phytosterols and cholesterol, and the highest concentration of squalene. The clinical impression of greater incidences of liver dysfunction with soybean versus MCT/LCT and olive/soy lipid emulsions may be reflective of the levels of phytosterols in these emulsions. This information may help guide future studies and clinical care of patients with lipid emulsion-associated liver dysfunction. PMID:23016123

  7. Total parenteral nutrition in diabetic rats

    SciTech Connect

    Norcross, E.D.; Stein, T.P.

    1986-03-01

    Parenteral Nutrition with hypertonic glucose is frequently given to diabetic patients. Large amounts of insulin can be required. The purpose of this investigation was to develop a totally parenterally nourished diabetic rat model. 200 g Female Sprague Dawley rats were made diabetic by i.v. injection of streptozotocin (50 mg/kg). Rats were then allowed to recover for at least 1 week before undergoing surgical insertion of a central venous catheter for parenteral feeding. TPN was begun 3 days after surgery. Prior to this they were allowed unlimited access to food and water. Control (non-streptozotocin treated) rats were run at the same time. Protein turnover was investigated by using /sup 15/N glycine. Preliminary results: diabetic rats given mostly fat as a calorie source survived well in the absence of exogenous insulin whereas those that were given glucose only as their non-protein calorie source showed poor survival even with exogenous insulin. N balance and protein turnover in the lipid treated diabetic rats were comparable to the non-diabetic control rats.

  8. Effects of glutamine-containing total parenteral nutrition on phagocytic activity and anabolic hormone response in rats undergoing gastrectomy

    PubMed Central

    Lee, Chen-Hsien; Chiu, Wan-Chun; Chen, Soul-Chin; Wu, Chih-Hsiung; Yeh, Sung-Ling

    2005-01-01

    AIM: To investigate the effect of glutamine (Gln)-containing parenteral nutrition on phagocytic activity and to elucidate the possible roles of Gln in the secretion of anabolic hormones and nitrogen balance in rats undergoing a gastrectomy. METHODS: Rats with an internal jugular catheter were divided into 2 experimental groups and received total parenteral nutrition (TPN). The TPN solutions were isonitrogenous and identical in nutrient compositions except for differences in amino acid content. One group received conventional TPN (control), and in the other group, 25% of the total amino acid nitrogen was replaced with Gln. After receiving TPN for 3 d, one-third of the rats in each experimental group were sacrificed as the baseline group. The remaining rats underwent a partial gastrectomy and were killed 1 and 3 d, respectively, after surgery. Plasma, peritoneal lavage fluid (PLF), and urine samples were collected for further analysis. RESULTS: The Gln group had fewer nitrogen losses 1 and 2 d after surgery (d1, 16.6±242.5 vs -233.4±205.9 mg/d, d2, 31.8±238.8 vs -253.4±184.6 mg/d, P<0.05). There were no differences in plasma growth hormone (GH) and insulin-like growth factor-1 levels between the 2 groups before or after surgery. The phagocytic activity of peritoneal macrophages was higher in the Gln group than in the control group 1 d after surgery (A 1185±931 vs 323±201, P<0.05). There were no differences in the phagocytic activities of blood polymorphonuclear neutrophils between the 2 groups at the baseline or on the postoperative days. No significant differences in interleukin-1β or interleukin-6 concentrations in PLF were observed between the 2 groups. However, tumor necrosis factor-α level in PLF was significantly lower in the Gln group than in the control group on postoperative d 3. CONCLUSION: TPN supplemented with Gln can improve the nitrogen balance, and enhance macrophage phagocytic activity at the site of injury. However, Gln supplementation has no

  9. Early combined parenteral and enteral nutrition for pancreaticoduodenectomy – Retrospective cohort analysis

    PubMed Central

    Probst, Pascal; Keller, Daniel; Steimer, Johannes; Gmür, Emanuel; Haller, Alois; Imoberdorf, Reinhard; Rühlin, Maya; Gelpke, Hans; Breitenstein, Stefan

    2016-01-01

    Background Suggested guidelines for nutritional support after pancreaticoduodenectomy are still controversial. Recent evidence suggests that combining enteral nutrition (EN) with parenteral nutrition (PN) improves outcome. For ten years, patients have been treated with Early Combined Parenteral and Enteral Nutrition (ECPEN) after PD. The aim of this study was to report on rationale, safety, effectiveness and outcome associated with this method. Methods Consecutive PD performed between 2003 and 2012 were analyzed retrospectively. Early EN and PN was standardized and started immediately after surgery. EN was increased to 40 ml/h (1 kcal/ml) over 24 h, while PN was supplemented based on a daily energy target of 25 kcal/kg. Standard enteral and parenteral products were used. Results Sixty-nine patients were nutritionally supplemented according to ECPEN. The median coverage of kcal per patients related to the total caloric requirements during the entire hospitalization (nutrition balance) was 93.4% (range: 100%–69.3%). The nutritional balance in patients with needle catheter jejunostomy (NCJ) was significantly higher than in the group with nasojejunal tube (97.1% vs. 91.6%; p < 0.0001). Mortality rate was 5.8%, while major complications (Clavien-Dindo 3–5) occurred in 21.7% of patients. Neither the presence of preoperative malnutrition nor the application of preoperative immunonutrition was associated with postoperative clinical outcome. Conclusion This is the first European study of ECPEN after PD. ECPEN is safe and, especially in combination with NCJ, provides comprehensive coverage of caloric requirements during the postoperative phase. Clinical controlled trials are needed to investigate potential benefits of complete energy supplementation during the early postoperative phase after PD. PMID:26955477

  10. Parenteral sulfur amino acid requirements in septic infants

    Technology Transfer Automated Retrieval System (TEKTRAN)

    To investigate parenteral methionine requirements of critically ill, septic infants, we conducted an investigation involving 12 infants (age 2+/-1 years; weight 13+/-2kg) using the intravenous indicator amino acid oxidation and balance technique. They received a balanced parenteral amino acid formul...

  11. The Updated Bottom Up Solution applied to mass spectrometry of soybean oil in a dietary supplement gelcap.

    PubMed

    Byrdwell, William Craig

    2015-07-01

    Among the goals of lipidomics applied to triacylglycerols (TAGs) is identification of molecular species, degree and location of unsaturation, and positions of fatty acyl chains (i.e., identification of regioisomers). Toward those ends, we define one, two, and three "Critical Ratios" for Types I, II, and III TAGs that provided different aspects of the desired information. Critical Ratio 1, [MH](+)/Σ[DAG](+), is correlated to the degree of unsaturation ([MH](+) is the protonated molecule and Σ[DAG](+) is the sum of diacylglycerol-like ions, [DAG](+)); Critical Ratio 2, [AA](+)/[AB](+) for Type II TAGs ("ABA/AAB/BAA") and [AC](+)/([AB](+)+[BC](+)) for Type III TAGs ("ABC/CBA/BAC/CAB/ACB/BCA"), is correlated to identification of regioisomers; and Critical Ratio 3, [BC](+)/[AB](+), provides information about those [DAG](+) from Type III TAGs. Furthermore, Critical Ratios are used in the Updated Bottom Up Solution (UBUS) to reproduce the mass spectra of TAGs by atmospheric pressure chemical ionization mass spectrometry applied to analysis of soybean oil in a dietary supplement gelcap. We present a new model for the [MH](+)/Σ[DAG](+) ratio, quantify regioisomers using the [AA](+)/[AB](+) ratio, and describe trends for [BC](+)/[AB](+) that have never been reported before. The UBUS is also applied to other classes of molecules, i.e., vitamin D and DAGs. The amount of vitamin D3 in the gelcap fell from 2011 ± 22 when received to 1689 ± 33 just prior to expiration. The Critical Ratios constitute a compact data set that can provide structural information and also act as a library of mass spectra. PMID:25855147

  12. Response of preterm infants to aluminum in parenteral nutrition.

    PubMed

    Koo, W W; Kaplan, L A; Krug-Wispe, S K; Succop, P; Bendon, R

    1989-01-01

    Twenty-five preterm infants with birth weights (BW) 540 to 2280 g (20 with birth weight less than 1500 g) and gestational ages 24 to 37 weeks, were studied to determine the response to 2 levels of aluminum (Al) loading from currently unavoidable contamination of various components of parenteral nutrition (PN) solution. High Al loading group (H) received solutions with measured Al content of 306 +/- 16 micrograms/liter and low A1 loading group (L) received solutions with 144 +/- 16 micrograms A1/liter. Urine Al:Creatinine (Al:Cr) ratios (micrograms:mg) became elevated and significantly higher in H (1.6 +/- 0.38 vs 0.5 +/- 0.1, p less than 0.05) at the third sampling point (mean 19 days). Serum Al concentrations were highest at onset in both groups and stabilized with study but remained consistently higher than the normal median of 18 micrograms/liter. Calculated urine Al excretion were consistently low and were 34 +/- 6% vs 28 +/- 5% in the H and L groups, respectively. One infant in the L group who died 39 days after termination of above study showed the presence of A1 in bone trabeculae and the presence of excessive unmineralized osteoid along the trabeculae. We conclude that small preterm infants are able to increase urine Al excretion with increased Al load. However urine Al excretion is incomplete with bone deposition of Al and persistently elevated serum Al concentrations. PMID:2514293

  13. Parenteral nutrition product shortages: impact on safety.

    PubMed

    Holcombe, Beverly

    2012-03-01

    The drug shortage crisis continues in the United States and threatens the integrity of the pharmaceutical supply chain and compromises patient care, especially patients requiring parenteral nutrition (PN) therapy. The number of new drug shortages has increased rapidly over the past 5 years, with the most significant increase in sterile injectable products. The most common reason for a shortage of a sterile injectable medication is a product quality issue. Two surveys of healthcare professionals have assessed the impact of drug shortages on patient safety. Participants in one survey reported over 1000 medication errors or patient adverse events as the result of shortages. The American Society for Parenteral and Enteral Nutrition also conducted a survey of healthcare professionals regarding PN product shortages and the associated patient care implications. Safety risks were reported throughout the entire PN process, from procurement of PN products to patient outcomes. Providing PN therapy during product shortages requires vigilance and continuous assessment of the entire PN process to optimize patient care quality and avoid patient harm. PMID:22282871

  14. Ketorolac: a parenteral nonsteroidal antiinflammatory drug.

    PubMed

    Resman-Targoff, B H

    1990-11-01

    Ketorolac tromethamine is a pyrrolo-pyrrole nonsteroidal antiinflammatory drug (NSAID) with potent analgesic effects when administered intramuscularly for the treatment of acute pain. Ketorolac is well absorbed and has a rapid onset of action. Maximum plasma concentrations are achieved in 45-50 minutes and peak analgesic effects in about one to two hours following intramuscular injection. Ketorolac is more than 99 percent bound to plasma proteins and has a mean apparent volume of distribution of 0.11-0.25 L/kg. About 91 percent of a dose is excreted in urine, mostly as inactive metabolites, and approximately 6 percent is eliminated in feces. The elimination half-life, approximately four to six hours, increases in elderly patients and those with renal impairment. Its analgesic effectiveness was similar or superior to that of morphine, meperidine, or pentazocine in single-dose studies of patients with postoperative pain or renal colic and greater than that of placebo in patients with chronic cancer pain. The adverse effects are generally mild to moderate, self-limiting, and similar to those seen with other prostaglandin inhibitors. Ketorolac has a reversible inhibitory effect on platelet aggregation. It can cause dose-related gastric ulcerations, even when administered parenterally. Ketorolac is a promising parenteral alternative to oral NSAIDs and a nonnarcotic alternative to opioid analgesics. Additional multiple-dose studies are needed to more clearly define its place in therapy. PMID:2275236

  15. Tocopherol and tocotrienol homologs in parenteral lipid emulsions

    PubMed Central

    Xu, Zhidong; Harvey, Kevin A; Pavlina, Thomas M; Zaloga, Gary P; Siddiqui, Rafat A

    2015-01-01

    Parenteral lipid emulsions, which are made of oils from plant and fish sources, contain different types of tocopherols and tocotrienols (vitamin E homologs). The amount and types of vitamin E homologs in various lipid emulsions vary considerably and are not completely known. The objective of this analysis was to develop a quantitative method to determine levels of all vitamin E homologs in various lipid emulsions. An HPLC system was used to measure vitamin E homologs using a Pinnacle DB Silica normal phase column and an isocratic, n-hexane:1,4 dioxane (98:2) mobile phase. An optimized protocol was used to report vitamin E homolog concentrations in soybean oil-based (Intralipid®, Ivelip®, Lipofundin® N, Liposyn® III, and Liposyn® II), medium- and long-chain fatty acid-based (Lipofundin®, MCT and Structolipid®), olive oil-based (ClinOleic®), and fish oil-based (Omegaven®) and mixture of these oils-based (SMOFlipid®, Lipidem®) commercial parenteral lipid emulsions. Total content of all vitamin E homologs varied greatly between different emulsions, ranging from 57.9 to 383.9 µg/mL. Tocopherols (α, β, γ, δ) were the predominant vitamin E homologs for all emulsions, with tocotrienol content < 0.3%. In all of the soybean emulsions, except for Lipofundin® N, the predominant vitamin E homolog was γ-tocopherol, which ranged from 57–156 µg/mL. ClinOleic® predominantly contained α-tocopherol (32 µg/mL), whereas α-tocopherol content in Omegaven® was higher than most of the other lipid emulsions (230 µg/mL). Practical applications The information on the types and quantity of vitamin E homologs in various lipid emulsions will be extremely useful to physicians and healthcare personnel in selecting appropriate lipid emulsions that are exclusively used in patients with inadequate gastrointestinal function, including hospitalized and critically ill patients. Some emulsions may require vitamin E supplementation in order to meet minimal human requirements

  16. Alteration of erythrocyte lipid composition following total parenteral nutrition in the rat.

    PubMed

    Innis, S M

    1989-01-01

    Rats were infused continuously for 7 days with a complete total parenteral nutrition (TPN) solution in which 27.5% total calories were given as a parenteral lipid emulsion containing soybean oil (Liposyn) or safflower oil (Intralipid) emulsified with egg phospholipid (PL). Compared to sham-operated rats fed chow, the erythrocyte membranes from rats given TPN with lipid emulsion had increased cholesterol and PL but normal molar cholesterol:PL ratios. The fatty acid changes in sphingomyelin and phosphatidylcholine, in particular, suggested replacement of endogenous PL with the exogenous egg PL infused with the emulsion. The changes in membrane lipid composition were accompanied by greater resistance of the cells from rats given TPN to osmotic lysis in vitro. PMID:2494367

  17. Wernicke's encephalopathy after total parenteral nutrition in patients with Crohn's disease

    PubMed Central

    Shin, In Seub; Seok, Hyeri; Eun, Yeong Hee; Lee, You-Bin; Lee, Seung-Eun; Kim, Eun Ran; Chang, Dong Kyung; Kim, Young-Ho

    2016-01-01

    Micronutrient deficiencies in Crohn's disease (CD) patients are not uncommon and usually result in a combination of reduced dietary intake, disease-related malabsorption, and a catabolic state. Decreased serum thiamine levels are often reported in patients with CD. Wernicke's encephalopathy (WE) is a severe form of thiamine deficiency that can cause serious neurologic complications. Although WE is known to occur frequently in alcoholics, a number of non-alcoholic causes have also been reported. Here, we report two cases of non-alcoholic WE that developed in two severely malnourished CD patients who were supported by prolonged total parenteral nutrition without thiamine supplementation. These patients complained of sudden-onset ophthalmopathy, cerebellar dysfunction, and confusion. Magnetic resonance imaging allowed definitive diagnosis for WE despite poor sensitivity. The intravenous administration of thiamine alleviated the symptoms of WE dramatically. We emphasize the importance of thiamine supplementation for malnourished patients even if they are not alcoholics, especially in those with CD. PMID:27175122

  18. Standardized Competencies for Parenteral Nutrition Order Review and Parenteral Nutrition Preparation, Including Compounding: The ASPEN Model.

    PubMed

    Boullata, Joseph I; Holcombe, Beverly; Sacks, Gordon; Gervasio, Jane; Adams, Stephen C; Christensen, Michael; Durfee, Sharon; Ayers, Phil; Marshall, Neil; Guenter, Peggi

    2016-08-01

    Parenteral nutrition (PN) is a high-alert medication with a complex drug use process. Key steps in the process include the review of each PN prescription followed by the preparation of the formulation. The preparation step includes compounding the PN or activating a standardized commercially available PN product. The verification and review, as well as preparation of this complex therapy, require competency that may be determined by using a standardized process for pharmacists and for pharmacy technicians involved with PN. An American Society for Parenteral and Enteral Nutrition (ASPEN) standardized model for PN order review and PN preparation competencies is proposed based on a competency framework, the ASPEN-published interdisciplinary core competencies, safe practice recommendations, and clinical guidelines, and is intended for institutions and agencies to use with their staff. PMID:27317615

  19. Compartment syndrome due to extravasation of peripheral parenteral nutrition: extravasation injury of parenteral nutrition

    PubMed Central

    Park, Huee Jin; Kim, Kyung Hoon; Lee, Hyuk Jin; Jeong, Eui Cheol; Kim, Kee Won

    2015-01-01

    Compartment syndrome is a rare but devastating condition that can result in permanent neuromuscular or soft tissue injuries. Extravasation injuries, among the iatrogenic causes of compartment syndrome, occur under a wide variety of circumstances in the inpatient setting. Total parenteral nutrition via a peripheral route is an effective alternative for the management of critically ill children who do not obtain adequate nutrition via the oral route. However, there is an inherent risk of extravasation, which can cause compartment syndrome, especially when detected at a later stage. Herein, we report a rare case of compartment syndrome and skin necrosis due to extravasation, requiring emergency fasciotomy and skin graft in a 7-month-old boy who was treated with peripheral parenteral nutrition via a pressurized infusion pump. Although we cannot estimate the exact time at which extravasation occurred, the extent and degree of the wound suggest that the ischemic insult was prolonged, lasting for several hours. Pediatric clinicians and medical teams should carefully examine the site of insertion of the intravenous catheter, especially in patients receiving parenteral nutrition via a peripheral intravenous catheter with a pressurized infusion pump. PMID:26692883

  20. 21 CFR 310.509 - Parenteral drug products in plastic containers.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 5 2012-04-01 2012-04-01 false Parenteral drug products in plastic containers... Parenteral drug products in plastic containers. (a) Any parenteral drug product packaged in a plastic... parenteral drug product for intravenous use in humans that is packaged in a plastic immediate container on...

  1. 21 CFR 310.509 - Parenteral drug products in plastic containers.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 5 2010-04-01 2010-04-01 false Parenteral drug products in plastic containers... Parenteral drug products in plastic containers. (a) Any parenteral drug product packaged in a plastic... parenteral drug product for intravenous use in humans that is packaged in a plastic immediate container on...

  2. 21 CFR 310.509 - Parenteral drug products in plastic containers.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 5 2013-04-01 2013-04-01 false Parenteral drug products in plastic containers... Parenteral drug products in plastic containers. (a) Any parenteral drug product packaged in a plastic... parenteral drug product for intravenous use in humans that is packaged in a plastic immediate container on...

  3. 21 CFR 310.509 - Parenteral drug products in plastic containers.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 5 2014-04-01 2014-04-01 false Parenteral drug products in plastic containers... Parenteral drug products in plastic containers. (a) Any parenteral drug product packaged in a plastic... parenteral drug product for intravenous use in humans that is packaged in a plastic immediate container on...

  4. 21 CFR 310.509 - Parenteral drug products in plastic containers.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Parenteral drug products in plastic containers... Parenteral drug products in plastic containers. (a) Any parenteral drug product packaged in a plastic... parenteral drug product for intravenous use in humans that is packaged in a plastic immediate container on...

  5. Development of pancreas storage solutions: Initial screening of cytoprotective supplements for β-cell survival and metabolic status after hypothermic storage.

    PubMed

    Campbell, Lia H; Taylor, Michael J; Brockbank, Kelvin G M

    2013-02-01

    Insulin-dependent diabetes mellitus is one of the leading causes of death world-wide. Donor-derived pancreas and Islet of Langerhans transplantation are potential cures; however, postmortem ischemia impacts islet quality. The murine βt3 cell line was employed as a model to study cell viability and proliferation after hypothermic storage by comparing Belzer's Machine Perfusion Solution with Unisol™ Solution. The objective was to determine which of these solutions provided the best base line support for βt3 cells and to screen potential cytoprotective additives to the solutions. Initial βt3 cell viability was similar in the two storage solutions; however, better proliferation was observed after storage in Unisol Solution. The caspase inhibitor, Q-VD-OPH, and α-tocopherol improved viability in both storage solutions, suggesting that apoptotic pathways may be responsible for cell death during hypothermic storage of βt3 cells. Analysis of apoptosis markers, caspase activity, and DNA laddering showed a reduction in apoptosis when these additives were included. The effects of Q-VD-OPH and α-tocopherol were also synergistic when employed together during either hypothermic exposure, post-hypothermic physiologic incubation, or combinations of hypothermic exposure and physiologic incubation. These results suggest that both supplements should be included in pancreas hypothermic storage solutions and in islet culture media during post-isolation culture prior to transplantation. PMID:24845250

  6. Insulin Resistance and Body Weight: Recent Human Studies Documenting the Benefits of Supplemental Chromium

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The essentiality of chromium for humans was confirmed more than three decades ago with the studies showing that patients on total parenteral nutritrion (TPN) developed severe diabetic-like symptoms that could be reversed by the addition of chromium to their parenteral nutrition solutions. Since the...

  7. Effect of fasting and parenteral alimentation on PIPIDA scintigraphy

    SciTech Connect

    Potter, T.; McClain, C.J.; Shafer, R.B.

    1983-08-01

    Ten patients were prospectively studied using 99mTc-PIPIDA imaging to evaluate the effects of fasting and parenteral alimentation on gallbladder function. Three of ten patients had initial nonvisualization of the gallbladder for up to 2 hr, yet had normal visualization on repeat imaging performed after resumption of oral intake or after parenteral alimentation was discontinued. 99mTc-PIPIDA imaging should be interpreted with caution in patients fitting into either of these groups.

  8. Evaluation of physicochemical incompatibilities during parenteral drug administration in a paediatric intensive care unit.

    PubMed

    Gikic, M; Di Paolo, E R; Pannatier, A; Cotting, J

    2000-06-01

    Patients in paediatric intensive care units (PICU) often receive numerous medications by the parenteral route. Frequently two or more drugs are delivered simultaneously through the same line and the risk of physicochemical incompatibilities is thus important. The objectives of this study were 1) to identify prospectively the combinations of injectable drugs administered in the PICU of our university hospital and 2) to analyze them according to information found in the literature. The data were collected by a pharmacist over a 30-day period and classified in three categories: compatible, incompatible and undocumented. Nineteen patients were included in the study with a median age of 3.2 years. The mean number (+/- SD) of injectable drugs per patient and per day was 6.5 (+/- 2.8), for a total of 26 drugs and 7 solutes. 64 combinations of drugs were observed with 2 (31.3%), 3 (45.3%), 4 (10.9%) or 5 (12.5%) drugs. 81 drug-drug and 94 drug-solute combinations were recorded. Among these, 151 (86.3%) were compatible, 6 (3.4%) incompatible and 18 (10.3%) undocumented. The incompatibilities included furosemide (Lasix), a drug in alkaline solution and Vamina-Glucose, a total parenteral nutrition solution. No clinical consequences resulting from drug incompatibilities were shown in this study. We suggest that in vitro compatibility tests on standard drug combinations, as well as a training program for nurses on drug incompatibility problems would sensitively increase the security of parenteral drug administration. PMID:11028261

  9. Parenteral nutrition in neonatology--to standardize or individualize?

    PubMed

    Riskin, Arieh; Shiff, Yaakov; Shamir, Raanan

    2006-09-01

    Premature very low birth weight (< 1500 g) infants comprise one of the largest groups receiving parenteral nutrition. PN should be optimized to answer their high nutritional requirements and suit their metabolic status, but should also be validated pharmaceutically. PN can be provided as a standard, usually commercial, formulation, representing the average needs of a large group of patients. Alternatively, an individualized PN compound adapted to the patient's needs can be prescribed and prepared, usually on a daily basis. The main advantage of individually prescribed PN is that it is tailored to suit a specific patient, thereby assuring the best possible nutrition and biochemical control. Batch-produced standardized PN bags can be readily available as ward stocks in neonatal intensive care units, enabling initiation of early PN immediately after the delivery of a premature infant. Moreover, standard PN solutions incorporate expert nutritional knowledge and support. A combination of standardized PN bags, prepared under strict standardization criteria, for most neonates, with a small number of specifically tailored individualized PN formulations for those in need for them, could reduce pharmacy workload and costs and increase safety, while maintaining the desired clinical flexibility. For those in need of the individualized PN formulations, a computerized ordering system can save time, decrease prescription and compounding errors, and improve quality of nutritional care. PMID:17058418

  10. Metabolic bone disease in home total parenteral nutrition.

    PubMed

    McCullough, M L; Hsu, N

    1987-07-01

    Home total parenteral nutrition (HTPN) is in its infancy but has proved to be lifesaving for patients unable to manage on enteral nutrition alone. However, this mode of nutrition therapy is not without problems. Aside from mechanical and other metabolic complications, a peculiar metabolic bone disease has been reported to occur in some HTPN recipients. The disease, characterized by abnormalities in calcium and phosphorus homeostasis, often results in osteomalacia, bone pain, and fractures. Reports of approximately 50 cases of metabolic bone disease have been published by centers in the United States and Canada. Factors that have been implicated as possible causes include infusion of excess vitamin D, aluminum, calcium, protein, or glucose; cyclic vs. continuous TPN administration; and the patient's previous nutritional state. Although removal of vitamin D or aluminum from the TPN solution and discontinuation of TPN altogether have been associated with improvement in symptoms, histology, and laboratory values, no single factor has been identified as the cause of this troubling phenomenon. PMID:3110249

  11. Parenteral Nutrition in the Critically Ill Patient

    PubMed Central

    Ziegler, Thomas R.

    2011-01-01

    A 67-year-old woman with type 2 diabetes mellitus undergoes extensive resection of the small bowel and right colon with a jejunostomy and colostomy because of mesenteric ischemia. In the surgical intensive care unit, severe systemic inflammatory response syndrome with possible sepsis develops. The patient is treated with volume resuscitation, vasopressor support, mechanical ventilation, broad-spectrum antibiotics, and intravenous insulin infusion. Low-dose tube feedings are initiated postoperatively through a nasogastric tube. However, these feedings are discontinued after the development of escalating vasopressor requirements, worsening abdominal distention, and increased gastric residual volume, along with an episode of emesis. The hospital nutritional-support service is consulted for feeding recommendations. A discussion with the patient's family reveals that during the previous 6 months, she lost approximately 15% of her usual body weight and decreased her food intake because of abdominal pain associated with eating. Her preoperative body weight was 51 kg (112 lb), or 90% of her ideal body weight. The physical examination reveals mild wasting of skeletal muscle and fat. Blood tests show hypomagnesemia, hypophosphatemia, and normal hepatic and renal function. Central venous parenteral nutrition is recommended. PMID:19741230

  12. Development and Evaluation of Artemether Parenteral Microemulsion

    PubMed Central

    Tayade, N. G.; Nagarsenker, Mangal S.

    2010-01-01

    The objective of the present investigation was to develop a parenteral microemulsion delivering artemether, a hydrophobic antimalarial drug and to evaluate antimalarial activity of the microemulsion in comparison to the marketed oily injection of artemether (Larither®). The microemulsion was evaluated for various parameters such as globule size, ability to withstand centrifugation and freeze-thaw cycling and effect of sterilization method on the drug content and globule size. The in vivo antimalarial activity of the microemulsion was evaluated in P. berghei infected mice in comparison to the Larither;. The stability of the microemulsion was evaluated at 5º for 1 month. The microemulsion exhibited globule size of 113 nm and it could successfully withstand centrifugation and freeze-thaw cycling. The method of sterilization did not have any significant effect on the artemether content and globule size of the microemulsion. The microemulsion showed around 1.5-fold higher antimalarial activity and higher survival as compared to that of marketed artemether injection Larither® and it showed a good stability at the end of 1 month. PMID:21694999

  13. Solute-Filled Syringe For Formulating Intravenous Solution

    NASA Technical Reports Server (NTRS)

    Owens, Jim; Bindokas, AL; Dudar, Tom; Finley, Mike; Scharf, Mike

    1993-01-01

    Prefilled syringe contains premeasured amount of solute in powder or concentrate form used to deliver solute to sterile interior of large-volume parenteral (LVP) bag. Predetermined amount of sterile water also added to LVP bag through sterilizing filter, and mixed with contents of syringe, yielding sterile intravenous solution of specified concentration.

  14. Parenteral nutrition improves nutritional status, autonomic symptoms and quality of life in transthyretin amyloid polyneuropathy.

    PubMed

    Russo, Massimo; Vita, Gian Luca; Stancanelli, Claudia; Mazzeo, Anna; Vita, Giuseppe; Messina, Sonia

    2016-06-01

    Transthyretin familial amyloid polyneuropathy (TTR-FAP) is an inherited amyloidosis, leading to death in about ten years in most cases due to cardiac failure or wasting syndrome. Previous studies showed that modified body mass index was related to time before death, duration of gastrointestinal disturbances, malabsorption and functional capacity. We report two patients in whom nutritional status worsened despite diet modification, hypercaloric supplement and two relevant therapeutic approaches such as liver transplant and tafamidis meglumine, respectively. The first patient, a 52-year-old lady carrying Thr49Ala mutation, had a disease duration of twelve years and had lost weight up to 35 kg because of daily diarrhea. The second patient, a 63-year-old man with Glu89Gln mutation and a disease duration of fifteen years, was in the New York Heart Association (NYHA) Functional Classification class III and his weight was 39 kg. In both cases, a peripherally inserted central catheter was placed for parenteral nutrition. It allowed to improve their nutritional status and clinical conditions, with body weight gains of 11 and 8 kg in a one year follow-up, respectively. Moreover, reduction of autonomic symptoms including postural hypotension, nausea and diarrhoea was recorded with ameliorated quality of life. Our experience suggests that parenteral nutrition may be useful in reducing complications and disabilities in TTR-FAP patients, even when all dietary adjustments have been ineffective. Reasonably, the improvement in nutritional status may prolong survival in TTR-FAP patients. PMID:27132122

  15. Early enteral nutrition vs parenteral nutrition following pancreaticoduodenectomy: Experience from a single center

    PubMed Central

    Lu, Jian-Wen; Liu, Chang; Du, Zhao-Qing; Liu, Xue-Min; Lv, Yi; Zhang, Xu-Feng

    2016-01-01

    AIM: To analyze and compare postoperative morbidity between patients receiving total parenteral nutrition (TPN) and early enteral nutrition supplemented with parenteral nutrition (EEN + PN). METHODS: Three hundred and forty patients receiving pancreaticoduodenectomy (PD) from 2009 to 2013 at our center were enrolled retrospectively. Patients were divided into two groups depending on postoperative nutrition support scheme: an EEN + PN group (n = 87) and a TPN group (n = 253). Demographic characteristics, comorbidities, preoperative biochemical parameters, pathological diagnosis, intraoperative information, and postoperative complications of the two groups were analyzed. RESULTS: The two groups did not differ in demographic characteristics, preoperative comorbidities, preoperative biochemical parameters or pathological findings (P > 0.05 for all). However, patients with EEN + PN following PD had a higher incidence of delayed gastric emptying (16.1% vs 6.7%, P = 0.016), pulmonary infection (10.3% vs 3.6%, P = 0.024), and probably intraperitoneal infection (18.4% vs 10.3%, P = 0.059), which might account for their longer nasogastric tube retention time (9 d vs 5 d, P = 0.006), postoperative hospital stay (25 d vs 20 d, P = 0.055) and higher hospitalization expenses (USD10397 vs USD8663.9, P = 0.008), compared to those with TPN. CONCLUSION: Our study suggests that TPN might be safe and sufficient for patient recovery after PD. Postoperative EEN should only be performed scrupulously and selectively. PMID:27076767

  16. Flow and injection characteristics of pharmaceutical parenteral formulations using a micro-capillary rheometer.

    PubMed

    Allahham, Ayman; Stewart, Peter; Marriott, Jennifer; Mainwaring, David E

    2004-02-11

    A micro-capillary rheometer consisted of a fine needle with an internal diameter of 347 microm attached to a 1 ml removable-needle syringe within an Instron device that operated in compression mode to provide various crosshead speeds ranging from 150 to 950 mm min(-1) covering typical clinical injection rates, and that determined the resulting force on the plunger. The crosshead speed and the resulting force were used to calculate the shear rate and the shear stress respectively. These were used in standard capillary flow expressions together with an independent measurement of the wall frictional force and allowed the viscosity of parenteral Newtonian solutions and non-Newtonian suspensions to be measured quantitatively and their rheological behaviour in needles of clinical dimensions to be established. Commercial pharmaceutical parenteral formulations consisting of three oil-based solutions and three aqueous suspensions were chosen for this study. The net injection forces were also obtained and it was shown that both the oil-based solutions and the aqueous suspensions covered similar ranges. The viscosities for the parenteral solutions were determined from the slope of the linear regression (R(2)>0.97) between shear stress and shear rate and ranged between 0.029 and 0.060 Pas. For the aqueous suspensions examined, viscosities decreased from low shear rate to high shear rate, following a power-law model and indicating a pseudo plastic behaviour. Standardisation of the micro-capillary rheometer with Newtonian silicone oils calibrated with a Rheometrics Fluids Spectrometer showed viscosity values consistent between the rotational flow measurements and capillary flow measurements which were within 5% and showed very high degrees of reproducibility between replicate samples. This degree of reproducibility allowed differences in the contribution of the wall frictional force to the required plunger force for both the oil-based and aqueous parenteral formulations to be

  17. Comparison of the Efficacies of Parenteral Iron Sucrose and Oral Iron Sulfate for Anemic Patients with Inflammatory Bowel Disease in Korea

    PubMed Central

    Han, Yoo Min; Yoon, Hyuk; Shin, Cheol Min; Koh, Seong-Joon; Im, Jong Pil; Kim, Byeong Gwan; Kim, Joo Sung; Jung, Hyun Chae

    2016-01-01

    Background/Aims The optimal route for iron administration in anemic patients with inflammatory bowel disease (IBD) has not been determined. The aim of this study was to compare the efficacies of parenteral and oral iron therapy in IBD patients in Korea. Methods A retrospective multicenter study was performed. Patients who had been administered parenteral iron were matched to the controls with oral iron at a 1:1 ratio according to age, sex, and type of IBD. Results Patients that received parenteral iron exhibited increases in hemoglobin levels of ≥20% from the baseline at lower doses and in shorter durations (p=0.034 and p=0.046, respectively). In the multivariate analysis, parenteral iron therapy appeared to be more efficient than oral iron therapy, but this difference was not statistically significant (hazard ratio [HR], 1.552; 95% confidence interval [CI], 0.844 to 2.851; p=0.157). Patients with ulcerative colitis responded better to iron therapy than those with Crohn’s disease (HR, 3.415; 95% CI, 1.808 to 6.450; p<0.001). Patients with an initial hemoglobin level of 10 g/dL or higher responded poorly to iron therapy (HR, 0.345; 95% CI, 0.177 to 0.671; p=0.002). Conclusions Parenteral iron therapy appears to be more efficient than oral iron therapy. Physicians should focus on the iron deficiency of IBD patients and consider parenteral iron supplements in appropriate patient groups. PMID:27021505

  18. [Septic pulmonary emboli caused by parenteral nutrition catheter infection].

    PubMed

    Kuwabara, M; Itoi, K; Ariyasu, T; Yanagihara, K; Nasu, T

    1990-09-01

    A case of septic pulmonary emboli due to parenteral nutrition catheter infection was reported. Characteristic radiologic features were recognized. A 50-year-old man, who was receiving parenteral nutrition after total gastrectomy, consulted our department with complaints of fever and general malaise. A chest radiograph showed scattered ill-defined small peripheral nodules, which were not present before parenteral nutrition, and these nodules were quickly formed cavities + in 2nd day. He was suffering from high fever, hemo-sputum and dyspnea after removal of the parenteral nutrition catheter. Pseudomonas aeruginosa was isolated from the tip of parenteral nutrition catheter and sputum cultures. Septic pulmonary emboli were diagnosed and antibiotic therapy was performed. Bacterial endocarditis and septic thrombophlebitis were ruled out. The multiple cavity nodules extended to involve the peripheral areas of the lung and invasive shadows appeared on the chest radiograph in 8th day. Then, the invasive shadows disappeared and the walls of the cavitary lesions became thinner. After 2 months, all cavitary lesions disappeared with only linear shadows remaining. PMID:2125088

  19. Pharmaceutical development and manufacturing of a parenteral formulation of a novel antitumor agent, VNP40101M.

    PubMed

    Krishna, G; Hodnick, W F; Lang, W; Lin, X; Karra, S; Mao, J; Almassian, B

    2001-01-01

    The objective of this study was to develop and manufacture a stable parenteral formulation for Phase I clinical trials of VNP40101M (1,2-Bis(methylsulfonyl)-1-(2-chloroethyl)-2-[(2-methylamino)carbonyl] hydrazine), a novel antitumor agent. The solubility and stability of the drug was determined. Solubility studies suggested that VNP40101M exhibited poor aqueous solubility but showed appreciable solubility in nonaqueous solvents. The aqueous solubility of the drug could not be increased by adjusting the pH. At a pH above 7, base-catalyzed decomposition of VNP40101M occurred. The low octanol-water partition coefficient of 0.75 suggested poor solubility in lipophilic solvents. Based on these preformulation observations, a parenteral formulation containing 10 mg/mL of VNP40101M was prepared in a solvent system consisting of 30% ethyl alcohol and 70% polyethylene glycol-300 (PEG-300). To minimize base-catalyzed hydrolytic degradation, citric acid at 0.6% concentration was included to acidify the formulation. Rubber closures, filter membranes, and liquid transfer tubing were selected on the basis of compatibility studies and absence of loss of drug due to adsorption of these components. The formulation was subjected to accelerated stability studies and dilution studies with large volume parenteral (LVP) solutions, normal saline, and 5% dextrose injection (D5W). The results of the dilution study indicated that the formulation could be diluted in these solutions up to 2 mg/mL for 8 hours without drug precipitation and degradation. Accelerated stability studies suggested that the product should be kept at 2 degrees C to 8 degrees C for long-term storage. The developed formulation was successfully scaled up and manufactured for use in clinical trials. PMID:14727873

  20. Home Parenteral Nutrition (HPN) Complication Chart

    MedlinePlus

    ... above baseline/normal temperature; chills, especially occurring with infusion; sweating; lethargy; body aches; urine spot checks may ... Fluids infused too fast; too little insulin in infusion solution if diabetic; improper mixture of HPN solution; ...

  1. Effect of total parenteral nutrition, systemic sepsis, and glutamine on gut mucosa in rats

    NASA Technical Reports Server (NTRS)

    Yoshida, S.; Leskiw, M. J.; Schluter, M. D.; Bush, K. T.; Nagele, R. G.; Lanza-Jacoby, S.; Stein, T. P.

    1992-01-01

    The effect of the combination of total parenteral nutrition (TPN) and systemic sepsis on mucosal morphology and protein synthesis was investigated. Rats were given a standard TPN mixture consisting of glucose (216 kcal.kg-1.day-1), lipid (24 kcal.kg-1.day-1), and amino acids (1.5 g N.kg-1.day-1) for 5 days. On the 5th day the rats (n = 37) were randomized into four groups according to diet as follows: 1) control nonseptic on standard TPN, 2) control nonseptic on TPN with glutamine, 3) septic on standard TPN, and 4) septic with the TPN supplemented with glutamine. Twenty hours after the injection of Escherichia coli, the rats were given a 4-h constant infusion of [U-14C]leucine to determine the mucosal fractional protein synthesis rates. The following results were obtained. 1) Histological examination showed that systemic sepsis caused tissue damage to the ileum and jejunum. 2) Glutamine supplementation attenuated these changes. 3) There were no visible changes to the colon either from glutamine supplementation or sepsis. 4) Sepsis was associated with an increase in mucosal protein synthesis and decreased muscle synthesis. 5) Addition of glutamine to the TPN mix further increased protein synthesis in the intestinal mucosa of septic rats.

  2. Dysregulation of bile acid homeostasis in parenteral nutrition mouse model.

    PubMed

    Zhan, Le; Yang, Ill; Kong, Bo; Shen, Jianliang; Gorczyca, Ludwik; Memon, Naureen; Buckley, Brian T; Guo, Grace L

    2016-01-15

    Long-term parenteral nutrition (PN) administration can lead to PN-associated liver diseases (PNALD). Although multiple risk factors have been identified for PNALD, to date, the roles of bile acids (BAs) and the pathways involved in BA homeostasis in the development and progression of PNALD are still unclear. We have established a mouse PN model with IV infusion of PN solution containing soybean oil-based lipid emulsion (SOLE). Our results showed that PN altered the expression of genes involved in a variety of liver functions at the mRNA levels. PN increased liver gene expression of Cyp7a1 and markedly decreased that of Cyp8b1, Cyp7b1, Bsep, and Shp. CYP7A1 and CYP8B1 are important for synthesizing the total amount of BAs and regulating the hydrophobicity of BAs, respectively. Consistently, both the levels and the percentages of primary BAs as well as total non-12α-OH BAs increased significantly in the serum of PN mice compared with saline controls, whereas liver BA profiles were largely similar. The expression of several key liver-X receptor-α (LXRα) target genes involved in lipid synthesis was also increased in PN mouse livers. Retinoid acid-related orphan receptor-α (RORα) has been shown to induce the expression of Cyp8b1 and Cyp7b1, as well as to suppress LXRα function. Western blot showed significantly reduced nuclear migration of RORα protein in PN mouse livers. This study shows that continuous PN infusion with SOLE in mice leads to dysregulation of BA homeostasis. Alterations of liver RORα signaling in PN mice may be one of the mechanisms implicated in the pathogenesis of PNALD. PMID:26564717

  3. Development of in vitro fertilized feline embryos in a modified Earle's balanced salt solution: influence of protein supplements and culture dishes on fertilization success and blastocyst formation.

    PubMed

    Kanda, M; Miyazaki, T; Kanda, M; Nakao, H; Tsutsui, T

    1998-04-01

    The effects of protein supplements and culture dish type on in vitro fertilization (IVF) and embryo development in culture were examined in the domestic cat. In Experiment I, follicular oocytes were fertilized and cultured in either 1) modified Earle's balanced salt solution, designated MK-1, supplemented with one of the following: 10% human serum (HS), 10% FCS or 0.4% BSA, or 2) Medium 199 (M-199) supplemented with 10% FCS. Fertilization rates were lower (P < 0.01) in MK-1 + BSA (74.4%), MK-1 + FCS (56.1%), and M-199 + FCS (51.4%) than in MK-1 + HS (94.7%). A greater (P < 0.01) percentage of blastocysts was obtained in MK-1 + HS (50.0%) than in other treatment groups (range, 4.3-17.2%). In Experiment II, the effect of dish type (tissue culture dish, TCD, versus suspension culture dish, SCD) on embryo development was evaluated in MK-1 supplemented with either HS or BSA. Significantly higher proportions of IVF-derived embryos developed to blastocysts at 120 and 144 hr post-insemination, respectively, when cultured in HS/SCD (47.2 and 71.7%) than in BSA/SCD (11.4 and 27.3%) or BSA/TCD (10.4 and 25.0%). At 120 hr post-insemination, there was a lower (P < 0.01) percentage of blastocysts in HS/TCD (22.2%) than in HS/SCD. In Experiment III, six embryos per cat were transferred to the uterine horns of 17 recipients at 144 hr after hCG treatment. Five of 7 recipients which received late morulae cultured in MK-1 + BSA (SCD) for 120 hr became pregnant (71.4%). Eight of 10 recipients which received early blastocysts cultured in MK-1 + HS (SCD) for 120 hr became pregnant (80.0%). We conclude that MK-1 containing HS is highly beneficial for overcoming the in vitro developmental block of IVF-derived feline embryos and increasing the success rate of IVF/ET. PMID:9592713

  4. Trace Element Supplementation Following Severe Burn Injury: A Systematic Review and Meta-Analysis.

    PubMed

    Kurmis, Rochelle; Greenwood, John; Aromataris, Edoardo

    2016-01-01

    Trace elements have an important physiological role after severe burn injury with patients routinely receiving supplementation. Although commonly prescribed after burn injury, variation exists among supplement composition, frequency, and the dosage administered. This review aims to assess the effectiveness of trace element supplementation on clinically meaningful outcomes in patients who have sustained a severe burn injury. Supplementation of selenium, copper and zinc, either alone or combined, compared with placebo or standard treatment were eligible for inclusion. Predetermined primary outcome measures were mortality, length of stay, rate of wound healing, and complications. A comprehensive search strategy was undertaken. Methodological quality of eligible studies was appraised and relevant data extracted for meta-analysis. Eight studies met eligibility criteria for the review; four randomized controlled trials and four nonrandomized experimental trials, including a total of 398 participants with an age range of 6 to 67 years. Parenteral supplementation of combined trace elements was associated with a significant decrease in infectious episodes (weighted mean difference: -1.25 episodes, 95% confidence intervals: -1.70, -0.80; P < .00001). The results of this review indicate that the use of parentally administered combined trace elements after burn injury confer positive effects in decreasing infectious complications. Combined parenteral trace element supplementation and combined oral and parenteral zinc supplementation have potentially clinically significant findings on reducing length of stay. Oral zinc supplementation shows possible beneficial effects on mortality. Definitive studies are required to accurately define optimal trace element supplementation regimens, dosages, and routes after burn injury. PMID:26056754

  5. Selenite metabolism in total parenteral nutrition (TPN)

    SciTech Connect

    Sitrin, M.D.; Ting, B.T.G.; Hazell, T.; Janghorbani, M. )

    1989-02-01

    Patients on long-term TPN commonly receive selenite to prevent selenium (Se) deficiency. Little information is available concerning the effect of chronic selenite supplementation on Se metabolism. In this study, we have used {sup 74}Se to examine selenite metabolism in 2 home TPN patents, one on selenite and one on no supplementation. Afte rcollection of baseline blood and urine samples, 80 {mu}g of selenite enriched with {sup 74}Se was added to the TPN formula, and infused over 12 hrs. Daily urine output was collected for 10 d. Inductively coupled plasma mass spectrometry was used to determine the isotope ratios of {sup 74}Se to {sup 77}Se, and {sup 74}Se to {sup 82}Se (added in vitro and an internal standard) in urine. Cumulative {sup 74}Se retention and an apparent selenite exchangeable pool size were calculated using standard isotope dilution equations. The unsupplemented TPN patient had biochemical Se deficiency, with decreased plasma Se (1 ng/ml) urine Se (1 ug/d) and red cell and plasma glutathione peroxidase activity (GSH-Px). Retention of {sup 74}Se was very high, 93% at 10 d, and the pool size was extremely low, 566 ug at 10 d. The supplemented patent had normal plasma and urine Se levels and plasma and red cell GSH-Px. {sup 74}Se retention was very poor, only 42% at 1 d and 38% at 10 d. The Se pool size increased rapidly over time, reaching 12000 ug at 10 d. In contrast, our previous studies in normal subjects consuming dietary orgaic Se showed a selenite retention of 85-90% at 1 d and 70-80% at 10 d, and a pool size of 6000-8000 ug at 10 day. Conclusions: 1. Using {sup 74}Se, differences in Se retention and pool size can easily be detected in Se deficient vs replete TPN patients 2. Chronic supplementation with selenite appears to result in decreased {sup 74}Se retention and an expanded selenite exchangeable pool in comparison with normals consuming dietary Se.

  6. Gluconeogenesis continues in premature infants receiving total parenteral nutrition

    Technology Transfer Automated Retrieval System (TEKTRAN)

    To determine the contribution of total gluconeogenesis, to glucose production in preterm infants receiving total parenteral nutrition (TPN) providing glucose exceeding normal infant glucose turnover rate, eight infants (0.955 +/- 0.066 kg, 26.5 - 0.5 wks, 4-1 d) were studied while receiving routine ...

  7. Micronutrients in Parenteral Nutrition: Boron, Silicon, and Fluoride

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Long-term parenteral nutrition (providing nutrients intravenously) is a life-saving treatment for patients with severe malabsorption of nutrients caused by intestinal failure, intestinal trauma (for example, gunshot or stab wounds), and intestinal removal. Metabolic bone disease characterized by min...

  8. Oral Parenteral Antimicrobial Therapy Administration in a Homeless Population.

    PubMed

    Hernandez, Whitney; Price, Connie; Knepper, Bryan; McLees, Margaret; Young, Heather

    2016-01-01

    Outpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat serious infections. Patients who identify themselves as homeless may receive OPAT less often, and little is known about their treatment outcomes. The purpose of this study was to describe challenges, treatment completion rates, and cost savings of OPAT in homeless patients discharged from a public safety-net hospital. PMID:26934162

  9. Lipid emulsions – Guidelines on Parenteral Nutrition, Chapter 6

    PubMed Central

    Adolph, M.; Heller, A. R.; Koch, T.; Koletzko, B.; Kreymann, K. G.; Krohn, K.; Pscheidl, E.; Senkal, M.

    2009-01-01

    The infusion of lipid emulsions allows a high energy supply, facilitates the prevention of high glucose infusion rates and is indispensable for the supply with essential fatty acids. The administration of lipid emulsions is recommended within ≤7 days after starting PN (parenteral nutrition) to avoid deficiency of essential fatty acids. Low-fat PN with a high glucose intake increases the risk of hyperglycaemia. In parenterally fed patients with a tendency to hyperglycaemia, an increase in the lipid-glucose ratio should be considered. In critically ill patients the glucose infusion should not exceed 50% of energy intake. The use of lipid emulsions with a low phospholipid/triglyceride ratio is recommended and should be provided with the usual PN to prevent depletion of essential fatty acids, lower the risk of hyperglycaemia, and prevent hepatic steatosis. Biologically active vitamin E (α-tocopherol) should continuously be administered along with lipid emulsions to reduce lipid peroxidation. Parenteral lipids should provide about 25–40% of the parenteral non-protein energy supply. In certain situations (i.e. critically ill, respiratory insufficiency) a lipid intake of up to 50 or 60% of non-protein energy may be reasonable. The recommended daily dose for parenteral lipids in adults is 0.7–1.3 g triglycerides/kg body weight. Serum triglyceride concentrations should be monitored regularly with dosage reduction at levels >400 mg/dl (>4.6 mmol/l) and interruption of lipid infusion at levels >1000 mg/dl (>11.4 mmol/l). There is little evidence at this time that the choice of different available lipid emulsions affects clinical endpoints. PMID:20049078

  10. Complexities of particulate matter measurement in parenteral formulations of small-molecule amphiphilic drugs.

    PubMed

    Hickey, Magali B; Waggener, Sara; Gole, Dilip; Jimidar, Ilias; Vermeersch, Hans; Ratanabanangkoon, Poe; Tinke, Arjen P; Almarsson, Örn

    2011-03-01

    Reconstituted parenteral solutions of three surface-active anti-infective small-molecule drugs and solutions of sodium dodecyl sulfate (SDS, a model surfactant) were studied to quantify the impact of sample preparation and handling on particle counts. Turbidimetry and light obscuration profiles were recorded as a function of agitation and shearing with and without the introduction of foam into the solutions. SDS solutions at concentrations above the critical micelle concentration (CMC) show significantly greater sensitivity to shear and foam presence than SDS solution below the CMC: Values of >10 μm particles increased 8 fold over control (an unsheared sample) in the micellar solution vs. 4 fold particle count increase over control at a sub-micellar concentration. An even more significant increase in the ratio of particle count in sheared/unsheared solution is seen for >25 μm unit counts, due to the increased interference of foam with the measurement. Two commercial products, injection formulations of teicoplanin and cefotaxime sodium, as well as an investigational compound 1, showed an increase in scattering as a function of foam production. The impact of foaming was significant, resulting in an increase of turbidity and light obscuration measurements in all solutions. The results illustrate some of the challenges that are inherent to optically clear, homogeneous pharmaceutical injections containing compounds which have a tendency toward self-association and surfactant-like behavior. PMID:21234824

  11. Treatment of Parenteral Nutrition-Associated Liver Disease: The Role of Lipid Emulsions123

    PubMed Central

    Nandivada, Prathima; Carlson, Sarah J.; Chang, Melissa I.; Cowan, Eileen; Gura, Kathleen M.; Puder, Mark

    2013-01-01

    Parenteral nutrition is a life-saving therapy for infants with intestinal failure. However, long-term parenteral nutrition carries the risk of progressive liver disease. Substantial data has implicated components of parenteral soybean oil in the pathogenesis of parenteral nutrition-associated liver disease (PNALD). Elevated serum concentrations of phytosterols, an abundance of omega-6 polyunsaturated fatty acids, and a relative paucity of α-tocopherol have been associated with the risk of cholestasis and hepatic injury observed in PNALD. Currently available treatment strategies include the reduction of the dose of administered parenteral soybean oil and/or the replacement of parenteral soybean oil with alternative parenteral lipid emulsions. The purpose of this review is to provide an overview of the pathogenetic mechanisms associated with the development of PNALD and the data evaluating currently available treatment strategies. PMID:24228202

  12. Validation of doubly labeled water for measuring energy expenditure during parenteral nutrition

    SciTech Connect

    Schoeller, D.A.; Kushner, R.F.; Jones, P.J.

    1986-08-01

    The doubly labeled water method was compared with intake-balance for measuring energy expenditure in five patients receiving total parenteral nutrition (TPN). Because parenteral solutions were isotopically different from local water, patients had to be placed on TPN at least 10 days before the metabolic period. Approximately 0.1 g 2H2O and 0.25 g H2(18)O per kg total body water were given orally. We collected saliva before, 3 h, and 4 h after the dose for measurement of total body water and urine before, 1 day, and 14 days after the dose for measurement of isotope eliminations. On day 14, total body weight was remeasured and change in body energy stores was calculated, assuming constant hydration. Intake was assessed from weights of TPN fluids plus dietary record for any oral intake. Energy expenditure from doubly labeled water (+/- SD) averaged 3 +/- 6% greater than intake-balance. Doubly labeled water method is a noninvasive, nonrestrictive method for measuring energy expenditure in patients receiving TPN.

  13. New generation lipid emulsions prevent PNALD in chronic parenterally fed preterm pigs

    PubMed Central

    Vlaardingerbroek, Hester; Ng, Kenneth; Stoll, Barbara; Benight, Nancy; Chacko, Shaji; Kluijtmans, Leo A. J.; Kulik, Wim; Squires, E. James; Olutoye, Oluyinka; Schady, Deborah; Finegold, Milton L.; van Goudoever, Johannes B.; Burrin, Douglas G.

    2014-01-01

    Total parenteral nutrition (TPN) is associated with the development of parenteral nutrition-associated liver disease (PNALD) in infants. Fish oil-based lipid emulsions can reverse PNALD, yet it is unknown if they can prevent PNALD. We studied preterm pigs administered TPN for 14 days with either 100% soybean oil (IL), 100% fish oil (OV), or a mixture of soybean oil, medium chain triglycerides (MCTs), olive oil, and fish oil (SL); a group was fed formula enterally (ENT). In TPN-fed pigs, serum direct bilirubin, gamma glutamyl transferase (GGT), and plasma bile acids increased after the 14 day treatment but were highest in IL pigs. All TPN pigs had suppressed hepatic expression of farnesoid X receptor (FXR), cholesterol 7-hydroxylase (CYP7A1), and plasma 7α-hydroxy-4-cholesten-3-one (C4) concentrations, yet hepatic CYP7A1 protein abundance was increased only in the IL versus ENT group. Organic solute transporter alpha (OSTα) gene expression was the highest in the IL group and paralleled plasma bile acid levels. In cultured hepatocytes, bile acid-induced bile salt export pump (BSEP) expression was inhibited by phytosterol treatment. We show that TPN-fed pigs given soybean oil developed cholestasis and steatosis that was prevented with both OV and SL emulsions. Due to the presence of phytosterols in the SL emulsion, the differences in cholestasis and liver injury among lipid emulsion groups in vivo were weakly correlated with plasma and hepatic phytosterol content. PMID:24478031

  14. Development of a process using electron beam for a terminal sterilization for parenteral formulations of pharmaceuticals

    NASA Astrophysics Data System (ADS)

    Matagne, D.; Delbar, N.; Hartmann, H.-J.; Gray, M.; Stickelmeyer, M.

    2004-09-01

    As pharmaceutical technology advances and sensitive drug formulations demand ever-greater stability, radiation processing is likely the only alternative that can be used to terminally sterilize thermo-labile pharmaceutical products intended for parenteral administration. To this end, a radiation process using e-beam technology has been developed. A key feature of this process is the elucidation of defined conditions of radiation processing in order to achieve the homogeneity of the absorbed dose inside a single vial and throughout a tray containing several vials. Results of several dosimetry studies, using e-beam technology, demonstrate the beneficial effects of the use of aluminum or stainless-steel plates to scatter the beam and therefore to obtain an excellent Dmax/ Dmin across all dose-monitoring positions within the vial and throughout a tray containing 260 vials filled with a dry powder or a tray containing approximately 30 vials filled with an aqueous solution. This ionizing radiation process can be directly applicable, at a manufacturing level, for a terminal sterilization of parenteral formulations of pharmaceuticals.

  15. Reduced serum levels of 1 alpha,25-dihydroxyvitamin D during long-term total parenteral nutrition.

    PubMed

    Klein, G L; Horst, R L; Norman, A W; Ament, M E; Slatopolsky, E; Coburn, J W

    1981-05-01

    Painful bone disease, characterized by patchy osteomalacia and inactive bone, can develop in patients treated with total parenteral nutrition for more than 3 months. Serum levels of 1 alpha,25-dihydroxyvitamin D (1 alpha, 25(OH)2D), 24,25-dihydroxyvitamin D and 25-hydroxyvitamin D were measured in seven adults and five children treated with parenteral nutrition for 9 to 60 months. Serum levels of 1 alpha, 25(OH)2D were markedly reduced, while levels of 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D were normal. Serum calcium and phosphorus levels were normal or slightly increased, and immunoreactive parathyroid hormone levels were normal or low. Renal function was normal or minimally reduced. Skeletal symptoms disappeared and serum 1 alpha, 25(OH)2D levels rose to normal in one patient when nutrient infusions were discontinued for 6 weeks. Removal of calcium from the nutrient solution for 2 to 4 days was associated with no change in serum 1 alpha, 25(OH)2D in two patients. The cause of the reduction in serum levels of 1 alpha, 25(OH)2D and its role in the pathogenesis of bone disease in these patients remain uncertain. PMID:6786151

  16. Parenteral trace element provision: recent clinical research and practical conclusions.

    PubMed

    Stehle, P; Stoffel-Wagner, B; Kuhn, K S

    2016-08-01

    The aim of this systematic review (PubMed, www.ncbi.nlm.nih.gov/pubmed and Cochrane, www.cochrane.org; last entry 31 December 2014) was to present data from recent clinical studies investigating parenteral trace element provision in adult patients and to draw conclusions for clinical practice. Important physiological functions in human metabolism are known for nine trace elements: selenium, zinc, copper, manganese, chromium, iron, molybdenum, iodine and fluoride. Lack of, or an insufficient supply of, these trace elements in nutrition therapy over a prolonged period is associated with trace element deprivation, which may lead to a deterioration of existing clinical symptoms and/or the development of characteristic malnutrition syndromes. Therefore, all parenteral nutrition prescriptions should include a daily dose of trace elements. To avoid trace element deprivation or imbalances, physiological doses are recommended. PMID:27049031

  17. Long-term parenteral nutrition: problems with venous access.

    PubMed Central

    McIntyre, A S; Gertner, D J; Wood, S; Phillips, R K; Lennard-Jones, J E

    1990-01-01

    Long-term parenteral nutrition requires central venous access, often difficult in patients who have had several central venous catheterizations. Therapy may be complicated by thrombosis and sepsis which may further compromise central access. We report five cases illustrating such difficulties and suggest that these patients be referred early to specialist centres where experienced catheter insertion and management results in a greatly reduced incidence of complications. PMID:2116522

  18. Parenteral and enteral nutrition: borderline substances.

    PubMed

    Hopley, P J

    1981-01-01

    The application of medicinal product legislation to products which have a possible dual function as drugs and as foods or cosmetics has been described. The approach of the Family Practitioner Services under the NHS is to allow for as much professional debate as possible over the indeterminate ground between food and drugs. The role of the Advisory Committee on Borderline Substances in this context is briefly mentioned. Finally, some practical problems which arise in hospital practise have been described and for the solution the emphasis is upon the multi-disciplinary team approach. PMID:6947663

  19. Evaluation of a new amino acid source for use in parenteral nutrition.

    PubMed Central

    Caldwell, M D; O'Neill, J A; Meng, H C; Stahlman, M H

    1977-01-01

    Ninety-two patients, ranging from two days to 92 years of age, received parenteral nutrition using a new synthetic amino acid solution designed to provide optimal nitrogen retention and obviate metabolic complications. Weight gain and positive nitrogen balance were produced in the majority of patients. Hyperchloremic acidosis and hypophosphatemia did not occur. Hyperammonemia in infants was avoided with the exception of occasional, transient, asymptomatic elevations of blood ammonia in low birth weight infants. It was suspected that an inadequate nonprotein calorie/gram of nitrogen ratio may have been employed in these infants. Blood ammonia levels declined from initial levels in 80% of adult patient. Nitrogen retention was directly proportional to the supply of nonprotein calories. PMID:402123

  20. Supplementing monosodium glutamate to partial enteral nutrition slows gastric emptying in preterm pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Emerging evidence suggests that free glutamate may play a functional role in modulating gastroduodenal motor function. We hypothesized that supplementing monosodium glutamate (MSG) to partial enteral nutrition stimulates gastric emptying in preterm pigs. Ten-day-old preterm, parenterally fed pigs re...

  1. Glutamine supplementation, citrulline production, and de novo arginine synthesis: Is there a relation?

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We would like to comment on the recent publications by Buijs et al. The authors hypothesized that a parenteral supplement of glutamine stimulates citrulline formation and enhances de novo arginine synthesis. To test this hypothesis, they conducted an experiment with stable isotopes in patients under...

  2. Dietary Supplements

    MedlinePlus

    Dietary supplements are vitamins, minerals, herbs, and many other products. They can come as pills, capsules, powders, drinks, and energy bars. Supplements do not have to go through the testing that drugs do. Some ...

  3. Dietary Supplements

    MedlinePlus

    Dietary supplements are vitamins, minerals, herbs, and many other products. They can come as pills, capsules, powders, drinks, ... possible Tell your health care provider about any dietary supplements you use Do not take a bigger dose ...

  4. [Maltodextrin in a 13% solution as a supplement in the first 4 days of life in breast-fed mature newborn infants. Effect on drinking behavior, weight curve, blood picture, blood glucose and bilirubin].

    PubMed

    Rosegger, H

    1986-05-16

    200 mature healthy newborn infants (birthweight 3382 +/- 377 g) were randomly divided into 2 groups of 100 each: all were breast fed according to the guidelines recommended by 'La Leche League'. If possible breast feeding was commenced in the delivery room. When breast feeds did not suffice infants of group A were supplemented ad libitum with a fully adapted formula (67 kcal/dl), those of group B with a 13% maltodextrine solution (52 kcal, 160 mOsm/l). Total fluid intake was similar in both groups. Group A took less supplementary feeds on day 2, the caloric uptake, however, was not different from that of group B. On day 4 group A had a somewhat higher caloric uptake due to supplementation, whereas group B needed less supplementation but had a higher intake of breast milk. On day 5 all babies were entirely breast fed. No supplementation was handed over to the mothers for at home use. The frequency of breast meals and supplementary meals was almost equal for both groups, as were sucking activity, appetite and degree of saturation. 18.6% of the infants in both groups had no need for any supplementary feeding at all. Temperature, stools, weight loss, blood glucose and bilirubin (taken on day 4 simultaneously with the Guthrie test) were almost identical. The red blood cell count showed slightly higher values in group A. Supplementation with fully adapted formula was not advantageous over supplementation with 13% maltodextrine solution. The latter was, indeed, tolerated well in all cases and satisfied all infants who remained hungry after being breast fed; additional early exposure to cow-milk protein was, thus, avoided in all these cases. PMID:3727591

  5. Management of intestinal failure in inflammatory bowel disease: Small intestinal transplantation or home parenteral nutrition?

    PubMed Central

    Harrison, Elizabeth; Allan, Philip; Ramu, Amrutha; Vaidya, Anil; Travis, Simon; Lal, Simon

    2014-01-01

    Inflammatory bowel disease and Crohn’s disease in particular, is a common cause of intestinal failure. Current therapeutic options include home parenteral nutrition and intestinal transplantation. For most patients, home intravenous therapy including parenteral nutrition, with a good probability of long-term survival, is the favoured choice. However, in selected patients, with specific features that may shorten survival or complicate home parenteral nutrition, intestinal transplantation presents a viable alternative. We present survival, complications, quality of life and economic considerations that currently influence individualised decision-making between home parenteral nutrition and intestinal transplantation. PMID:24696601

  6. n-3 fatty acid-enriched parenteral nutrition regimens in elective surgical and ICU patients: a meta-analysis

    PubMed Central

    2012-01-01

    Introduction Previous studies and a meta-analysis in surgical patients indicate that supplementing parenteral nutrition regimens with n-3 polyunsaturated fatty acids (PUFAs), in particular eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), is associated with improved laboratory and clinical outcomes in the setting of hyper-inflammatory conditions. Refined or synthetic fish oils are commonly used as a source of EPA and DHA. The objective of the present meta-analysis was to evaluate n-3 PUFA-enriched parenteral nutrition regimens in elective surgical and intensive care unit (ICU) patients. Methods Medline was searched for randomized controlled trials comparing n-3 PUFA-enriched lipid emulsions with standard non-enriched lipid emulsions (i.e. soybean oil, MCT/LCT or olive/soybean oil emulsions) in surgical and ICU patients receiving parenteral nutrition. Extracted data were pooled by means of both random and fixed effects models, and subgroup analyses were carried forward to compare findings in ICU versus non-ICU patients. Results A total of 23 studies (n = 1502 patients: n = 762 admitted to the ICU) were included. No statistically significant difference in mortality rate was found between patients receiving n-3 PUFA-enriched lipid emulsions and those receiving standard lipid emulsions (RR= 0.89; 0.59, 1.33), possibly reflecting a relatively low underlying mortality risk. However, n-3 PUFA-enriched emulsions are associated with a statistically and clinically significant reduction in the infection rate (RR =0.61; 0.45, 0.84) and the lengths of stay, both in the ICU (-1.92; -3.27, -0.58) and in hospital overall (-3.29; -5.13, -1.45). Other beneficial effects included reduced markers of inflammation, improved lung gas exchange, liver function, antioxidant status and fatty acid composition of plasma phospholipids, and a trend towards less impairment of kidney function. Conclusions These results confirm and extend previous findings, indicating that n-3 PUFAs

  7. Parenteral use of medium-chain triglycerides: a reappraisal.

    PubMed

    Ulrich, H; Pastores, S M; Katz, D P; Kvetan, V

    1996-04-01

    Over the last two decades, the clinical use of intravenous fat emulsions for the nutritional support of hospitalized patients has become routine. During this time long-chain triglycerides (LCT) derived from soybean and/or safflower oils were the exclusive lipid source for these emulsions, providing both a safe calorically dense alternative to dextrose and essential fatty acids needed for biologic membranes and the maintenance of immune function. During the past decade, the availability of novel experimental triglycerides for parenteral use has generated interest in the use of these substrates for nutritional and metabolic support. Medium-chain triglycerides (MCT), long advocated as a superior substrate for parenteral use, possess many unique physiochemical and metabolic properties that make them theoretically advantageous over their LCT counterparts. Although not yet approved in the United States, preparations containing MCT have been widely available in Europe. Intravenous MCT preparations, either as physical mixtures or structured lipids, have been used clinically in patients with immunosuppresion, critical illness, liver and pulmonary disease and in premature infants. Despite great promise, the clinical data comparing the efficacy of MCT-based lipid emulsions to their LCT counterparts has been equivocal. This may be due in part to the limited nature of the published clinical trials. Measures of efficacy for parenteral or enteral nutritional products has taken on new meaning, in light of the reported experience using immunomodulatory nutrients. Current concerns about cost of medical care and resource use warrant careful deliberation about the utility of any new and expensive therapy. Until clinical data can fulfill expectations derived from animal studies, it is difficult to advocate the general use of MCT-based lipid emulsions. Future clinical studies with MCT-based emulsions should have clear outcome objectives sufficient to prove their theorized metabolic

  8. Inflammatory Response Using Different Lipid Parenteral Nutrition Formulas in Children After Hematopoietic Stem Cell Transplantation.

    PubMed

    Baena-Gómez, María Auxiliadora; de la Torre-Aguilar, María José; Aguilera-García, Concepción María; Olza, Josune; Pérez-Navero, Juan Luis; Gil-Campos, Mercedes

    2016-07-01

    Nutritional support is an integral part of the supportive care of hematopoietic stem cell transplantation (HSCT) patients. Omega-3 fatty acids (n-3 FA) emulsions in parenteral nutrition (PN) may modify the inflammatory response. The purpose of this study is to compare plasma cytokine levels in children after HSCT using an n-3 FA-containing lipid emulsion (LE) and a soybean oil-based formulation in PN. A randomized double-blind controlled trial was conducted on 14 children following HSCT. Children were randomized to receive either a fish oil or a soybean oil LE. Blood samples were drawn at baseline, on Day 10 and after completion of PN to analyze plasma interleukin 1 beta (IL-1β), 2 (IL-2), 6 (IL-6), 8 (IL-8), 10 (IL-10), and tumor necrosis factor alpha (TNF-α). After 10 days of PN, there were no significant changes in interleukins levels when comparing the two groups or time points (baseline vs. Day 10 of PN). In children requiring PN >21 days, IL-10 and TNF-α levels (P ≤ 0.05) were lower in the fish-oil-containing LE group. Fish oil- and soybean oil-supplemented PN administered for at least 10 days does not cause inflammatory changes. Prolonged PN based on fish oil LE may modulate the inflammatory response. PMID:27270245

  9. Parenteral opioids for maternal pain management in labour

    PubMed Central

    Ullman, Roz; Smith, Lesley A; Burns, Ethel; Mori, Rintaro; Dowswell, Therese

    2014-01-01

    Background Parenteral opioids are used for pain relief in labour in many countries throughout the world. Objectives To assess the acceptability, effectiveness and safety of different types, doses and modes of administration of parenteral opioids given to women in labour. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 April 2011) and reference lists of retrieved studies. Selection criteria We included randomised controlled trials examining the use of intramuscular or intravenous opioids (including patient controlled analgesia) for women in labour. We looked at studies comparing an opioid with another opioid, placebo, other non-pharmacological interventions (TENS) or inhaled analgesia. Data collection and analysis At least two review authors independently assessed study eligibility, collected data and assessed risk of bias. Main results We included 57 studies involving more than 7000 women that compared an opioid with placebo, another opioid administered intramuscularly or intravenously or compared with TENS to the back. The 57 studies reported on 29 different comparisons, and for many outcomes only one study contributed data. Overall, the evidence was of poor quality regarding the analgesic effect of opioids, satisfaction with analgesia, adverse effects and harm to women and babies. There were few statistically significant results. Many of the studies had small sample sizes, and low statistical power. Overall findings indicated that parenteral opioids provided some pain relief and moderate satisfaction with analgesia in labour, although up to two-thirds of women who received opioids reported moderate or severe pain and/or poor or moderate pain relief one or two hours after administration. Opioid drugs were associated with maternal nausea, vomiting and drowsiness, although different opioid drugs were associated with different adverse effects. There was no clear evidence of adverse effects of opioids on the newborn. We

  10. Parenteral nutrition-associated liver disease in adult and pediatric patients.

    PubMed

    Kumpf, Vanessa J

    2006-06-01

    There are essentially 3 types of hepatobiliary disorders associated with parenteral nutrition (PN) therapy: steatosis, cholestasis, and gallbladder sludge/stones. Reported prevalence rates of PN-associated liver disease (PNALD) vary greatly, and there are distinct differences between adult and pediatric patients. Various etiologic factors have been evaluated for significance in contributing to PNALD, including enteral feeding history, septic events, bacterial overgrowth, length of intestinal resection, and prematurity/low birth weight. Etiologic factors specifically related to the PN formulation or nutrient intake have also been evaluated, including excessive calorie intake, dextrose-to-lipid ratio, amino acid dose, taurine deficiency, IV fat emulsion (IVFE) dose, carnitine deficiency, choline deficiency, and continuous vs cyclic infusion. Minor increases in serum aminotransferase concentrations are relatively common in patients receiving PN therapy and generally require no intervention. The primary indicator of cholestasis is a serum conjugated bilirubin >2 mg/dL. When a patient receiving PN develops liver complications, it is necessary to rule out all treatable causes and minimize other risk factors. All potential hepatotoxic medications and herbal supplements should be eliminated. Modifications to the PN regimen that may be helpful include reduction of calories, reduction of IVFE dose to <1 g/kg/d, supplementation of taurine in the infant, and use of cyclic infusion. Initiation of even small amounts of enteral nutrition and use of ursodiol may be beneficial in stimulating bile flow. In the long-term PN patient with severe and progressive liver disease, intestinal or liver transplantation may be the only remaining treatment option. PMID:16772545

  11. Mechanisms of disease: update on the molecular etiology and fundamentals of parenteral nutrition associated cholestasis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Since its introduction into clinical practice in the 1970s, parenteral nutrition has revolutionized the care of premature neonates. Serum transaminase and bilirubin levels are commonly elevated in infants on parenteral nutrition, but their normalization is typical in the setting of short-term admini...

  12. Enteral obeticholic acid prevents hepatic cholestasis in total parenteral nutrition-fed neonatal pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Total parenteral nutrition (TPN) is a vital support for neonatal infants with congenital or acquired gastrointestinal (GI) disorders and requiring small bowel resection. An adverse outcome associated with prolonged TPN use is parenteral nutrition associated cholestasis (PNAC). We previously showed t...

  13. Evaluation of Outpatient Parenteral Antimicrobial Therapy at a Veterans Affairs Hospital.

    PubMed

    Spivak, Emily Sydnor; Kendall, Brian; Orlando, Patricia; Perez, Christian; De Amorim, Marina; Samore, Matthew; Pavia, Andrew T; Hersh, Adam L

    2015-09-01

    We reviewed outpatient parenteral antimicrobial therapy at a Veterans Affairs Medical Center to identify opportunities for antimicrobial stewardship intervention. A definite or possible modification would have been recommended in 60% of courses. Forty-one percent of outpatient parenteral antimicrobial therapy courses were potentially avoidable, including 22% involving infectious diseases consultation. PMID:26006046

  14. Hepatic transcriptomic profiles of preterm piglets nourished by enteral and parenteral nutrition

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Parenteral nutrition is a life-saving nutritional support for more than half a million premature and hospitalized infants in the U.S. annually. Lipids in parenteral nutrition provide essential fatty acids and are a major source of energy. Intralipid (IL) is the only approved lipid emulsion in the U....

  15. Erosive oesophagitis revealing acute zinc deficiency during parenteral nutrition. A case report.

    PubMed

    Amoussou-Guenou, D; Boland, B; Rousseau, C; Lambert, M; Marbaix, E; Bourlond, J; Stein, F

    1989-01-01

    We report a case of acute zinc deficiency which occurred during parenteral nutrition in a patient with anorexia nervosa and which was characterized by a painful erosive oesophagitis preceding the typical oro-cutaneous symptoms. We also discuss the interpretation of plasma and urine zinc levels, the predisposing role of total parenteral alimentation and the specific therapeutic implications. PMID:2518587

  16. Aggressive parenteral nutrition in sick very low birth weight babies: a randomized controlled trial.

    PubMed

    Tagare, Amit; Walawalkar, Meenal; Vaidya, Umesh

    2013-10-01

    Survival of preterm neonates in developing world has improved. Developing countries lag behind in nutritional management in NICU especially parenteral nutrition (PN). This randomized controlled trial was done to evaluate the effect of aggressive parenteral nutrition on nitrogen retention of sick VLBW and extremely low birth weight (ELBW) babies. From September 2009 to February 2010, total 34 babies were randomized to receive aggressive parenteral nutrition (APN)(n=17) or standard parenteral nutrition (SPN) (n=17). The average daily total and PN calory intake of babies in APN group was significantly higher during first week. APN was well-tolerated; however, nitrogen retention was not significantly higher in APN group. Aggressive parenteral nutrition in sick VLBW babies is feasible in developing world, though it did not improve nitrogen retention in first week of life. PMID:23798635

  17. Gall bladder contractility in neonates: effects of parenteral and enteral feeding.

    PubMed Central

    Jawaheer, G.; Pierro, A.; Lloyd, D. A.; Shaw, N. J.

    1995-01-01

    The gall bladder size was measured in 30 newborn infants: 18 had been fed parenterally and 12 enterally. The two groups were comparable for gestational age, birthweight, postnatal age and study weight. Exclusion criteria were haemodynamic instability, septicaemia, abdominal disease and opioid treatment. Gall bladder size was measured at 15 minute intervals for 90 minutes using real-time ultrasonography and the volume calculated using the ellipsoid method. Parenterally fed infants had further measurements at 120, 150, and 360 minutes. The gall bladder was significantly larger in parenterally fed infants than in enterally fed infants (p = 0.0001). In enterally fed infants a 50% reduction in gall bladder volume was observed 15 minutes after starting the feed with a return to baseline volume by 90 minutes. In parenterally fed infants there was no gall bladder contraction. Such information may give insight into the pathophysiology of hepato-biliary complications during parenteral nutrition in infants. PMID:7796240

  18. Recent developments in protein and peptide parenteral delivery approaches

    PubMed Central

    Patel, Ashaben; Cholkar, Kishore; Mitra, Ashim K

    2014-01-01

    Discovery of insulin in the early 1900s initiated the research and development to improve the means of therapeutic protein delivery in patients. In the past decade, great emphasis has been placed on bringing protein and peptide therapeutics to market. Despite tremendous efforts, parenteral delivery still remains the major mode of administration for protein and peptide therapeutics. Other routes such as oral, nasal, pulmonary and buccal are considered more opportunistic rather than routine application. Improving biological half-life, stability and therapeutic efficacy is central to protein and peptide delivery. Several approaches have been tried in the past to improve protein and peptide in vitro/in vivo stability and performance. Approaches may be broadly categorized as chemical modification and colloidal delivery systems. In this review we have discussed various chemical approaches such as PEGylation, hyperglycosylation, mannosylation, and colloidal carriers including microparticles, nanoparticles, liposomes, carbon nanotubes and micelles for improving protein and peptide delivery. Recent developments on in situ thermosensitive gel-based protein and peptide delivery have also been described. This review summarizes recent developments on some currently existing approaches to improve stability, bioavailability and bioactivity of peptide and protein therapeutics following parenteral administration. PMID:24592957

  19. Nitrogen sparing by 2-ketoisocaproate in parenterally fed rats

    SciTech Connect

    Yagi, M.; Matthews, D.E.; Walser, M. )

    1990-11-01

    In rats receiving total parenteral nutrition with or without sodium 2-ketoisocaproate (KIC; 2.48 g.kg-1.day-1), L-(1-{sup 13}C)leucine and (1-{sup 14}C)KIC were constantly infused for 6 h. CO{sub 2} production, {sup 14}CO{sub 2} production, {sup 13}CO{sub 2} enrichment, urinary urea nitrogen (N) plus ammonia N and total urinary N were measured. Whole body protein synthesis (S) was calculated in non-KIC-infused rats and also in unfed rats infused with (1-{sup 14}C)leucine from fractional oxidation of labeled leucine (1-F), where F is fractional utilization for protein synthesis, and urea N plus ammonia N excretion (C) as S = C x F/(1-F). Addition of KIC caused a significant reduction in N excretion and a significant improvement in N balance. Fractional oxidation of labeled KIC increased, whereas fractional utilization of labeled KIC for protein synthesis decreased, but the extent of incorporation of infused KIC into newly synthesized protein (as leucine) amounted to at least 40% of the total rate of leucine incorporation into newly synthesized whole body protein. We conclude that addition of KIC spares N in parenterally fed rats and becomes a major source of leucine for protein synthesis.

  20. Acute Pelvic Inflammatory Disease and Clinical Response to Parenteral Doxycycline

    PubMed Central

    Chow, Anthony W.; Malkasian, Kay L.; Marshall, John R.; Guze, Lucien B.

    1975-01-01

    The bacteriology of acute pelvic inflammatory disease (PID) and clinical response to parenteral doxycycline were evaluated in 30 patients. Only 3 of 21 cul-de-sac cultures from PID patients were sterile, whereas all 8 normal control subjects yielded negative results (P< 0.005). Poor correlation was observed between cervical and cul-de-sac cultures. Neisseria gonorrhoeae, isolated from the cervix in 17 patients (57%), was recovered from the cul-de-sac only once. Streptococcus, Peptococcus, Peptostreptococcus, coliforms, and other organisms normally present in the vagina were the predominant isolates recovered from the cul-de-sac. Parenteral doxycycline resulted in rapid resolution of signs and symptoms (within 48 h) in 20 of 27 evaluable patients (74%). In five others, signs and symptoms of infection abated within 4 days. The remaining two patients failed to respond; in both cases, adnexal masses developed during doxycycline therapy. Gonococci were eradicated from the cervix in all but one patient who, nevertheless, had a rapid defervescence of symptoms. There was no clear-cut correlation between the clinical response and in vitro susceptibility of cul-de-sac isolates to doxycycline. These data confirm the usefulness of broad-spectrum antibiotics in acute PID. Culdocentesis is a reliable means of obtaining material for the bacteriological diagnosis of acute PID; however, the pathogenetic role and relative importance of gonococci and various other bacteria in acute PID need to be clarified further. PMID:1169908

  1. Tocol emulsions for drug solubilization and parenteral delivery.

    PubMed

    Constantinides, Panayiotis P; Tustian, Alex; Kessler, Dean R

    2004-05-01

    Tocols represent a family of tocopherols, tocotrienols, and their derivatives, and are fundamentally derived from the simplest tocopherol, 6-hydroxy-2-methyl-2-phytylchroman, which is referred to as "tocol". The most common tocol is D-alpha-tocopherol, also known as vitamin E. Tocols can be excellent solvents for water insoluble drugs and are compatible with other cosolvents, oils and surfactants. This review highlights the major developments in the use of tocols in parenteral emulsions for drug delivery, with a focus on drug solubilization, physicochemical properties, and biopharmaceutical applications. Tocol emulsions offer an appealing alternative for the parenteral administration of poorly soluble drugs, including major chemotherapeutics such as paclitaxel. Data will be presented on solubilization of paclitaxel, a key chemotherapeutic agent, and its corresponding formulation development, toxicity, efficacy and pharmacokinetic studies in animal models and humans. The breadth of the utility of tocol-based emulsions will be discussed and examples of specific therapeutic drugs and applications will be provided. As these formulations progress further in the clinic, the therapeutic utility of tocol emulsions is anticipated to expand. PMID:15109767

  2. Antimicrobial preservative use in parenteral products: past and present.

    PubMed

    Meyer, Brian K; Ni, Alex; Hu, Binghua; Shi, Li

    2007-12-01

    The following review provides a comprehensive summary of antimicrobial preservatives that are commonly used in licensed parenteral products to date. The information reviewed includes the general properties of the preservatives, the doses and frequency of their use, the classes of the preserved products (peptide, protein, vaccine, and small molecule products), the interactions with other formulation components, and the criteria commonly used for their selection in parental product formulations. It was revealed that phenol and benzyl alcohol are the two most common antimicrobial preservatives used in peptide and protein products, while phenoxyethanol is the most frequently used preservative in vaccines. Benzyl alcohol or a combination of methylparaben and propylparaben are generally found in small molecule parenteral formulations. The key criteria for antimicrobial preservative selection are the preservative's dose, antimicrobial functionality, and effect on the active ingredient. Additionally, the use of spectroscopic techniques (circular dicroism (CD) and fluorescence) and differential scanning calorimetry (DSC) were identified as common techniques used in evaluating an antimicrobial preservative for its impact on the conformational stability of peptide, protein, and vaccine antigens. The future use of preservatives is also discussed, including antimicrobial agents such as peptides, and regulatory requirements for antimicrobial effectiveness testing. PMID:17722087

  3. Parenteral nutrition in short bowel syndrome patients, regardless of its duration, increases serum proinflammatory cytokines.

    PubMed

    Bizari, Letícia; da Silva Santos, Andressa Feijó; Foss, Norma Tiraboschi; Marchini, Júlio Sérgio; Suen, Vivian Marques Miguel

    2016-07-01

    Short bowel syndrome is a severe malabsorption disorder, and prolonged parenteral nutrition is essential for survival in some cases. Among the undesirable effects of long-term parenteral nutrition is an increase in proinflammatory cytokines. The aim of the present study was to measure the serum levels of interleukin-6, interleukin-10, tumor necrosis factor alpha, and transforming growth factor beta, in patients with short bowel syndrome on cyclic parenteral nutrition and patients who had previously received but no longer require parenteral nutrition. The study was cross-sectional and observational. Three groups were studied as follows: Parenteral nutrition group, 9 patients with short bowel syndrome that receive cyclic parenteral nutrition; Oral nutrition group, 10 patients with the same syndrome who had been weaned off parenteral nutrition for at least 1 year prior to the study; Control group, 13 healthy adults, matched for age and sex to parenteral and oral groups. The following data were collected: age, tobacco use, drug therapies, dietary intake, body weight, height, blood collection. All interleukins were significantly higher in the parenteral group compared with the control group as follows: interleukin-6: 22 ± 19 vs 1.5 ± 1.4 pg/mL, P= .0002; transforming growth factor β: 854 ± 204 vs 607 ± 280 pg/mL, P= .04; interleukin-10: 8 ± 37 vs 0.6 ± 4, P= .03; tumor necrosis factor α: 20 ± 8 vs 8 ± 4 pg/mL, P< .0001. We concluded that parenteral nutrition in short bowel syndrome patients, regardless of its duration, increases serum proinflammatory cytokines. PMID:27267135

  4. Dietary supplements in sport.

    PubMed

    Burke, L M; Read, R S

    1993-01-01

    Studies of the dietary practices of athletes report that nutritional supplements are commonly used. Supplementation practices vary between sports and individual athletes; however, there is evidence that at least some athletes use a large number of supplements concurrently, often in doses that are very high in comparison with normal dietary intakes. In exploring supplementation practices we propose a classification system separating the supplements into dietary supplements and nutritional erogogenic aids. The dietary supplement is characterised as a product which can be used to address physiological or nutritional issues arising in sport. It may provide a convenient or practical means of consuming special nutrient requirements for exercise, or it may be used to prevent/reverse nutritional deficiencies that commonly occur among athletes. The basis of the dietary supplement is an understanding of nutritional requirements and physiological effects of exercise. When the supplement is used to successfully meet a physiological/nutritional goal arising in sport it may be demonstrated to improve sports performance. While there is some interest in refining the composition or formulation of some dietary supplements, the real interest belongs to the use or application of the supplement; i.e. educating athletes to understand and achieve their nutritional needs in a specific sports situation. The sports drink (carbohydrate-electrolyte replacement drink) is a well known example of a dietary supplement. Scientific attitudes towards the sports drink have changed over the past 20 years. Initial caution that carbohydrate-electrolyte fluids compromise gastric emptying during exercise has now been shown to be unjustified. Numerous studies have shown that 5 to 10% solutions of glucose, glucose polymers (maltodextrins) and other simple sugars all have suitable gastric emptying characteristics for the delivery of fluid and moderate amounts of carbohydrate substrate. The optimal

  5. Dietary supplements.

    PubMed

    Maughan, Ron J; King, Doug S; Lea, Trevor

    2004-01-01

    For the athlete training hard, nutritional supplements are often seen as promoting adaptations to training, allowing more consistent and intensive training by promoting recovery between training sessions, reducing interruptions to training because of illness or injury, and enhancing competitive performance. Surveys show that the prevalence of supplement use is widespread among sportsmen and women, but the use of few of these products is supported by a sound research base and some may even be harmful to the athlete. Special sports foods, including energy bars and sports drinks, have a real role to play, and some protein supplements and meal replacements may also be useful in some circumstances. Where there is a demonstrated deficiency of an essential nutrient, an increased intake from food or from supplementation may help, but many athletes ignore the need for caution in supplement use and take supplements in doses that are not necessary or may even be harmful. Some supplements do offer the prospect of improved performance; these include creatine, caffeine, bicarbonate and, perhaps, a very few others. There is no evidence that prohormones such as androstenedione are effective in enhancing muscle mass or strength, and these prohormones may result in negative health consequences, as well as positive drug tests. Contamination of supplements that may cause an athlete to fail a doping test is widespread. PMID:14971436

  6. Acute effects of enteral leucine supplementation of a low protein diet on muscle protein synthesis in neonatal pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Protein synthesis and eukaryotic initiation factor (eIF) activation are increased in skeletal muscle of neonatal pigs parenterally infused with insulin and amino acids (AA), particularly leucine. We hypothesized that enteral Leu supplementation of a low protein diets in neonatal pigs will acutely in...

  7. Glutamine supplementation in sick children: is it beneficial?

    PubMed

    Mok, Elise; Hankard, Régis

    2011-01-01

    The purpose of this review is to provide a critical appraisal of the literature on Glutamine (Gln) supplementation in various conditions or illnesses that affect children, from neonates to adolescents. First, a general overview of the proposed mechanisms for the beneficial effects of Gln is provided, and subsequently clinical studies are discussed. Despite safety, studies are conflicting, partly due to different effects of enteral and parenteral Gln supplementation. Further insufficient evidence is available on the benefits of Gln supplementation in pediatric patients. This includes premature infants, infants with gastrointestinal disease, children with Crohn's disease, short bowel syndrome, malnutrition/diarrhea, cancer, severe burns/trauma, Duchenne muscular dystrophy, sickle cell anemia, cystic fibrosis, and type 1 diabetes. Moreover, methodological issues have been noted in some studies. Further mechanistic data is needed along with large randomized controlled trials in select populations of sick children, who may eventually benefit from supplemental Gln. PMID:22175008

  8. Glutamine Supplementation in Sick Children: Is It Beneficial?

    PubMed Central

    Mok, Elise; Hankard, Régis

    2011-01-01

    The purpose of this review is to provide a critical appraisal of the literature on Glutamine (Gln) supplementation in various conditions or illnesses that affect children, from neonates to adolescents. First, a general overview of the proposed mechanisms for the beneficial effects of Gln is provided, and subsequently clinical studies are discussed. Despite safety, studies are conflicting, partly due to different effects of enteral and parenteral Gln supplementation. Further insufficient evidence is available on the benefits of Gln supplementation in pediatric patients. This includes premature infants, infants with gastrointestinal disease, children with Crohn's disease, short bowel syndrome, malnutrition/diarrhea, cancer, severe burns/trauma, Duchenne muscular dystrophy, sickle cell anemia, cystic fibrosis, and type 1 diabetes. Moreover, methodological issues have been noted in some studies. Further mechanistic data is needed along with large randomized controlled trials in select populations of sick children, who may eventually benefit from supplemental Gln. PMID:22175008

  9. Bag For Formulating And Dispersing Intravenous Solution

    NASA Technical Reports Server (NTRS)

    Kipp, Jim; Owens, Jim; Scharf, Mike; Finley, Mike; Dudar, Tom; Veillon, Joe; Ogle, Jim

    1993-01-01

    Large-volume parenteral (LVP) bag in which predetermined amount of sterile solution formulated by combining premeasured, prepackaged amount of sterile solute with predetermined amount of water. Bag designed to hold predetermined amount, typically 1 L, of sterile solution. Sterility of solution maintained during mixing by passing water into bag through sterilizing filter. System used in field or hospitals not having proper sterile facilities, and in field research.

  10. Polyethylene glycols in oral and parenteral formulations--A critical review.

    PubMed

    Gullapalli, Rampurna P; Mazzitelli, Carolyn L

    2015-12-30

    Polyethylene glycols (PEGs) are frequently employed as vehicles in oral and parenteral dosage forms. PEGs have low toxicity, are miscible with aqueous fluids in all proportions, and dissolve many poorly aqueous soluble compounds. Compounds with poor aqueous solubility and resulting poor bioavailability and considerable individual variability in the absorption were shown to provide exceptionally high bioavailability and reduced inter-subject variability in plasma concentrations when dosed as solutions or suspensions in PEGs. The advantages offered by PEGs, however, are not without potential challenges that must also be considered and which are the focus of this review. First, PEGs often may have high solubilizing power for some poorly aqueous soluble compounds, the high affinity of these vehicles for water can potentially lead to precipitation of the dissolved compounds when the formulations encounter an aqueous environment in vitro or in vivo, resulting in reduced bioavailability of the compounds. Second, PEGs, due to the presence of hydroxyl groups in their structures, are reactive with compounds dissolved within, resulting in the formation of degradation products. Third, PEGs, due to the presence of recurring ether groups in their polymer chains, are also inherently susceptible to autooxidative reactions, resulting in the formation of highly reactive products, which degrade several compounds formulated with PEGs. The objective is to review the applications and limitations of PEGs in pharmaceutical dosage forms and discuss solutions to mitigate challenges that may potentially arise from their use. PMID:26581774

  11. Pharmacokinetic Comparison of Oral Bacampicillin and Parenteral Ampicillin

    PubMed Central

    Bergan, Tom

    1978-01-01

    Bacampicillin is a new oral prodrug which is rapidly converted to ampicillin during absorption from the gastrointestinal tract. High serum peaks of ampicillin are obtained. Bacampicillin orally was compared pharmacokinetically with parenteral ampicillin (intravenously and intramuscularly). A cross-over study on healthy volunteers showed that ampicillin concentrations after equimolar doses of bacampicillin orally and ampicillin intramuscularly were of the same order. The mean of the individual peak values (regardless of time of occurrence) after a dose of 800 mg of bacampicillin was 13.1 ± 3.8 μg/ml. Absorption rates of the two doses were similar, as were their distribution volumes (approximately 25% of the body weight). Bioavailability was 87% for bacampicillin, compared to 71% for ampicillin. PMID:677863

  12. [HIV infection and parenteral virus hepatitis in the Krasnodar territory].

    PubMed

    Larin, F I; Lebedev, V V; Red'ko, A N

    2005-01-01

    The analysis of the morbidity dynamics of HIV infection, hepatitis B and C in the Krasnodar territory for 1996-2003 is presented. The tendency of strengthening direct correlation between age-dependent rates in these groups of diseases has been established. The correlation coefficient (rxy) is at present +0.851 (HIV infection-virus hepatitis B) and +0.892 (HIV infection-virus hepatitis C). The highest levels of primary morbidity are registered in persons aged 20-39 years. The established epidemiological parallels between HIV infection and parenteral hepatitis require the development of the unified strategy of the prophylaxis of these diseases on the federal and regional levels. PMID:16028521

  13. [Spontaneous reporting system data analysis of parenterally administered Shenmai].

    PubMed

    Wang, Lian-Xin; Xiang, Yong-Yang; Xie, Yan-Ming; Shen, Hao; Ai, Qing-Hua

    2013-09-01

    Spontaneous reporting system (SRS) datais currently an important source of monitoring and finding ADRs signals throughout the world. This method can promptly and effectively discover ADR signals, thus preventing and avoiding ADRs effectively. Parenterally administered Shenmai has the functions of benefiting vital energy, nourishing Yin and generating body fluids, and activating the pulse. Clinically it is used in various diseases including shock, coronary heart disease, viral myocarditis, chronic pulmonary heart disease, and granulocytopenia. The large, national SRS database of ADRs needs effective evaluation methods. We report on the use of Bayesian confidence propagation neural network method (BCPNN) and proportional reporting ration (PRR) with propensity score to control for confounding variables. Early warning signs of an ADR are, a feeling of suffocation (difficulty exhaling), anaphylactoid reactions and flushing. Furthermore, relevant relationships between the different factors is analysed by association rules (AR). It is found that there is a close relationship between past history of ADRs, a family history of ADRs and itching. PMID:24471317

  14. A review of parenteral sustained-release naltrexone systems

    SciTech Connect

    Olsen, J.L.; Kincl, F.A.

    1981-01-01

    The ideal naltrexone sustained-release delivery system should be easy to inject or implant, not cause adverse tissue reaction, release the drug at a relatively constant rate for at least 30 days, and biodegrade within a short time afterwards. Mechanisms which can be used for sustaining drug release include reducing solubility and surface area, coating, encapsulation and microencapsulation, complexation, binding and hydrophilic gelation. Drug release from such systems is controlled by diffusion through a barrier/film, diffusion from a monolithic device, erosion of the surface, hydrolysis, ion exchange, biodegradation, or a combination of these. Injectable systems would seem to be ultimately preferred because of the ease of administration and handling, while the implantable devices may find first use in man since they are easily removable, should that be necessary. Maintaining particulate-free products and sterilization methods are two problems with all parenteral dosage forms. Production must be particularly well controlled and validated.

  15. Calcium supplements

    MedlinePlus

    ... TYPES OF CALCIUM SUPPLEMENTS Forms of calcium include: Calcium carbonate: Over-the-counter (OTC) antacid products, such as Tums and Rolaids, contain calcium carbonate. These sources of calcium do not cost much. ...

  16. Dietary Supplements

    MedlinePlus

    ... are not intended to treat, diagnose, prevent, or cure diseases. Do not take supplements instead of your ... Partners Women's Health Topics Mammography Women and Diabetes HPV, HIV, Birth Control Heart Health for Women Pregnancy ...

  17. Nepali Supplements.

    ERIC Educational Resources Information Center

    Peace Corps, Washington, DC.

    This volume is intended as a supplement to Nepali language instruction. It contains songs, numerals, dialogues in Devanagari script, a Nepali-English, English-Nepali glossary, and an English-Nepali surveyor technical glossary. (AM)

  18. Dietary Supplements

    MedlinePlus

    ... take these supplements off the market. The Federal Trade Commission looks into reports of ads that might ... 504-5414 http://fnic.nal.usda.gov Federal Trade Commission 600 Pennsylvania Avenue, NW Washington, DC 20580 ...

  19. Validating hyperbilirubinemia and gut mucosal atrophy with a novel ultramobile ambulatory total parenteral nutrition piglet model

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Total parenteral nutrition (TPN) provides all nutrition intravenously. Although TPN therapy has grown enormously, it causes significant complications, including gut and hepatic dysfunction. Current models use animal tethering which is unlike ambulatory human TPN delivery and is cost prohibitive. We ...

  20. Tissue plasminogen activator in the treatment of superior vena caval thrombosis associated with parenteral nutrition.

    PubMed Central

    Barclay, G. R.; Allen, K.; Pennington, C. R.

    1990-01-01

    Two patients, one of whom was pregnant, developed superior vena caval thrombosis while receiving central parenteral nutrition. They were successfully treated with recombinant tissue plasminogen activator (t-PA). Images Figure 1 Figure 2 PMID:2115160

  1. PIPIDA scintigraphy for cholecystitis: false positives in alcoholism and total parenteral nutrition

    SciTech Connect

    Shuman, W.P.; Gibbs, P.; Rudd, T.G.; Mack, L.A.

    1982-01-01

    A review of gallbladder scintigraphy in patients with potentially compromised hepatobiliary function revealed two groups in whom cholecystitis might be mistakenly diagnosed. In 200 consecutive hospitalized patients studied with technetium-99m-PIPIDA for acute cholecystitis or cholestasis, there were 41 alcoholics and 17 patients on total parenteral nutrition. In 60% of the alcoholics and 92% of those on parenteral nutrition, absent or delayed visualization of the gallbladder occurred without physical or clinical evidence of cholecystitis. A cholecystagogue, sincalide, did not prevent the false-positive features which presumably are due to altered bile flow kinetics related to alcoholism and parenteral nutrition. Four patients on parenteral nutrition undergoing cholecystectomy for suspected cholecystitis had normal gallbladders filled with jellylike viscous thick bile. A positive (nonvisualized or delayed visualized) gallbladder PIPIDA scintigram in these two populations should not be interpreted as indicating a need for cholecystectomy.

  2. Selected pharmacokinetic issues of the use of antiepileptic drugs and parenteral nutrition in critically ill patients

    PubMed Central

    2010-01-01

    Objectives To conduct a systematic review for the evidence supporting or disproving the reality of parenteral nutrition- antiepileptic drugs interaction, especially with respect to the plasma protein-binding of the drug. Methods The articles related to the topic were identified through Medline and PubMed search (1968-Feburary 2010) for English language on the interaction between parenteral nutrition and antiepileptic drugs; the search terms used were anti-epileptic drugs, parenteral nutrition, and/or interaction, and/or in vitro. The search looked for prospective randomized and nonrandomized controlled studies; prospective nonrandomized uncontrolled studies; retrospective studies; case reports; and in vitro studies. Full text of the articles were then traced from the Universiti Sains Malaysia (USM) library subscribed databases, including Wiley-Blackwell Library, Cochrane Library, EBSCOHost, OVID, ScienceDirect, SAGE Premier, Scopus, SpringerLINK, and Wiley InterScience. The articles from journals not listed by USM library were traced through inter library loan. Results There were interactions between parenteral nutrition and drugs, including antiepileptics. Several guidelines were designed for the management of illnesses such as traumatic brain injuries or cancer patients, involving the use of parenteral nutrition and antiepileptics. Moreover, many studies demonstrated the in vitro and in vivo parenteral nutrition -drugs interactions, especially with antiepileptics. Conclusions There was no evidence supporting the existence of parenteral nutrition-antiepileptic drugs interaction. The issue has not been studied in formal researches, but several case reports and anecdotes demonstrate this drug-nutrition interaction. However, alteration in the drug-free fraction result from parenteral nutrition-drug (i.e. antiepileptics) interactions may necessitate scrupulous reassessment of drug dosages in patients receiving these therapies. This reassessment may be particularly

  3. Home parenteral nutrition in management of patients with severe radiation enteritis

    SciTech Connect

    Lavery, I.C.; Steiger, E.; Fazio, V.W.

    1980-03-01

    Five patients who would have been unable to survive because of intestinal complications of radiation therapy were able to lead an otherwise normal life with the use of parenteral nutrition administered at home. One patient died of recurrent carcinoma of the cervix after 14 months. Another patient died as the result of a totally avoidable pharmaceutical error after 2 1/2 years. The remaining three are still disease free without morbidity relating to the parenteral nutrition.

  4. Parenteral buprenorphine-naloxone abuse is a major cause of fatal buprenorphine-related poisoning.

    PubMed

    Häkkinen, Margareeta; Heikman, Pertti; Ojanperä, Ilkka

    2013-10-10

    Buprenorphine (BPN) medication for opioid maintenance treatment in Finland consists predominantly of buprenorphine-naloxone (BNX). Both BPN and BNX are associated with diversion, abuse and non-medically supervised use worldwide. Our purpose was to estimate the proportion of BNX to all BPN-related fatalities. The material consisted of 225 deceased drug abusers in Finland from January 2010 to June 2011 with a positive BPN and/or norbuprenorphine (NOR) and/or naloxone (NX) finding in urine. The data were divided into three groups based on the urine NX and BPN concentrations. The "Parenteral BNX" group (>100 μg/l NX) was presumed to consist of injecting or snorting BNX abusers and the "Parenteral BPN" group (>50 μg/l BPN, 0 μg/l NX) of injecting or snorting BPN abusers, while the "Other BNX or BPN" group (≤100 μg/l NX, or ≤50 μg/l BPN combined with 0 μg/l NX) was presumed to consist of mainly sublingual BNX or BPN users. In 12.4% of cases the NX urine concentration was higher than the threshold 100 μg/l. In fatal BPN poisonings, the proportion of parenteral BNX was 28.4%. In the "Parenteral BNX", "Parenteral BPN" and "Other BNX or BPN" groups, the proportion of fatal BPN poisonings was 67.9, 31.0 and 22.6%, respectively. BNX abuse can be fatal. Among the 225 BPN-related fatalities, parenteral abuse of BNX was shown to be common (12.4%) and BNX poisoning was the underlying cause of death in 8.4%. Parenteral BNX caused fatal BPN poisoning proportionally more often than parenteral BPN. PMID:24053859

  5. Development of parenteral formulations and evaluation of the biological activity of the trypanocide drug benznidazole.

    PubMed

    Lamas, María C; Villaggi, Luciano; Nocito, Isabel; Bassani, Georgina; Leonardi, Darío; Pascutti, Fernanda; Serra, Esteban; Salomón, Claudio J

    2006-01-13

    Chagas disease, caused by Trypanosoma cruzi, is a major public health problem in Latin America. According to the World Health Organization, around 20 million people are infected and another 40 million are at risk of acquiring the disease. One of the drugs most frequently used for the treatment of Chagas disease is benznidazole (BZL). It is practically insoluble in water (0.4 mg/ml), which precludes the preparation of liquid dosage forms, in particular, parenteral formulations. Thus, the aim of this work was to investigate the solubilization of BZL at two pH values using various cosolvents such as ethyl alcohol, propylene glycol, polyethylene glycol 400, benzyl alcohol, diethylene glycol monoethyl ether (Transcutol) and surfactants such as polysorbates (Tween) 40 and 80, and sodium dioctyl sulfosuccinate (AOT). Solvent systems based on PEG 400, with the addition ethyl alcohol and/or potassium biphthalate buffer solution, increased the BZL solubility up to 10 mg/ml. These alcoholic vehicles showed no toxicity against parasite when assayed at 1%. Physical and chemical stability studies showed that the formulations were stable for at least 1.5 years. In agreement with the biological activity results, the selected formulations are suitable for further clinical studies. Moreover, increasing the aqueous solubility of BZL reduced the problems in vitro testing techniques and bioassays leading to more reliable results and/or reproducibility. PMID:16293378

  6. Role of carbonic anhydrase in bone - Partial inhibition of disuse atrophy of bone by parenteral acetazolamide

    NASA Technical Reports Server (NTRS)

    Kenny, A. D.

    1985-01-01

    The effectiveness of orally and subcutaneously administered acetazolamide sodium in preventing denervation-induced bone loss in rats is examined. Male Sprague-Dawley rats were treated with acetazolamide either orally by incorporation of 0.2, 0.5, or 1.5 percent concentrations in their diet for 15 days, or subcutaneously by either injection of 0.5 ml/rat of a solution containing either 20 or 100 mg/ml of the drug twice daily for 15 days or by continuous infusion of 5, 50, 500, or 1000 mg/ml of acetazolamide sodium for 8 days using an osmotic minipump. The effects of acetazolamide on body weight, food consumption, and plasma calcium content are evaluated. It is observed that parenteral administration is equally effective as oral administration in partially preventing denervation-induced bone mass changes. The data reveal that approximately 50 percent protection occurs with daily doses of 1094, 129, and 8 mg/kg body weight for the oral, subcutaneous injection, and subcutaneous infusion methods, respectively.

  7. Quality of life in patients receiving home parenteral nutrition

    PubMed Central

    Jeppesen, P; Langholz, E; Mortensen, P

    1999-01-01

    BACKGROUND/AIMS—Quality of life is an important determinant of the effectiveness of health technologies, but it has rarely been assessed in patients receiving home parenteral nutrition (HPN).
PATIENTS/METHODS—The non-disease specific sickness impact profile (SIP) and the disease specific inflammatory bowel disease questionnaire (IBDQ) were used on a cohort of 49 patients receiving HPN, and the results compared with those for 36 non-HPN patients with either anatomical (<200 cm) or functional (faecal energy excretion >2.0 MJ/day (~488 kcal/day)) short bowel.
RESULTS—In the HPN patients the SIP scores were worse (higher) overall (17 (13)% v 8 (9)%) and with regard to physical (13 (15)% v 5 (8)%) and psychosocial (14 (12)% v 9 (11)%) dimensions and independent categories (20 (12)% v 9 (8)%) compared with the non-HPN patients (means (SD); all p<0.001). The IBDQ scores were worse (lower) in the HPN patients overall (5.0 (4.3-5.7) v 5.6 (4.8-6.2)) and with regard to systemic symptoms (3.8 (2.8-5.4) v 5.2 (3.9-5.9)) and emotional (5.3 (4.4-6.2) v 5.8 (5.4-6.4)) and social (4.3 (3.4-5.5) v 4.8 (4.5-5.8)) function (median (25-75%); all p<0.05), but only tended to be worse with regard to bowel symptoms (5.2 (4.8-6.1) v 5.7 (4.9-6.4), p = 0.08). HPN also reduced quality of life in patients with a stoma, whereas a stoma did not reduce quality of life among the non-HPN patients. Female HPN patients and HPN patients older than 45 scored worse.
CONCLUSION—Quality of life is reduced in patients on HPN compared with those with anatomical or functional short bowel not receiving HPN, and compares with that reported for patients with chronic renal failure treated by dialysis.


Keywords: parenteral nutrition; quality of life; sickness impact profile; inflammatory bowel disease PMID:10323888

  8. Metabolic bone disease associated with total parenteral nutrition.

    PubMed

    Klein, G L; Coburn, J W

    1984-01-01

    Patients receiving long-term treatment with total parenteral nutrition often develop bony abnormalities characterized by patchy osteomalacia and low bone turnover. The patients present evidence of physiologic hypoparathyroidism, although low levels of iPTH cannot entirely explain the osteomalacia. Abnormally low serum levels of 1,25(OH)2-vitamin D have been demonstrated, but the significance of these reduced levels in the pathogenesis of the bone lesions is not defined. Aluminum has been detected in large quantities in the plasma, urine, and bone of some patients treated with TPN, and there is mounting evidence that aluminum may be associated with skeletal pathology, particularly osteomalacia. There is, however, no clear documentation that aluminum accumulation produces the skeletal lesions observed, although it could be a contributing factor. There has been the unusual empiric observation that the removal of vitamin D2 from the infusate is associated with a decrease in the quantity of unmineralized osteoid in TPN patients. A possible role of vitamin D2 in producing osteomalacia is not easy to understand since normal serum levels of 25(OH)-D2, the circulating form of vitamin D2, have been reported. The long-term consequences of intravenous nutritional support for many aspects of metabolism remain unknown. Administration into the systemic circulation of predetermined quantities of calcium and phosphorus via a route that bypasses their passage across the intestinal mucosa, the portal system and the liver may have adverse consequences. It is possible that bypassing homeostatic mechanisms may affect bone formation and metabolism or lead to alterations in vitamin D sterols. Alternatively, a deficiency of an essential trace metal or the accumulation of a toxic trace substance could be responsible for the bony abnormalities. Much remains to be clarified concerning calcium homeostasis and bone disease during total parenteral nutrition. Among various possible factors, it

  9. Technology Solutions Case Study: Evaluation of the Performance of Houses With and Without Supplemental Dehumidification in a Hot-Humid Climate, New Orleans, Louisiana

    SciTech Connect

    2014-11-01

    The purpose of this project by Building Science Corporation was to evaluate the humidity control performance of new single family high performance homes, and compare the interior conditions and mechanical systems operation between two distinct groups of houses: homes with a supplemental dehumidifier installed in addition to HVAC system, and homes without any supplemental dehumidification. The subjects of the study were 10 single-family new construction homes in New Orleans, LA. Data logging equipment was installed at each home in 2012, and interior conditions and various end-use loads were monitored for one year. In terms of averages, the homes with dehumidifiers are limiting elevated levels of humidity in the living space; however, there was significant variation in humidity control between individual houses. An analysis of the equipment operation did not show a clear correlation between energy use and humidity levels. In general, no single explanatory variable appears to provide a consistent understanding of the humidity control in each house. Indoor humidity is likely due to all of the factors we have examined, and the specifics of how they are used by each occupant.

  10. Sports Supplements

    MedlinePlus

    ... specialist. The doc will be able to offer alternatives to supplements based on your body and sport. Reviewed by: Mary L. Gavin, MD Date reviewed: January 2015 previous 1 • 2 • 3 For Teens For Kids For Parents MORE ON THIS TOPIC Sports Center Energy Drinks and Food Bars: Power or Hype? A ...

  11. Calcium supplements

    MedlinePlus

    ... SHOULD TAKE CALCIUM SUPPLEMENTS? Calcium is an important mineral for the human body. It helps build and protect your teeth ... absorb calcium. You can get vitamin D from sunlight exposure to your skin and from your diet. Ask your provider whether ...

  12. Fatty Acids as Therapeutic Auxiliaries for Oral and Parenteral Formulations

    PubMed Central

    Hackett, Michael J.; Zaro, Jennica L.; Shen, Wei-Chiang; Guley, Patrick C.; Cho, Moo J.

    2012-01-01

    Many drugs have decreased therapeutic activity due to issues with absorption, distribution, metabolism and excretion. The co-formulation or covalent attachment of drugs with fatty acids has demonstrated some capacity to overcome these issues by improving intestinal permeability, slowing clearance and binding serum proteins for selective tissue uptake and metabolism. For orally administered drugs, albeit at low level of availability, the presence of fatty acids and triglycerides in the intestinal lumen may promote intestinal uptake of small hydrophilic molecules. Small lipophilic drugs or acylated hydrophilic drugs also show increased lymphatic uptake and enhanced passive diffusional uptake. Fatty acid conjugation of small and large proteins or peptides have exhibited protracted plasma half-lives, site-specific delivery and sustained release upon parenteral administration. These improvements are most likely due to associations with lipid-binding serum proteins, namely albumin, LDL and HDL. These molecular interactions, although not fully characterized, could provide the ability of using the endogenous carrier systems for improving therapeutic outcomes. PMID:22921839

  13. Current status in outpatient parenteral antimicrobial therapy: a practical view.

    PubMed

    Candel, F J; Julián-Jiménez, A; González-Del Castillo, J

    2016-04-01

    Outpatient parenteral antimicrobial therapy (OPAT) programs are a current and widely spread trend in clinical practice because of it´s a cost-effective option, it´s associated with a greater comfort for the patient, a lower risk of nosocomial complications and an important cost saving for the health care system. OPAT is used for treating a wide range of infections, including skin and soft tissue infections, osteoarticular infections, bacteraemia, endocarditis and complex intra-abdominal and urinary tract infections, even in presence of multiresistant microorganisms. Correct choice of antimicrobial agent and adequate patient selection are crucial for reaching therapeutic success and avoiding readmissions, treatment prolongation or treatment-related toxicity. The optimal antimicrobial for OPAT must be highly effective, have a long half-life and an adequate spectrum of action. Ceftriaxone and teicoplanin are currently the most prescribed antibiotics for OPAT, though daptomycin and ertapenem are also on the rise, due to their high efficiency, safety and wide spectrum of action. Antibiotics that are stable at room temperature can be administered through a continuous perfusion, though self-administration is preferable although it requires training of the patient or the caregiver. Factors that are most frequently associated with OPAT failure include advanced age, recent hospitalization and isolation of multiresistant microorganisms. PMID:27014770

  14. Development and characterization of voriconazole loaded nanoparticles for parenteral delivery.

    PubMed

    Füredi, Petra; Kovács, Kristóf; Ludányi, Krisztina; Antal, István; Klebovich, Imre

    2016-08-20

    Human serum albumin (HSA) has attracted the most attention in the last decades as a new nanocarrier system of active pharmaceutical ingredients (API) due to its biocompatibility and high binding capacity to hydrophobic drugs. Voriconazole (VCZ), an antifungal agent with low water solubility, was selected to produce albumin based nanoparticles using nanoparticle albumin-bound technology (nab™-technology). Aim of our study was to study the development process of VCZ-loaded nanoparticles for parenteral drug delivery, such as homogenizing pressure, homogenizing cycle number and drug loading capacity. The main characters of nanoparticles such as particle size distribution and polydispersity index (PDI) were determined by dynamic light scattering. Six homogenization cycles at 1800bar were ensured the acceptable PDI value (lower than 0.3) of the VCZ content nanoparticles. Optimized formulation process produced 81.2±1nm average particle size which meets the requirements of intravenous administration. Furthermore, the encapsulated concentration of VCZ was 69.7±4.2% and the water solubility was over 2 times greater than the API itself which were determined by the developed HPLC method. The in vivo release behavior can be predicted from our applied in vitro dissolution study. Almost 50% of VCZ was liberated from the nanoparticles in the first 60min. PMID:27291972

  15. Parenteral Lipid Tolerance and Adverse Effects: Fat Chance for Trouble?

    PubMed

    Wanten, Geert J A

    2015-09-01

    Lipid emulsions (LEs) are indispensable sources of fuel calories and (essential) fatty acids (FAs) in modern parenteral nutrition formulations. The use of LE, however, also remains associated with the development of adverse effects. Intolerance for LE mostly becomes apparent upon the development of patient complaints or disturbed blood function tests, mainly of the liver. These issues may be associated with the composition, stability, or the infusion rate of the emulsion. Also, altered balances of (anti)oxidants or the presence or absence of protective or toxic bioactive agents such as phytosterols and tocopherol in LE may lead to complications, especially in already vulnerable patients with an inflammatory condition. While the oldest available LEs are based on pure soybean oil (SO-LE), rich in the proinflammatory ω-6 polyunsaturated fatty acid linoleic acid, more recent next-generation LEs where alternative FA sources such as olive and fish oil (partially) replace soybean oil to lower the content of linoleic acid seem safe and effective. Especially LEs containing fish oil (FO-LE) have less proinflammatory characteristics that promise to convey beneficial effects on immune system and organ functions, although much of the available evidence awaits more robust clinical validation. PMID:26177663

  16. Safe Handling of Parenteral Cytotoxics: Recommendations for Ontario

    PubMed Central

    Green, Esther; Johnston, Mary; Trudeau, Maureen; Schwartz, Lisa; Poirier, Susan; Macartney, Gail; Milliken, Deborah

    2009-01-01

    Purpose: To develop a set of recommendations for the safe handling of parenteral cytotoxics in health care facilities in Ontario, Canada. Methods: Systematic reviews were conducted to assemble evidence on risks to health care staff who prepare or administer cytotoxic drugs for cancer care and on closed systems for handling these drugs. Recent guidelines on safe handling of hazardous drugs were also reviewed. A multidisciplinary expert panel used an ethical framework to interpret this evidence and develop a set of recommendations to guide oncology practice in Ontario. Practitioners were surveyed and asked to provide input for the final set of recommendations. Results: Available evidence on risks associated with handling cytotoxic drugs is of poor quality, but it suggests that health care workers exposed to cytotoxic agents may be at increased risk for miscarriages. There is general agreement across guideline development groups in North America, Europe, and Australia concerning recommendations related to policies and procedures for handling cytotoxic drugs, use of personal protective equipment, and standards for ventilated cabinets, syringes and intravenous sets, transport and labeling, and education and training of staff. Limited evidence from poor-quality studies suggests that closed systems may reduce surface contamination with hazardous drugs during preparation. Conclusion: A set of recommendations was formulated by the expert panel and approved by practitioners surveyed across Ontario. PMID:20856737

  17. Should pediatric parenteral nutrition be individualized?☆

    PubMed Central

    Freitas, Renata Germano Borges de Oliveira Nascimento; Nogueira, Roberto José Negrão; Saron, Margareth Lopes Galvão; Lima, Alexandre Esteves Souza; Hessel, Gabriel

    2014-01-01

    INTRODUCTION: Parenteral nutrition (PN) formulations are commonly individualized, since their standardization appears inadequate for the pediatric population. This study aimed to evaluate the nutritional state and the reasons for PN individualization in pediatric patients using PN, hospitalized in a tertiary hospital in Campinas, São Paulo. METHODS: This longitudinal study comprised patients using PN followed by up to 67 days. Nutritional status was classified according to the criteria established by the World Health Organization (WHO) (2006) and WHO (2007). The levels of the following elements in blood were analyzed: sodium, potassium, ionized calcium, chloride, magnesium, inorganic phosphorus, and triglycerides (TGL). Among the criteria for individualization, the following were considered undeniable: significant reduction in blood levels of potassium (<3mEq/L), sodium (<125mEq/L), magnesium (<1mEq/L), phosphorus (<1.5mEq/L), ionic calcium (<1mmol), and chloride (<90mEq/L), or any value above the references. RESULTS: Twelve pediatric patients aged 1 month to 15 years were studied (49 individualizations). Most patients were classified as malnourished. It was observed that 74/254 (29.2%) of examinations demanded individualized PN for indubitable reasons. CONCLUSION: The nutritional state of patients was considered critical in most cases. Thus, the individualization performed in the beginning of PN for energy protein adequacy was indispensable. In addition, the individualized PN was indispensable in at least 29.2% of PN for correction of alterations found in biochemical parameters. PMID:25510996

  18. Innovative Parenteral and Enteral Nutrition Therapy for Intestinal Failure

    PubMed Central

    Le, Hau D.; Fallon, Erica M.; de Meijer, Vincent E.; Malkan, Alpin D.; Puder, Mark; Gura, Kathleen M.

    2010-01-01

    Children with intestinal failure suffer from insufficient intestinal length or function, making them dependent on parenteral nutrition (PN) for growth and survival. PN and its components are associated with many complications ranging from simple electrolyte abnormalities to life-threatening PN-associated liver disease, which is also called intestinal failure-associated liver disease (ILALD). From a nutrition perspective, the ultimate goal is to provide adequate caloric requirements and make the transition from PN to full enteral Nutrition (EN) successful. Upon review of the literature, we have summarized the most effective and innovative PN and EN therapies for this patient population. Antibiotic-coated catheters and antibiotic or ethanol locks can be implemented, as they appear effective in reducing catheter-related infection and thus further reduce the risk of IFALD. Lipid emulsions should be given judiciously. The use of an omega-3 fatty acid-based formulation should be considered in patients who develop IFALD. Trophic feeding is important for intestinal adaptation, and EN should be initiated early to help wean patients from PN. Long term management of children with IF continues to be an emerging field. We have entered uncharted territory as more children survive complications of IF, including IFALD. Careful monitoring and individualized management to ensure maintenance of growth with avoidance of complications are the keys to successful patient outcomes. PMID:20123271

  19. Nutritional intake of gut failure patients on home parenteral nutrition

    SciTech Connect

    DiCecco, S.; Nelson, J.; Burnes, J.; Fleming, C.R.

    1987-11-01

    Nutrient intake patterns were analyzed in 23 patients with gut failure who were receiving home parenteral nutrition (HPN). All patients had stable weights without changes in intravenous calories or protein for 3 consecutive months. Our objectives were to assess oral intake of calories, carbohydrates, fat, and protein, to examine relationships between oral nutrient intakes and disease categories, and to compare oral and intravenous intakes to calculated resting energy expenditure (REE). Two patterns of oral nutrient intake were identified among the patients. Patients with short bowel syndrome, regardless of the underlying disease, consumed calories by mouth that clearly exceeded calculated resting energy expenditure (short bowel, non-Crohn's, 170% of REE; short bowel, Crohn's, 200 of REE); however, calories approximating the REE had to be given via HPN, suggesting that efficiency of absorption was at a very low level. Patients with diffuse gut diseases (radiation enteritis or pseudo-obstruction syndromes) had very low intakes of oral nutrients. The distribution of oral calories among carbohydrate, protein, and fat did not differ among the disease categories.

  20. Severe Refractory Coeliac Disease with Response Only to Parenteral Nutrition

    PubMed Central

    Ng, Ka Ying Bonnie; Mehta, Ravi; Mohamed, Salma; Mohamed, Zameer; Arnold, Jayantha

    2014-01-01

    Refractory coeliac disease (RCD) is characterised by recurrent or persistent malabsorptive symptoms and villous atrophy, despite strict adherence to a gluten-free diet for at least 6 months and where other causes of malabsorption including malignancy have been excluded. There is limited evidence and guidance on the effective management of these patients. We describe a case of severe RCD in our hospital, with symptoms controlled effectively only by total parenteral nutrition (TPN). This 68-year-old woman initially presented to the clinic with persistent non-bloody diarrhoea and vomiting. A diagnosis of coeliac disease was confirmed with a positive tissue transglutaminase assay and histology. A strict gluten-free diet was ineffective and she represented 6 months later with 13 kg weight loss (16.7%), ongoing abdominal pain and diarrhoea, with bowels opening 16 times a day. She was oedematous, had an albumin of 12 g/l and required hospital admission. She was treated for pancreatic insufficiency and presumptively for small bowel bacterial overgrowth with no resolution of symptoms. We ruled out infectious causes and investigated for small bowel malignancy; all results were negative. Small bowel enteroscopy showed ulcerative jejunitis. She was given 5 days of TPN, following which her symptoms improved and albumin normalised. This was sustained with symptom resolution and weight gain seen at follow-up. TPN successfully and rapidly induced remission in this case. Thus, a short period of TPN should be considered as a potential component of management in patients with severe RCD. PMID:25473387

  1. Home Parenteral Nutrition: Fat Emulsions and Potential Complications.

    PubMed

    Mundi, Manpreet S; Salonen, Bradley R; Bonnes, Sara

    2016-10-01

    Since the first intravenous nutrition support attempt with olive oil in the 17th century, intravenous fat emulsions (IVFEs) have evolved to become an integral component in the management of patients receiving home parenteral nutrition (HPN). IVFEs serve as a calorie source and provide essential fatty acids (linoleic acid and α-linolenic acid) in patients unable to achieve adequate intake of these fatty acids through alternative means. However, IVFE use is also associated with multiple complications, including increased infection risk, liver disease, and systemic proinflammatory states. In the United States, most IVFEs are composed of 100% soybean oil; internationally multiple alternative IVFEs (using fish oil, olive oil, and long- and medium-chain triglycerides) are available or being developed. The hope is that these IVFEs will prevent, or decrease the risk of, some of the HPN-associated complications. The goal of this article is to review how IVFEs came into use, their composition and metabolism, options for IVFE delivery in HPN, benefits and risks of IVFE use, and strategies to minimize the risks associated with IVFE use in HPN patients. PMID:27533943

  2. Leucine supplementation of a low-protein meal increases skeletal muscle and visceral tissue protein synthesis in neonatal pigs by stimulating mTOR-dependent translation initiation

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Protein synthesis and eukaryotic initiation factor (eIF) activation are increased in skeletal muscle of neonatal pigs parenterally infused with amino acids. Leucine appears to be the most effective single amino acid to trigger these effects. To examine the response to enteral leucine supplementation...

  3. Fish oil-based lipid emulsion: current updates on a promising novel therapy for the management of parenteral nutrition-associated liver disease

    PubMed Central

    Bharadwaj, Shishira; Gohel, Tushar; Deen, Omer J.; DeChicco, Robert; Shatnawei, Abdullah

    2015-01-01

    Intestinal failure is characterized by loss of enteral function to absorb necessary nutrients and water to sustain life. Parenteral nutrition (PN) is a lifesaving therapeutic modality for patients with intestinal failure. Lifelong PN is also needed for patients who have short bowel syndrome due to extensive resection or a dysmotility disorder with malabsorption. However, prolonged PN is associated with short-term and long-term complications. Parenteral nutrition-associated liver disease (PNALD) is one of the long-term complications associated with the use of an intravenous lipid emulsion to prevent essential fatty acid deficiency in these patients. PNALD affects 30–60% of the adult population on long-term PN. Further, PNALD is one of the indications for isolated liver or combined liver and intestinal transplantation. There is no consensus on how to manage PNALD, but fish oil-based lipid emulsion (FOBLE) has been suggested to play an important role both in its prevention and reversal. There is significant improvement in liver function in those who received FOBLE as lipid supplement compared with those who received soy-based lipid emulsion. Studies have also demonstrated that FOBLE reverses hepatic steatosis and reduces markers of inflammation in patients on long-term PN. Future prospective studies with larger sample sizes are needed to further strengthen the positive role of FOBLE in PNALD. PMID:25858884

  4. Comparison of early enteral nutrition in severe acute pancreatitis with prebiotic fiber supplementation versus standard enteral solution: A prospective randomized double-blind study

    PubMed Central

    Karakan, Tarkan; Ergun, Meltem; Dogan, Ibrahim; Cindoruk, Mehmet; Unal, Selahattin

    2007-01-01

    AIM: To compare the beneficial effects of early enteral nutrition (EN) with prebiotic fiber supplementation in patients with severe acute pancreatitis (AP). METHODS: Thirty consecutive patients with severe AP, who required stoppage of oral feeding for 48 h, were randomly assigned to nasojejunal EN with or without prebiotics. APACHE II score, Balthazar’s CT score and CRP were assessed daily during the study period. RESULTS: The median duration of hospital stay was shorter in the study group [10 ± 4 (8-14) d vs 15 ± 6 (7-26) d] (P < 0.05). The median value of days in intensive care unit was also similar in both groups [6 ± 2 (5-8) d vs 6 ± 2 (5-7) d]. The median duration of EN was 8 ± 4 (6-12) d vs 10 ± 4 (6-13) d in the study and control groups, respectively (P > 0.05). Deaths occurred in 6 patients (20%), 2 in the study group and 4 in the control group. The mean duration of APACHE II normalization (APACHE II score < 8) was shorter in the study group than in the control group (4 ± 2 d vs 6.5 ± 3 d, P < 0.05). The mean duration of CRP normalization was also shorter in the study group than in the control group (7 ± 2 d vs 10 ± 3 d, P < 0.05). CONCLUSION: Nasojejunal EN with prebiotic fiber supplementation in severe AP improves hospital stay, duration nutrition therapy, acute phase response and overall complications compared to standard EN therapy. PMID:17569144

  5. Vitamin E in new-generation lipid emulsions protects against parenteral nutrition-associated liver disease in parenteral nutrition-fed preterm pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Parenteral nutrition (PN) in preterm infants leads to PN-associated liver disease (PNALD). PNALD has been linked to serum accumulation of phytosterols that are abundant in plant oil but absent in fish oil emulsions. Whether modifying the phytosterol and vitamin E composition of soy and fish oil lipi...

  6. Parenteral nutrition support: Beyond gut feeling? Quality control study of parenteral nutrition practices in a Tertiary Care Hospital

    PubMed Central

    Ramakrishnan, Nagarajan; Shankar, Bhuvaneshwari; Ranganathan, Lakshmi; Daphnee, D. K.; Bharadwaj, Adithya; Venkataraman, Ramesh

    2016-01-01

    Background: Enteral nutrition (EN) is preferred over parenteral nutrition (PN) in hospitalized patients based on International consensus guidelines. Practice patterns of PN in developing countries have not been documented. Objectives: To assess practice pattern and quality of PN support in a tertiary hospital setting in Chennai, India. Methods: Retrospective record review of patients admitted between February 2010 and February 2012. Results: About 351,008 patients were admitted to the hospital in the study period of whom 29,484 (8.4%) required nutritional support. About 70 patients (0.24%) received PN, of whom 54 (0.18%) received PN for at least three days. Common indications for PN were major gastrointestinal surgery (55.6%), intolerance to EN (25.9%), pancreatitis (5.6%), and gastrointestinal obstruction (3.7%). Conclusions: The proportion of patients receiving PN was very low. Quality issues were identified relating to appropriateness of indication and calories and proteins delivered. This study helps to introspect and improve the quality of nutrition support. PMID:26955215

  7. Nucleic acid labeling with ( sup 3 H)orotic acid and nucleotide profile in rats in protein deprivation, enteral and parenteral essential amino acid administration, and 5-fluorouracil treatment

    SciTech Connect

    Jakobsson, B.; el Hag, I.A.; Andersson, M.; Christensson, P.I.; Stenram, U. )

    1990-09-01

    Rats were fed a 0% casein diet for 1 week, with or without enteral or parenteral administration of essential amino acids, or a 25% casein diet, in one group supplemented with 5-fluorouracil treatment. Ninety minutes before sacrifice the rats were given a tracer of (3H)orotic acid. Incorporation into the acid soluble fraction, RNA, and DNA was determined in liver, small intestine, bone marrow, and kidney. Nucleotide profile was examined in liver and intestine. Protein deficiency caused inter alia a decrease in body weight; a decrease in RNA/DNA ratio and an increase in the specific RNA labeling in liver and kidney; an altered nucleotide profile in the liver; an increase in the nucleotide/DNA and RNA/DNA ratios and a decrease in the specific labeling of the acid soluble fraction, RNA, and DNA in the bone marrow. These changes were prevented to the same extent by giving essential amino acids, either orally or intravenously. The minor changes in intestinal nucleotide profile in protein deprivation were prevented to a slightly larger extent by amino acids orally than parenterally. 5-Fluorouracil treatment gave a decrease in the RNA/DNA ratio in the liver and kidney but an increase in the nucleotide/DNA and RNA/DNA ratios in the bone marrow. Nucleotide profiles were unaltered. The amount of DNA per gram of tissue decreased in bone marrow and increased in kidney. Parenteral administration per se resulted in almost no changes.

  8. Glycemic Variation in Tumor Patients with Total Parenteral Nutrition

    PubMed Central

    Yang, Jin-Cheng; Dai, Yuan-Yuan; Wang, Li-Ming; Xie, Yi-Bin; Zhou, Hai-Yan; Li, Guo-Hui

    2015-01-01

    Background: Hyperglycemia is associated with poor clinical outcomes and mortality in several patients. However, studies evaluating hyperglycemia variation in tumor patients receiving total parenteral nutrition (TPN) are scarce. The aim of this study was to assess the relationship between glycemia and tumor kinds with TPN by monitoring glycemic variation in tumor patients. Methods: This retrospective clinical trial selected 312 patients with various cancer types, whose unique nutrition treatment was TPN during the monitoring period. All patients had blood glucose (BG) values assessed at least six times daily during the TPN infusion. The glycemic variation before and after TPN was set as the indicator to evaluate the factors influencing BG. Results: The clinical trial lasted 7.5 ± 3.0 days adjusted for age, gender, family cancer history and blood types. There were six cancer types: Hepatic carcinoma (HC, 21.8%), rectal carcinoma (17.3%), colon carcinoma (CC, 14.7%), gastric carcinoma (29.8%), pancreatic carcinoma (11.5%), and duodenal carcinoma (DC, 4.8%). The patients were divided into diabetes and nondiabetes groups. No statistical differences in TPN glucose content between diabetes and nondiabetes groups were found; however, the tumor types affected by BG values were obvious. With increasing BG values, DC, HC and CC were more represented than other tumor types in this sequence in diabetic individuals, as well as in the nondiabetic group. BG was inclined to be more easily influenced in the nondiabetes group. Other factors did not impact BG values, including gender, body mass index, and TPN infusion duration time. Conclusions: When tumor patients are treated with TPN, BG levels should be monitored according to different types of tumors, besides differentiating diabetes or nondiabetes patients. Special BG control is needed for DC, HC and CC in both diabetic and nondiabetic patients. If BG overtly increases, positive measurements are needed to control BG values. The

  9. 100 patient-years of ambulatory home total parenteral nutrition.

    PubMed Central

    Dudrick, S J; O'Donnell, J J; Englert, D M; Matheny, R G; Blume, E R; Nutt, R E; Hickey, M S; Barroso, A O

    1984-01-01

    More than 100 patient-years' experience has been acquired in the treatment of 133 patients with ambulatory home total parenteral nutrition (TPN) between May 1974 and December 1983. Indications for chronic or permanent home TPN include short bowel syndrome, malabsorption, scleroderma, and vasoactive intestinal polypeptide syndrome. Indications for acute or temporary home TPN include Crohn's disease, malignancies, gastrointestinal fistulas, ulcerative colitis, anorexia nervosa, and numerous other disorders. Eighty-two patients in the acute group were treated primarily with percutaneously placed standard subclavian catheters and 51 patients in the chronic group have been treated thus far with implanted silicone rubber, Dacron-cuffed catheters for a cumulative total of 38,939 patient days. Of the 125 implanted catheters, 115 were placed in the superior vena cava and ten in the inferior vena cava for an average duration of 250 catheter-days, the longest single catheter remaining in situ for more than 8 1/2 years. Catheter-related sepsis occurred 33 times with the implanted catheters, or once every 2.6 catheter-years. One hundred and fourteen temporary catheters were placed percutaneously in the superior vena cava via a subclavian vein for an average duration of 68 days, the longest single catheter remaining in situ for 213 days. Catheter-related sepsis occurred seven times, equivalent to one episode per 3 catheter-years. Total catheter-related complications were quite infrequent and were directly related to duration of catheterization. They included venous thrombosis (12), clotted catheter (11), catheter failure or rupture (8), catheter compression (5) and inadvertent catheter removal (4). Twenty-six catheters were repaired or spliced in situ when the external segment was accidentally damaged or deteriorated secondary to long-term material fatigue. One remarkable patient has been maintained exclusively by TPN originally as an inpatient and subsequently as an outpatient

  10. Parenteral nutrition in adult inpatients with functioning gastrointestinal tracts: assessment of outcomes.

    PubMed

    Zaloga, Gary P

    2006-04-01

    Malnutrition is a common comorbidity that places inpatients at risk of complications, infections, long length of stay, higher costs, and increased mortality. Thus, nutrition support has become an important therapeutic adjunctive to the care of these patients. For patients unable to feed themselves, nutrition can be delivered via the parenteral or enteral routes. The formulations used to deliver nutrients and the route of nutrient delivery, absorption, and processing differ substantially between parenteral and enteral nutrition. Over the past two decades, many randomised clinical trials have assessed the effects of parenteral versus enteral nutrition on outcomes (ie, complications, infections, length of stay, costs, mortality) in diverse inpatient populations. From a search of medical publications, studies were selected that assessed important clinical outcomes of parenteral versus enteral feeding or intravenous fluids in patients with trauma/burn injuries, surgery, cancer, pancreatic disease, inflammatory bowel disease, critical illness, liver failure, acute renal failure, and organ transplantation. Our goal was to determine the optimum route of feeding in these patient groups. The available evidence lends support to the use of enteral over parenteral feeding in inpatients with functioning gastrointestinal tracts. PMID:16581410

  11. Haemodynamic effects of parenteral vs. enteral paracetamol in critically ill patients: a randomised controlled trial.

    PubMed

    Kelly, S J; Moran, J L; Williams, P J; Burns, K; Rowland, A; Miners, J O; Peake, S L

    2016-10-01

    Paracetamol is a commonly used drug in the intensive care unit. There have been reports in the literature of an association with significant hypotension, a potentially important interaction for labile critically ill patients. Route of administration may influence the incidence of hypotension. This single-centre, prospective, open-label, randomised, parallel-arm, active-control trial was designed to determine the incidence of hypotension following the administration of paracetamol to critically ill patients. Fifty adult patients receiving paracetamol for analgesia or pyrexia were randomly assigned to receive either the parenteral or enteral formulation of the drug. Paracetamol concentrations were measured at baseline and at multiple time points over 24 h. The maximal plasma paracetamol concentration was significantly different between routes; 156 vs. 73 micromol.l(-1) [p = 0.0005] following the first dose of parenteral or enteral paracetamol, respectively. Sixteen hypotensive events occurred in 12 patients: parenteral n = 12; enteral n = 4. The incident rate ratio for parenteral vs. enteral paracetamol was 2.94 (95% CI 0.97-8.92; p = 0.06). The incidence of hypotension associated with paracetamol administration is higher than previously reported and tends to be more frequent with parenteral paracetamol. PMID:27611038

  12. Time history solution program, L225 (TEV126). Volume 2: Supplemental system design and maintenance document. [for airplane dynamic response using frequency response data

    NASA Technical Reports Server (NTRS)

    Tornallyay, A.; Clemmons, R. E.; Kroll, R. I.

    1979-01-01

    The time history solution program L225 (TEV126) is described. The program calculates the time responses of a linear system by convoluting the impulsive response functions with the time dependent excitation. The convolution is performed as a multiplication in the frequency domain. Fast Fourier transform techniques are used to transform the product back into the time domain to obtain response time histories. The design and structure of the program is presented.

  13. Characterization and protective efficacy in an animal model of a novel truncated rotavirus VP8 subunit parenteral vaccine candidate.

    PubMed

    Xue, Miaoge; Yu, Linqi; Che, Yaojian; Lin, Haijun; Zeng, Yuanjun; Fang, Mujin; Li, Tingdong; Ge, Shengxiang; Xia, Ningshao

    2015-05-21

    The cell-attachment protein VP8* of rotavirus is a potential candidate parenteral vaccine. However, the yield of full-length VP8 protein (VP8*, residues 1-231) expressed in Escherichia coli was low, and a truncated VP8 protein (ΔVP8*, residues 65-231) cannot elicit efficient protective immunity in a mouse model. In this study, tow novel truncated VP8 proteins, VP8-1 (residues 26-231) and VP8-2 (residues 51-231), were expressed in E. coli and evaluated for immunogenicity and protective efficacy, compared with VP8* and ΔVP8*. As well as ΔVP8*, the protein VP8-1 and VP8-2 were successfully expressed in high yield and purified in homogeneous dimeric forms, while the protein VP8* was expressed with lower yield and prone to aggregation and degradation in solution. Although the immunogenicity of the protein VP8*, VP8-1, VP8-2 and ΔVP8* was comparable, immunization of VP8* and VP8-1 elicited significantly higher neutralizing antibody titers than that of VP8-2 and ΔVP8* in mice. Furthermore, when assessed using a mouse maternal antibody model, the efficacy of VP8-1 to protect against rotavirus-induced diarrhea in pups was comparable to that of VP8*, both were dramatically higher than that of VP8-2 and ΔVP8*. Taken together, the novel truncated protein VP8-1, with increased yield, improved homogeneity and high protective efficacy, is a viable candidate for further development of a parenterally administrated prophylactic vaccine against rotavirus infection. PMID:25882173

  14. Non-Parenteral Medications for Procedural Sedation in Children- A Narrative: Review Article.

    PubMed

    Fallah, Razieh; Ferdosian, Farzad; Shajari, Ahmad

    2015-01-01

    Procedural sedation may be needed in many diagnostic and therapeutic procedures in children. To make pediatric procedural sedation as safe as possible, protocols should be developed by institutions. Response to sedation in children is highly variable, while some become deeply sedated after minimal doses, others may need much higher doses. Child developmental status, clinical circumstances and condition of patient should be considered and then pharmacologic and non-pharmacologic interventions for sedation be selected. Drug of choice and administration route depend on the condition of the child, type of procedure, and predicted pain degree. The drugs might be administered parenteral (intravenous or intramuscular) or non parenteral including oral, rectal, sublingual, aerosolized buccal and intranasal. The use of intravenous medication such propofol, ketamine, dexmedetomidine, or etomidate may be restricted in use by pediatric anesthesiologist or pediatric critical care specialists or pediatric emergency medicine specialists. In this review article we discuss on non-parenteral medications that can be used by non- anesthesiologist. PMID:26401146

  15. Aluminum in parenteral products: Overview of chemistry concerns and regulatory actions

    SciTech Connect

    Hoiberg, C.P.

    1989-05-01

    In the May 23, 1985 issue of the New England Journal of Medicine, Dr. Sedman et al. reported that many drug products that are routinely administered in parenteral therapy contain aluminum. From a manufacturing and control perspective, the Agency had obtained considerable information and data regarding (1) sources of aluminum contamination, (2) types of parenteral drug products containing aluminum, and (3) assay methodologies. Currently, in the review of drug applications in DSDDP, applicants are being requested to incorporate aluminum monitoring into their stability protocols and to implement, where possible, changes that will reduce aluminum contamination. Since acceptable analytical procedures are available and the aluminum contaminate is believed to be harmful to certain patient populations receiving parenteral therapy, the Agency is considering actions resulting in the imposition of regulatory controls.

  16. [Technical specifications for rational clinical use of parenterally administered Chinese medicine (draft version for comments)].

    PubMed

    Xie, Yan-Ming; Li, Ming-Quan; Zhang, Yun-Ling; Ma, Rong; Xian, Shao-Xiang; Liu, Jian; Li, Su-Yun; Zhao, Yu-Bin

    2013-09-01

    The regulations on basic clinical use of parenterally administered Chinese medicine, issued jointly in 2008, by the ministry of health (MOH), China food and drug administration (SFDA) and the state administration of traditional Chinese medicine (SATCM). Integrating actual clinical practice, these presented doctors and nurses with detailed specifications for the safe use of parenterally administered Chinese medicine. The regulations emphasize the use of Chinese medicine pattern differentiation, use in strict accordance with instructions, and they prohibit use combined with other medicines. The emphasis of the regulations are practicality and operability, and provide meaningful guidance to doctors and nurses for the rational and safe use of parenterally administered Chinese medicine, to reduce adverse reactions/adverse events caused by improper use. PMID:24471306

  17. Non-Parenteral Medications for Procedural Sedation in Children- A Narrative: Review Article

    PubMed Central

    FALLAH, Razieh; FERDOSIAN, Farzad; SHAJARI, Ahmad

    2015-01-01

    Procedural sedation may be needed in many diagnostic and therapeutic procedures in children. To make pediatric procedural sedation as safe as possible, protocols should be developed by institutions. Response to sedation in children is highly variable, while some become deeply sedated after minimal doses, others may need much higher doses. Child developmental status, clinical circumstances and condition of patient should be considered and then pharmacologic and non-pharmacologic interventions for sedation be selected. Drug of choice and administration route depend on the condition of the child, type of procedure, and predicted pain degree. The drugs might be administered parenteral (intravenous or intramuscular) or non parenteral including oral, rectal, sublingual, aerosolized buccal and intranasal. The use of intravenous medication such propofol, ketamine, dexmedetomidine, or etomidate may be restricted in use by pediatric anesthesiologist or pediatric critical care specialists or pediatric emergency medicine specialists. In this review article we discuss on non-parenteral medications that can be used by non- anesthesiologist. PMID:26401146

  18. An assessment of techniques for evaluating the physical stability of parenteral emulsions.

    PubMed

    Zhang, Xiaoguang; Kirsch, Lee E

    2003-01-01

    The physical stability of the parenteral emulsions is a key product quality issue. The purpose of this study is to develop, prepare and characterize model phospholipid emulsions and to critically evaluate various physical stability-indicating methods. Oil-in-water (O/W) emulsions were prepared using 20% (w/w) medium chain triglycerides (MCT) or soybean oil in 2.21% (w/w) aqueous glycerin solutions emulsified with 0.1 to 1.8 % (w/w) lecithin. The reproducibility of emulsion preparation was determined by measuring the volume-based mean droplet diameter using photon correlation spectroscopy (PCS) and zeta potential using electrophoretic light scattering. Evaluation of stability-indicating methods was conducted by comparing the mean droplet growth rate of a thermally-stressed emulsion using PCS, a light obscuration particle counter (HIAC, equipped with a laser diode sensor) and a droplet image analyzer interfaced with transmission electron microscopy (TEM) using osmium tetraoxide fixation. Emulsions with identical compositions and preparation properties had reproducible mean droplet diameter and initial zeta potential values with RSD < 5.0%. Upon the application of thermal stress, the volume-based diameter increased linearly with time for all three sizing techniques (PCS, HIAC, and TEM). The droplet growth rates estimated using PCS and TEM were nearly identical. PCS is a sufficiently accurate technique for measuring emulsion stability and is less time-consuming than TEM. The HIAC technique only measured the size of droplets with diameters larger than about 1 micron, which was considerably greater than the mean droplet diameter as determined by PCS and microscopic image analysis (TEM). Moreover, the growth rate obtained using HIAC was much greater than the rates estimated by PCS and TEM; therefore the HIAC technique was not an accurate measure of the physical stability of the thermally stressed emulsions. PMID:14558703

  19. Parenteral nutrition in the management of a dog with lymphocytic-plasmacytic enteritis and severe protein-losing enteropathy.

    PubMed Central

    Lane, I F; Miller, E; Twedt, D C

    1999-01-01

    Management of lymphocytic-plasmacytic enteritis in a dog with whipworm infestation, hypoproteinemia, and ascites is described. Short-term parenteral nutrition hastened normalization of serum proteins, resolution of diarrhea, and weight gain. A description of the potential benefits, limitations, and possible complications of parenteral nutrition in refractory inflammatory bowel disease is given. PMID:10572669

  20. 10 CFR 35.396 - Training for the parenteral administration of unsealed byproduct material requiring a written...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Training for the parenteral administration of unsealed byproduct material requiring a written directive. 35.396 Section 35.396 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Unsealed Byproduct Material-Written Directive Required § 35.396 Training for the parenteral administration...

  1. 10 CFR 35.396 - Training for the parenteral administration of unsealed byproduct material requiring a written...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Training for the parenteral administration of unsealed byproduct material requiring a written directive. 35.396 Section 35.396 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Unsealed Byproduct Material-Written Directive Required § 35.396 Training for the parenteral administration...

  2. 10 CFR 35.396 - Training for the parenteral administration of unsealed byproduct material requiring a written...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Training for the parenteral administration of unsealed byproduct material requiring a written directive. 35.396 Section 35.396 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Unsealed Byproduct Material-Written Directive Required § 35.396 Training for the parenteral administration...

  3. 10 CFR 35.396 - Training for the parenteral administration of unsealed byproduct material requiring a written...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 1 2014-01-01 2014-01-01 false Training for the parenteral administration of unsealed byproduct material requiring a written directive. 35.396 Section 35.396 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Unsealed Byproduct Material-Written Directive Required § 35.396 Training for the parenteral administration...

  4. 10 CFR 35.396 - Training for the parenteral administration of unsealed byproduct material requiring a written...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Training for the parenteral administration of unsealed byproduct material requiring a written directive. 35.396 Section 35.396 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Unsealed Byproduct Material-Written Directive Required § 35.396 Training for the parenteral administration...

  5. Enteral bile acid treatment improves parenteral nutrition-related liver disease and intestinal mucosal atrophy in neonatal pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Total parenteral nutrition (TPN) is essential for patients with impaired gut function but leads to parenteral nutrition-associated liver disease (PNALD). TPN disrupts the normal enterohepatic circulation of bile acids, and we hypothesized that it would decrease intestinal expression of the newly des...

  6. Parenteral Nutrition Suppresses the Bactericidal Response of the Small Intestine

    PubMed Central

    Omata, Jiro; Pierre, Joseph F; Heneghan, Aaron F; Tsao, Francis HC; Sano, Yoshifumi; Jonker, Mark A; Kudsk, Kenneth A

    2012-01-01

    Background Parenteral nutrition (PN) increases infectious risk in critically ill patients compared with enteral feeding. Previously, we demonstrated that PN feeding suppresses the concentration of the Paneth cell antimicrobial protein secretory phospholipase A2 (sPLA2) in the gut lumen. sPLA2 and other Paneth cell proteins are released in response to bacterial components, such as lipopolysaccharide (LPS), and they modulate the intestinal microbiome. Since the Paneth cell protein sPLA2 was suppressed with PN feeding, we hypothesized PN would diminish the responsiveness of the small bowel to LPS through reduced secretions and as a result exhibit less bactericidal activity. Methods The distal ileum was harvested from ICR mice, washed, and randomized for incubation with LPS (0, 1, or 10 μg/mL). Culture supernatant was collected and sPLA2 Activity was measured. Bactericidal activity of the ileum segment secretions was assessed against P. aeruginosa with and without a sPLA2 inhibitor at two concentrations, 100nM and 1μM. ICR mice were randomized to Chow or PN for 5 days. Tissue was collected for immunohistochemistry (IHC) and ileal segments were incubated with LPS (0 or 10 μg/mL). sPLA2 activity and bactericidal activity were measured in secretions from ileal segments. Results The ileal segments responded to 10 ug/mL LPS with significantly greater sPLA2 activity and bactericidal activity. The bactericidal activity of secretions from LPS stimulated tissue was suppressed 50% and 70%, respectively, with the addition of the sPLA2-inhibitor. Chow displayed greater sPLA2 in the Paneth cell granules and secreted higher levels of sPLA2 than PN before and after LPS. Accordingly, media collected from Chow was more bactericidal than PN. IHC confirmed a reduction in Paneth cell granules after PN. Conclusions This work demonstrates that ileal segments secrete bactericidal secretions after LPS exposure and the inhibition of the Paneth cell antimicrobial protein sPLA2 significantly

  7. Standardised neonatal parenteral nutrition formulations – an Australasian group consensus 2012

    PubMed Central

    2014-01-01

    Standardised parenteral nutrition formulations are routinely used in the neonatal intensive care units in Australia and New Zealand. In 2010, a multidisciplinary group was formed to achieve a consensus on the formulations acceptable to majority of the neonatal intensive care units. Literature review was undertaken for each nutrient and recommendations were developed in a series of meetings held between November 2010 and April 2011. Three standard and 2 optional amino acid/dextrose formulations and one lipid emulsion were agreed by majority participants in the consensus. This has a potential to standardise neonatal parenteral nutrition guidelines, reduce costs and prescription errors. PMID:24548745

  8. Reactive Geochemical Transport Modeling of Concentrated AqueousSolutions: Supplement to TOUGHREACT User's Guide for the PitzerIon-Interaction Model

    SciTech Connect

    Zhang, Guoxiang; Spycher, Nicolas; Xu, Tianfu; Sonnenthal, Eric; Steefel , Carl

    2006-12-15

    In this report, we present: -- The Pitzer ion-interactiontheory and models -- Input file requirements for using the TOUGHREACTPitzer ion-interaction model and associated databases -- Run-time errormessages -- Verification test cases and application examples. For themain code structure, features, overall solution methods, description ofinput/output files for parameters other than those specific to theimplemented Pitzer model, and error messages, see the TOUGHREACT User'sGuide (Xu et al., 2005). The TOUGHREACT Pitzer version runs on aDEC-alpha architecture CPU, under OSF1 V5.1, with Compaq Digital FortranCompiler. The compiler run-time libraries are required for execution aswell as compilation. The code also runs on Intel Pentium IV andhigher-version CPU-based machines with Compaq Visual Fortran Compiler orIntel Fortran Compiler (integrated with the Microsoft DevelopmentEnvironment). The minimum hardware configuration should include 1 GB RAMand 1 GB (2 GB recommended) of available disk space.

  9. Effects of glutamine supplementation on splenocyte cytokine mRNA expression in rats with septic peritonitis

    PubMed Central

    Yeh, Sung-Ling; Lai, Yu-Ni; Shang, Huey-Fang; Lin, Ming-Tsan; Chiu, Wan-Chun; Chen, Wei-Jao

    2005-01-01

    AIM: To investigate the effects of glutamine (GLN)-enriched diets before and GLN-containing total parenteral nutrition (TPN) after sepsis or both on the secretion of cytokines and their mRNA expression levels in splenocytes of rats with septic peritonitis. METHODS: Rats were assigned to a control group and 4 experimental groups. The control group and experimental groups 1 and 2 were fed a semipurified diet, while experimental groups 3 and 4 had part of the casein replaced by GLN which provided 25% of the total nitrogen. After rats were fed with these diets for 10 d, sepsis was induced by cecal ligation and puncture (CLP), whereas the control group underwent a sham operation, at the same time, an internal jugular vein was cannulated. All rats were maintained on TPN for 3 d. The control group and experimental groups 1 and 3 were infused with conventional TPN, while the TPN in experimental groups 2 and 4 was supplemented with GLN, providing 25% of the total nitrogen in the TPN solution. All rats were kiued 3 d after sham operation or CLP to examine their splenocyte subpopulation distribution and cytokine expression levels. RESULTS: Most cytokines could not be detected in plasma except for IL-10. No difference in plasma IL-10 was observed among the 5 groups. The IL-2, IL-4, IL-10, and TNF-α mRNA expression levels in splenocytes were significantly higher in experimental groups 2 and 4 than in the control group and group 1. The mRNA expression of IFN-γ was significantly higher in the GLN-supplemented groups than in the control group and experimental group 1. The proportion of CD45Ra+ was increased, while those of CD3+ and CD4+ were decreased in experimental group 1 after CLP was performed. There were no differences in spleen CD3+ lymphocyte distributions between the control and GLN-supplemented groups. CONCLUSION: GLN supplementation can maintain T-lymphocyte populations in the spleen and significantly enhance the mRNA expression levels of Th1 and Th2 cytokines and TNF

  10. Comparison of Intradialytic Parenteral Nutrition with Glucose or Amino Acid Mixtures in Maintenance Hemodialysis Patients

    PubMed Central

    Liu, Yan; Xiao, Xiao; Qin, Dan-Ping; Tan, Rong-Shao; Zhong, Xiao-Shi; Zhou, Dao-Yuan; Liu, Yun; Xiong, Xuan; Zheng, Yuan-Yuan

    2016-01-01

    Many long-term maintenance hemodialysis patients have symptoms of protein-energy wasting caused by malnutrition. Each session of hemodialysis removes about 10 to 12 g of amino acids and 200 to 480 kcal of energy. Patients receiving hemodialysis for chronic kidney disease may be undernourished for energy, protein consumption, or both. Non-diabetic hemodialysis patients were randomized to three treatment groups: oral supplementation, oral supplementation plus high-concentration glucose solution (250 mL containing 50% glucose) and these two interventions plus 8.5% amino acids solution. The post-treatment energy status of the glucose group was significantly higher than its baseline level, whereas the control group’s status was significantly lower. The glucose group had significantly higher concentrations of asparagine, glutamine, glycine, alanine, and lysine after treatment. All treatment groups had significantly increased hemoglobin levels but significantly decreased transferrin levels after treatment compared to baseline. After treatment, the amino acid group had significantly higher albumin level compared to the glucose group (p = 0.001) and significantly higher prealbumin level compared to the control group (p = 0.017). In conclusion, long-term intervention with high-concentration glucose solution at each hemodialysis session is a simple and cheap method that replenished energy stores lost during hemodialysis of non-diabetic patients. PMID:27271658

  11. Comparison of Intradialytic Parenteral Nutrition with Glucose or Amino Acid Mixtures in Maintenance Hemodialysis Patients.

    PubMed

    Liu, Yan; Xiao, Xiao; Qin, Dan-Ping; Tan, Rong-Shao; Zhong, Xiao-Shi; Zhou, Dao-Yuan; Liu, Yun; Xiong, Xuan; Zheng, Yuan-Yuan

    2016-01-01

    Many long-term maintenance hemodialysis patients have symptoms of protein-energy wasting caused by malnutrition. Each session of hemodialysis removes about 10 to 12 g of amino acids and 200 to 480 kcal of energy. Patients receiving hemodialysis for chronic kidney disease may be undernourished for energy, protein consumption, or both. Non-diabetic hemodialysis patients were randomized to three treatment groups: oral supplementation, oral supplementation plus high-concentration glucose solution (250 mL containing 50% glucose) and these two interventions plus 8.5% amino acids solution. The post-treatment energy status of the glucose group was significantly higher than its baseline level, whereas the control group's status was significantly lower. The glucose group had significantly higher concentrations of asparagine, glutamine, glycine, alanine, and lysine after treatment. All treatment groups had significantly increased hemoglobin levels but significantly decreased transferrin levels after treatment compared to baseline. After treatment, the amino acid group had significantly higher albumin level compared to the glucose group (p = 0.001) and significantly higher prealbumin level compared to the control group (p = 0.017). In conclusion, long-term intervention with high-concentration glucose solution at each hemodialysis session is a simple and cheap method that replenished energy stores lost during hemodialysis of non-diabetic patients. PMID:27271658

  12. Diabetes and Dietary Supplements

    MedlinePlus

    ... R S T U V W X Y Z Diabetes and Dietary Supplements: In Depth Share: On This ... health product or practice. Are dietary supplements for diabetes safe? Some dietary supplements may have side effects, ...

  13. Enteral obeticholic acid promotes intestinal growth in total parenteral nutrition fed neonatal pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Intestinal atrophy is an adverse outcome associated with prolonged total parenteral nutrition (PN) partly due to disruption of normal enterohepatic circulation of bile acids. Previously we showed that enteral treatment with chenodeoxycholic acid (CDCA), a dual agonist for the nuclear receptor, farne...

  14. Impact of parenteral lipid emulsions on metabolomic phenotype in preterm TPN-fed piglets

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Lipids in parenteral nutrition provide essential fatty acids and are a major source of energy for hospitalized neonates. Intralipid (IL) is the only approved lipid emulsion in the US, but new generation emulsions include Omegaven (OV) and SMOFlipid (SL). There are no studies describing the metabolit...

  15. Impact of parenteral lipid emulsions on the metabolomic phenotype in preterm TPN-fed piglets

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Lipids in parenteral nutrition provide essential fatty acids and are a major source of energy for hospitalized neonates. Intralipid (IL) is the only approved lipid emulsion in the U.S, but new generation emulsions include Omegaven (OV) and SMOFlipid (SL). There are no studies describing the metaboli...

  16. Continuous parenteral and enteral nutrition induces metabolic dysfunction in neonatal pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We previously showed that parenteral nutrition (PN) compared with formula feeding results in hepatic insulin resistance and steatosis in neonatal pigs. The current aim was to test whether the route of feeding (intravenous [IV] vs enteral) rather than other feeding modalities (diet, pattern) had cont...

  17. 76 FR 50741 - 2011 Parenteral Drug Association/Food and Drug Administration Joint Public Conference; Quality...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-16

    ... HUMAN SERVICES Food and Drug Administration 2011 Parenteral Drug Association/Food and Drug... AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public conference. The Food and Drug.... Written requests are to be sent to Division of Freedom of Information (ELEM-1029), Food and...

  18. Course and outcome of parenteral nutrition-associated cholestasis in neonates

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Parenteral nutrition-associated cholestasis (TPN-Chol) leads to significant morbidity and mortality. To assess the safety and effectiveness of potential interventions, it is necessary to evaluate the natural history of TPN-Chol. This retrospective review was undertaken to evaluate the typical course...

  19. Persistence of an adverse metabolic phenotype in parenterally fed neonatal pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The nutritional environment during fetal and neonatal life is a key determinant affecting the risk for adult-onset diseases, such as diabetes and obesity. We previously showed that chronic parenteral (PN) compared to enteral (EN) nutrition in neonatal pigs for two weeks leads to increased glucose in...

  20. Parenteral antiretroviral formulations are still urgently needed: a case report and commentary.

    PubMed

    Odongo, Fatuma Catherine Atieno

    2015-05-01

    This case report highlights a challenging clinical dilemma to administer antiretroviral therapy in a critically-ill human immunodeficiency virus-infected patient who presented with multiple opportunistic infections and a non-functional gastrointestinal tract. The need for parenteral antiretroviral drug options is discussed and investigational drugs are briefly reviewed. PMID:24890687

  1. Gastrointestinal safety and therapeutic efficacy of parenterally administered phosphatidylcholine-associated indomethacin in rodent model systems

    PubMed Central

    Lichtenberger, LM; Romero, JJ; Dial, EJ

    2009-01-01

    Background and purpose Indomethacin is a non-steroidal anti-inflammatory drug (NSAID) that is limited in its enteral or parenteral use by side effects of gastroduodenal bleeding and ulceration. We have investigated the ability of phosphatidylcholine associated with indomethacin to form a therapeutically effective drug (INDO-PC) with reduced gastrointestinal (GI) toxicity for parenteral use. Experimental approach Rats were treated acutely by intravenous or chronically with subcutaneous injection of vehicle, indomethacin or INDO-PC using three related protocols. We then evaluated the following properties of these parenterally administered test drugs: (i) GI toxicity (luminal and faecal haemoglobin; intestinal perforations and adhesions; and haematocrit); (ii) bioavailability (plasma indomethacin); and (iii) therapeutic efficacy (analgesia from sensitivity to pressure; anti-inflammatory from ankle thickness; cyclo-oxygenase (COX) inhibition from synovial fluid prostaglandin E2 concentration) in rats with adjuvant-induced joint inflammation. Key results Acute and chronic dosing with INDO-PC produced less GI bleeding and intestinal injury than indomethacin alone, whereas the bioavailability, analgesic, anti-inflammatory and COX inhibitory activity of INDO-PC were comparable to indomethacin. Conclusions and implications The chemical association of phosphatidylcholine with indomethacin appears to markedly reduce the GI toxicity of the NSAID while providing equivalent therapeutic efficacy in a parenteral INDO-PC formulation. PMID:19366347

  2. Total parenteral nutrition induces liver steatosis and apoptosis in neonatal piglets

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Total parenteral nutrition (TPN) induces a high rate of liver disease in infants, yet the pathogenesis remains elusive. We used neonatal piglets as an animal model to assess early events leading to TPN-mediated liver injury. Newborn piglets (n = 7) were nourished for 7 d on TPN or enteral nutrition ...

  3. Chronic parenteral nutrition reduces lean tissue growth and induces insulin resistance in neonatal piglets

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Most very low birthweight infants receive their nutrition parenterally prior to achieving full enteral feedings. Recent studies indicate that infants born less than 32 weeks gestation showed evidence of insulin resistance at 4 to 10 years. However, there is little information regarding the effect of...

  4. Chronic parenteral nutrition induces hepatic inflammation, steatosis and insulin resistance in neonatal pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Prematurity and overfeeding in infants are associated with insulin resistance in childhood and may increase the risk of adult disease. Total parenteral nutrition (TPN) is a major source of infant nutrition support and may influence neonatal metabolic function. Our aim was to test the hypothesis that...

  5. Unit-Dose Bags For Formulating Intravenous Solutions

    NASA Technical Reports Server (NTRS)

    Finley, Mike; Kipp, Jim; Scharf, Mike; Packard, Jeff; Owens, Jim

    1993-01-01

    Smaller unit-dose flowthrough bags devised for use with large-volume parenteral (LVP) bags in preparing sterile intravenous solutions. Premeasured amount of solute stored in such unit-dose bag flushed by predetermined amount of water into LVP bag. Relatively small number of LVP bags used in conjunction with smaller unit-dose bags to formulate large number of LVP intravenous solutions in nonsterile environment.

  6. Quality by design in formulation and process development for a freeze-dried, small molecule parenteral product: a case study.

    PubMed

    Mockus, Linas N; Paul, Timothy W; Pease, Nathan A; Harper, Nancy J; Basu, Prabir K; Oslos, Elizabeth A; Sacha, Gregory A; Kuu, Wei Y; Hardwick, Lisa M; Karty, Jacquelyn J; Pikal, Michael J; Hee, Eun; Khan, Mansoor A; Nail, Steven L

    2011-01-01

    A case study has been developed to illustrate one way of incorporating a Quality by Design approach into formulation and process development for a small molecule, freeze-dried parenteral product. Sodium ethacrynate was chosen as the model compound. Principal degradation products of sodium ethacrynate result from hydrolysis of the unsaturated ketone in aqueous solution, and dimer formation from a Diels-Alder condensation in the freeze-dried solid state. When the drug crystallizes in a frozen solution, the eutectic melting temperature is above -5°C. Crystallization in the frozen system is affected by pH in the range of pH 6-8 and buffer concentration in the range of 5-50 mM, where higher pH and lower buffer concentration favor crystallization. Physical state of the drug is critical to solid state stability, given the relative instability of amorphous drug. Stability was shown to vary considerably over the ranges of pH and buffer concentration examined, and vial-to-vial variability in degree of crystallinity is a potential concern. The formulation design space was constructed in terms of pH and drug concentration, and assuming a constant 5 mM concentration of buffer. The process design space is constructed to take into account limitations on the process imposed by the product and by equipment capability. PMID:21932931

  7. Early Post Operative Enteral Versus Parenteral Feeding after Esophageal Cancer Surgery

    PubMed Central

    Rajabi Mashhadi, Mohammad Taghi; Bagheri, Reza; Ghayour-Mobarhan, Majid; Zilaee, Marzie; Rezaei, Reza; Maddah, Ghodratollah; Majidi, Mohamad Reza; Bahadornia, Mojgan

    2015-01-01

    Introduction: The incidence of malnutrition in hospitalized patients is reported to be high. In particular, patients with esophageal cancer are prone to malnutrition, due to preoperative digestive system dysfunctions and short-term non-oral feeding postoperatively. Selection of an appropriate method for feeding in the postoperative period is important in these patients. Materials and Methods: In this randomized clinical trial, 40 patients with esophageal cancer who had undergone esophagectomy between September 2008 and October 2009 were randomly assigned into either enteral feeding or parenteral feeding groups, with the same calorie intake in each group. The level of serum total protein, albumin, prealbumin, transferrin, C3, C4 and hs-C-reactive protein (hs-CRP), as well as the rate of surgical complications, restoration of bowel movements and cost was assessed in each group. Results: Our results showed that there was no significant difference between the groups in terms of serum albumin, prealbumin or transferrin. However, C3 and C4 levels were significantly higher in the enteral feeding group compared with the parenteral group, while hs-CRP level was significantly lower in the enteral feeding group. Bowel movements were restored sooner and costs of treatment were lower in the enteral group. Postoperative complications did not differ significantly between the groups. There was one death in the parenteral group 10 days after surgery due to myocardial infarction. Conclusion: The results of our study showed that enteral feeding can be used effectively in the first days after surgery, with few early complications and similar nutritional outcomes compared with the parenteral method. Enteral feeding was associated with reduced inflammation and was associated with an improvement in immunological responses, quicker return of bowel movements, and reduced costs in comparison with parenteral feeding. PMID:26568935

  8. Parenteral and mucosal prime-boost immunization strategies in mice with hepatitis B surface antigen and CpG DNA.

    PubMed

    McCluskie, Michael J; Weeratna, Risini D; Payette, Paul J; Davis, Heather L

    2002-02-18

    Synthetic oligodeoxynucleotides (ODN) containing immunostimulatory CpG motifs (CpG ODN) are potent adjuvants to protein antigens administered by parenteral or mucosal routes to BALB/c mice. To date, there have been no studies using combined parenteral/mucosal approaches with CpG DNA as adjuvant. In this study we evaluated different parenteral prime-mucosal boost and mucosal prime-parenteral boost strategies using hepatitis B surface antigen (HBsAg) alone or with different adjuvants: aluminum hydroxide (alum), cholera toxin (CT), CpG ODN. In addition, since CpG ODN has previously been shown to act synergistically with other adjuvants after parenteral or mucosal delivery, we also evaluated adjuvant combinations: alum+CpG ODN and CT+CpG ODN. The effects of adjuvant and administration strategy on systemic and mucosal humoral responses were measured, as well as cell-mediated immune responses (cytotoxic T lymphocyte activity). These results were compared to parenteral only or mucosal only strategies. Our findings demonstrate that parenteral immunization can prime for mucosal responses even when different lymph nodes were being targeted. HBsAg-specific immune responses (IgG in plasma, cytotoxic T lymphocytes) induced by parenteral prime could all be significantly enhanced by mucosal boosting and despite the fact that intramuscular immunization alone could not induce mucosal IgA, it could prime for a subsequent mucosal boost. In addition, the presence of adjuvant at time of boosting could influence the nature of subsequent immune responses (Th1 vs. Th2). Mice primed intranasally could have their systemic immune responses boosted with a parenteral administration and it was also possible to enhance mucosal responses induced by intranasal prime with an intramuscular boost. PMID:11934561

  9. Fermentation of deproteinized cheese whey powder solutions to ethanol by engineered Saccharomyces cerevisiae: effect of supplementation with corn steep liquor and repeated-batch operation with biomass recycling by flocculation.

    PubMed

    Silva, Ana Carina; Guimarães, Pedro M R; Teixeira, José A; Domingues, Lucília

    2010-09-01

    The lactose in cheese whey is an interesting substrate for the production of bulk commodities such as bio-ethanol, due to the large amounts of whey surplus generated globally. In this work, we studied the performance of a recombinant Saccharomyces cerevisiae strain expressing the lactose permease and intracellular beta-galactosidase from Kluyveromyces lactis in fermentations of deproteinized concentrated cheese whey powder solutions. Supplementation with 10 g/l of corn steep liquor significantly enhanced whey fermentation, resulting in the production of 7.4% (v/v) ethanol from 150 g/l initial lactose in shake-flask fermentations, with a corresponding productivity of 1.2 g/l/h. The flocculation capacity of the yeast strain enabled stable operation of a repeated-batch process in a 5.5-l air-lift bioreactor, with simple biomass recycling by sedimentation of the yeast flocs. During five consecutive batches, the average ethanol productivity was 0.65 g/l/h and ethanol accumulated up to 8% (v/v) with lactose-to-ethanol conversion yields over 80% of theoretical. Yeast viability (>97%) and plasmid retention (>84%) remained high throughout the operation, demonstrating the stability and robustness of the strain. In addition, the easy and inexpensive recycle of the yeast biomass for repeated utilization makes this process economically attractive for industrial implementation. PMID:20535525

  10. Are additional trace elements necessary in total parenteral nutrition for patients with esophageal cancer receiving cisplatin-based chemotherapy?

    PubMed

    Akutsu, Yasunori; Kono, Tsuguaki; Uesato, Masaya; Hoshino, Isamu; Murakami, Kentaro; Fujishiro, Takeshi; Imanishi, Shunsuke; Endo, Satoshi; Toyozumi, Takeshi; Matsubara, Hisahiro

    2012-12-01

    It is known that cisplatin induces the excretion of zinc from the urine and thereby reduces its serum concentration. However, the fluctuation of these trace elements during or after cisplatin-based chemotherapy has not been evaluated. To answer this question, we performed a clinical study in esophageal cancer patients undergoing cisplatin-based chemotherapy. Eighteen patients with esophageal cancer who were not able to swallow food or water orally due to complete stenosis of the esophagus were evaluated. The patients were divided into a control group [total parenteral nutrition (TPN) alone for 28 days, ten cases] and an intervention group (TPN with additional trace elements for 28 days, eight cases). The serum concentrations of zinc, iron, copper, manganese, triiodothyronin (T3), and thyroxin (T4), as alternative indicators of iodine, were measured on days 0, 14, and 28 of treatment, and statistically analyzed on day 28. In the control group, the serum concentration of copper was significantly decreased from 135.4 (day 0) to 122.1 μg/ml (day 14), and finally to 110.6 μg/ml (day 28, p = 0.015). The concentration of manganese was also significantly decreased from 1.34 (day 0) to 1.17 μg/ml (day 14) and finally to 1.20 (day 28, p = 0.049). The levels of zinc, iron, T3, and T4 were not significantly changed. In the intervention group, the supplementation with trace elements successfully prevented these decreases in their concentrations. TPN with supplementary trace elements is preferable and recommended for patients who are undergoing chemotherapy in order to maintain the patients' nutrient homeostasis. PMID:23054866

  11. Errors in administration of parenteral drugs in intensive care units: multinational prospective study

    PubMed Central

    Capuzzo, Maurizia; Guidet, Bertrand; Moreno, Rui; Metnitz, Barbara; Bauer, Peter; Metnitz, Philipp

    2009-01-01

    Objective To assess on a multinational level the frequency, characteristics, contributing factors, and preventive measures of administration errors in parenteral medication in intensive care units. Design Observational, prospective, 24 hour cross sectional study with self reporting by staff. Setting 113 intensive care units in 27 countries. Participants 1328 adults in intensive care. Main outcome measures Number of errors; impact of errors; distribution of error characteristics; distribution of contributing and preventive factors. Results 861 errors affecting 441 patients were reported: 74.5 (95% confidence interval 69.5 to 79.4) events per 100 patient days. Three quarters of the errors were classified as errors of omission. Twelve patients (0.9% of the study population) experienced permanent harm or died because of medication errors at the administration stage. In a multiple logistic regression with patients as the unit of analysis, odds ratios for the occurrence of at least one parenteral medication error were raised for number of organ failures (odds ratio per increase of one organ failure: 1.19, 95% confidence interval 1.05 to 1.34); use of any intravenous medication (yes v no: 2.73, 1.39 to 5.36); number of parenteral administrations (per increase of one parenteral administration: 1.06, 1.04 to 1.08); typical interventions in patients in intensive care (yes v no: 1.50, 1.14 to 1.96); larger intensive care unit (per increase of one bed: 1.01, 1.00 to 1.02); number of patients per nurse (per increase of one patient: 1.30, 1.03 to 1.64); and occupancy rate (per 10% increase: 1.03, 1.00 to 1.05). Odds ratios for the occurrence of parenteral medication errors were decreased for presence of basic monitoring (yes v no: 0.19, 0.07 to 0.49); an existing critical incident reporting system (yes v no: 0.69, 0.53 to 0.90); an established routine of checks at nurses’ shift change (yes v no: 0.68, 0.52 to 0.90); and an increased ratio of patient turnover to the size of the

  12. INFUSION RATE OF GLUCOSE IS THE MAJOR PREDICTOR OF HYEPRGLYCEMIA IN VERY PREMATURE INFANTS RECEIVING TOTAL PARENTERAL NUTRITION

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Background: Hyperglycemia is frequently occurring in very premature infants receiving total parenteral nutrition. In adult intensive care patients, hyperglycemia has been associated with increased mortality. Although no such data are available in premature infants, it is conceivable that nutritional...

  13. PLASMA CHOLINE IN NORMAL NEWBORNS, INFANTS, TODDLERS, AND IN VERY-LOW-BIRTH-WEIGHT NEONATES REQUIRING TOTAL PARENTERAL NUTRITION

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Choline deficiency is associated with hepatic abnormalities in adult volunteers and patients administered total parenteral nutrition (TPN). Preliminary investigation has suggested that plasma-free choline concentration (PFCh) is greater in neonatal animals, including humans, than in adults. The aims...

  14. Parenteral nanoemulsions as promising carriers for brain delivery of risperidone: Design, characterization and in vivo pharmacokinetic evaluation.

    PubMed

    Đorđević, Sanela M; Cekić, Nebojša D; Savić, Miroslav M; Isailović, Tanja M; Ranđelović, Danijela V; Marković, Bojan D; Savić, Saša R; Timić Stamenić, Tamara; Daniels, Rolf; Savić, Snežana D

    2015-09-30

    This paper describes design and evaluation of parenteral lecithin-based nanoemulsions intended for brain delivery of risperidone, a poorly water-soluble psychopharmacological drug. The nanoemulsions were prepared through cold/hot high pressure homogenization and characterized regarding droplet size, polydispersity, surface charge, morphology, drug-vehicle interactions, and physical stability. To estimate the simultaneous influence of nanoemulsion formulation and preparation parameters--co-emulsifier type, aqueous phase type, homogenization temperature--on the critical quality attributes of developed nanoemulsions, a general factorial experimental design was applied. From the established design space and stability data, promising risperidone-loaded nanoemulsions (mean size about 160 nm, size distribution <0.15, zeta potential around -50 mV), containing sodium oleate in the aqueous phase and polysorbate 80, poloxamer 188 or Solutol(®) HS15 as co-emulsifier, were produced by hot homogenization and their ability to improve risperidone delivery to the brain was assessed in rats. Pharmacokinetic study demonstrated erratic brain profiles of risperidone following intraperitoneal administration in selected nanoemulsions, most probably due to their different droplet surface properties (different composition of the stabilizing layer). Namely, polysorbate 80-costabilized nanoemulsion showed increased (1.4-7.4-fold higher) risperidone brain availability compared to other nanoemulsions and drug solution, suggesting this nanoemulsion as a promising carrier worth exploring further for brain targeting. PMID:26209070

  15. Selenium deficiency and the effects of supplementation on preterm infants

    PubMed Central

    Freitas, Renata Germano B. O. N.; Nogueira, Roberto José N.; Antonio, Maria Ângela R. G. M.; Barros-Filho, Antonio de Azevedo; Hessel, Gabriel

    2014-01-01

    Objective: This study aimed to review the literature about blood concentrations of selenium associated with gestational age, feeding, supplementation and related clinical features in preterm infants. Data sources: Systematic review in the following databases: MEDLINE, PubMed, Google academics, SciELO. org, ScienceDirect (Elsevier) and CINAHL-Plus with Full Text (EBSCO). Articles published up to January 2013 with the keywords "selenium deficiency", "selenium supplementation", "neonates", "infants", "newborn" and "preterm infants" were selected. Data synthesis: The studies reported that low blood selenium levels are associated with increased risk of respiratory diseases. Preterm infants, especially with low birth weight, presented lower selenium levels. Selenium deficiency has also been associated with the use of oral infant formula, enteral and parenteral nutrition (with or without selenium addition). The optimal dose and length of selenium supplementation is not well-established, since they are based only on age group and selenium ingestion by breastfed children. Furthermore, the clinical status of the infant affected by conditions that may increase oxidative stress, and consequently, selenium requirements is not taken into account. Conclusions: Prematurity and low birth weight can contribute to low blood selenium in premature infants. Selenium supplementation seems to minimize or prevent clinical complications caused by prematurity. PMID:24676200

  16. Gastrointestinal Manifestations, Malnutrition, and Role of Enteral and Parenteral Nutrition in Patients With Scleroderma.

    PubMed

    Bharadwaj, Shishira; Tandon, Parul; Gohel, Tushar; Corrigan, Mandy L; Coughlin, Kathleen L; Shatnawei, Abdullah; Chatterjee, Soumya; Kirby, Donald F

    2015-08-01

    Scleroderma (systemic sclerosis) is an autoimmune disease that can affect multiple organ systems. Gastrointestinal (GI) involvement is the most common organ system involved in scleroderma. Complications of GI involvement including gastroesophageal reflux disease, small intestinal bacterial overgrowth, and chronic intestinal pseudoobstruction secondary to extensive fibrosis may lead to nutritional deficiencies in these patients. Here, we discuss pathophysiology, progression of GI manifestations, and malnutrition secondary to scleroderma, and the use of enteral and parenteral nutrition to reverse severe nutritional deficiencies. Increased mortality in patients with concurrent malnutrition in systemic sclerosis, as well as the refractory nature of this malnutrition to pharmacologic therapies compels clinicians to provide novel and more invasive interventions in reversing these nutritional deficiencies. Enteral and parenteral nutrition have important implications for patients who are severely malnourished or have compromised GI function as they are relatively safe and have substantial retrospective evidence of success. Increased awareness of these therapeutic options is important when treating scleroderma-associated malnutrition. PMID:25992813

  17. Parenteral control of gastric acid hypersecretion in patients with Zollinger-Ellison syndrome.

    PubMed

    Vinayek, R; Hahne, W F; Euler, A R; Norton, J A; Jensen, R T

    1993-10-01

    Parenteral control of gastric acid hypersecretion in patients with Zollinger-Ellison syndrome is increasingly required; however, existing methods of determining the required dose are cumbersome and not applicable in all centers. A previous study suggested that the required parenteral dose of histamine H2-receptor antagonists correlated with the previous oral dose. In the present study, in 31 patients with Zollinger-Ellison syndrome we evaluated the hypothesis that an effective parenteral histamine H2-receptor antagonist dose could be predicted from the previous oral dose. Twenty-three patients were taking oral ranitidine (mean 1.3 g/day), six patients famotidine (152 mg/day), and two patients cimetidine (1.8 g/day). Each patient was treated with a continuous intravenous infusion of the equivalent dose of ranitidine (mean dose 1 mg/kg/hr with 35% requiring 0.5 mg/kg/hr, 49% 1 mg/kg/hr, 3% 1.5 mg/kg/hr, 10% 2 mg/kg/hr, and 3% 2.5 mg/kg/hr. This dose of ranitidine acutely controlled acid secretion (< 10 meq/hr) in all patients. To evaluate long-term efficacy and safety, 20 patients were maintained on this dose through the peri- and postoperative periods. Mean duration was 7.1 days with 25% treated 3-5 days, 40% 6-8 days, 30% 8-10 days, and 5% > 10 days. The predicted dose continued to control acid secretion in 95% of patients with one patient requiring one dose adjustment. No biochemical, clinical, or hematological toxicity was seen, although ranitidine was stopped in one patient because of skin rash. These results demonstrate that the parenteral dose of ranitidine required to control acid secretion in patients with Zollinger-Ellison syndrome can be predicted from the oral dose.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8104773

  18. Coverage of pilot parenteral vaccination campaign against canine rabies in N'Djaména, Chad.

    PubMed Central

    Kayali, U.; Mindekem, R.; Yémadji, N.; Vounatsou, P.; Kaninga, Y.; Ndoutamia, A. G.; Zinsstag, J.

    2003-01-01

    Canine rabies, and thus human exposure to rabies, can be controlled through mass vaccination of the animal reservoir if dog owners are willing to cooperate. Inaccessible, ownerless dogs, however, reduce the vaccination coverage achieved in parenteral campaigns. This study aimed to estimate the vaccination coverage in dogs in three study zones of N'Djaména, Chad, after a pilot free parenteral mass vaccination campaign against rabies. We used a capture-mark-recapture approach for population estimates, with a Bayesian, Markov chain, Monte Carlo method to estimate the total number of owned dogs, and the ratio of ownerless to owned dogs to calculate vaccination coverage. When we took into account ownerless dogs, the vaccination coverage in the dog populations was 87% (95% confidence interval (CI), 84-89%) in study zone I, 71% (95% CI, 64-76%) in zone II, and 64% (95% CI, 58-71%) in zone III. The proportions of ownerless dogs to owned dogs were 1.1% (95% CI, 0-3.1%), 7.6% (95% CI, 0.7-16.5%), and 10.6% (95% CI, 1.6-19.1%) in the three study zones, respectively. Vaccination coverage in the three populations of owned dogs was 88% (95% CI, 84-92%) in zone I, 76% (95% CI, 71-81%) in zone II, and 70% (95% CI, 66-76%) in zone III. Participation of dog owners in the free campaign was high, and the number of inaccessible ownerless dogs was low. High levels of vaccination coverage could be achieved with parenteral mass vaccination. Regular parenteral vaccination campaigns to cover all of N'Djaména should be considered as an ethical way of preventing human rabies when post-exposure treatment is of limited availability and high in cost. PMID:14758434

  19. Severe lactic acidosis and multiorgan failure due to thiamine deficiency during total parenteral nutrition

    PubMed Central

    Ramsi, Musaab; Mowbray, Claire; Hartman, Gary; Pageler, Natalie

    2014-01-01

    A 16-year-old perioperative paediatric patient presented with refractory lactic acidosis and multiorgan failure due to thiamine-deficient total parenteral nutrition during a recent national multivitamin shortage. Urgent empiric administration of intravenous thiamine resulted in prompt recovery from this life-threatening condition. Despite readily available treatment, a high index of suspicion is required to prevent cardiovascular collapse and mortality. PMID:24895398

  20. [Metabolic effect of a parenterally administered fat emulsion with middle-chain triglycerides in healthy men].

    PubMed

    Sailer, D; Berg, G

    1976-09-01

    Within 3 hours, 10 healthy male volunteers were infused 500 ml of a 5 percent emulsion in which 25 percent of the fat proportion had been replaced by MCT-fats. As expected, the ketone body concentration in the blood rose, while pyruvate remained constant and lactate dropped. The results show that, basically, a MCT-containing fat infusion is suited for parenteral nutrition and, because of their specific properties, medium chain triglycerides may be used as rapid energy donators. PMID:969713

  1. Quantitative and mechanistic measurements of parenteral vial container/closure integrity. Leakage quantitation.

    PubMed

    Morton, D K; Lordi, N G; Ambrosio, T J

    1989-01-01

    Leakage across the parenteral vial/closure seal interface is quantitatively measured in terms of mass of gas per unit time using a differential pressure method of leakage measurement. With this test system, uncoated, Purcoat coated, and film coated closures are compared for their ability to seal nondefective and defective vial surfaces. Correlations are made between closure sealing performance and rubber viscoelasticity, closure coating material type and thickness, and crimped vial residual seal force. PMID:2709241

  2. Comparison between Total Parenteral Nutrition Vs. Partial Parenteral Nutrition on Serum Lipids Among Chronic Ventilator Dependent Patients; A Multi Center Study

    PubMed Central

    Radpay, Rojan; Radpay, Badiozaman

    2016-01-01

    Background: Malnutrition is very common among chronically hospitalized patients, especially those in the intensive care unit (ICU). Identifying the patients at risk and providing suitable nutritional support can prevent and/or overcome malnutrition in them. Total parenteral nutrition (TPN) and partial parenteral nutrition (PPN) are two common routes to deliver nutrition to hospitalized patients. We conducted a multicenter, prospective double blind randomized controlled trial to evaluate the benefits and compare their adverse effects of each method. Materials and Methods: 97 patients were enrolled and divided into two groups based on the inclusion criteria. Serum protein, serum albumin, serum transferrin, and total lymphocyte count were measured on days 7 and 14. Results: We did not find any statistically significant differences in clinical status or laboratory values between the two groups but there were significant improvements in measured lab values between days 7 and 14 (p<0.005) indicating improved nutritional status in each groups. Conclusion: This study shows that both TPN and PPN can be used safely in chronic ICU patients to provide nutritional support and prevent catabolic state among chronic critically ill patients. We need to develop precise selection criteria in order to choose the patients who would benefit the most from TPN and PPN. In addition, appropriate laboratory markers are needed to monitor the metabolic requirements of the patients and assess their progress. PMID:27403176

  3. Effect of the addition of beta-mercaptoethanol to a thawing solution supplemented with caffeine on the function of frozen-thawed boar sperm and on the fertility of sows after artificial insemination.

    PubMed

    Yamaguchi, S; Funahashi, H

    2012-03-15

    We have reported that artificial insemination (AI) with frozen-thawed boar semen supplemented with caffeine increased the number of uterine sperm by inhibiting the migration of polymorphonuclear leukocytes (PMNs) into the uterine lumen, thereby improving the fertility of gilts and sows. The objective of the present study was to examine the effects of the addition of the antioxidant beta-mercaptoethanol (bME) and caffeine to the thawing solution on the function of frozen-thawed sperm, on the phagocytic activity of PMNs for sperm, and on the fertility of sows after AI. When frozen-thawed sperm were cultured in the presence of 25 or 50 μm bME, sperm capacitation and spontaneous acrosome reactions were inhibited (P < 0.01). There was no effect of bME on phagocytic activity of PMNs for sperm in vitro. When hormonally treated (400 IU of equine chorionic gonadotropin + 200 IU of human chorionic gonadotropin) weaned sows experienced a single intrauterine insemination with frozen-thawed sperm (25 × 10(8) sperm per 50 ml dose) 40 h after subsequent hCG administration, pregnancy and farrowing rates were unaffected by the addition of 50 μm bME (pregnancy rate, 20 vs 21% in controls; farrowing rate, 20 vs 21%; n = 15 and 14, respectively). However, litter size tended to be higher than in the presence of 50 μm bME compared to its absence (10.0 ± 1.0 vs 5.7 ± 1.5, respectively; P < 0.07). Thus, the addition of bME to the thawing solution containing caffeine could be of benefit for improving the function of frozen-thawed sperm without influencing the phagocytic activity of PMNs for sperm. Although there were no statistically significant effects of bME on pregnancy or farrowing rates, the litter size tended to be higher in the sows subjected to a fixed-time single AI treatment with synchronized ovulation. PMID:22115816

  4. [Consensus on paediatric parenteral nutrition: a document approved by SENPE/SEGHNP/SEFH].

    PubMed

    Muñoz, P Gomis; López, L Gómez; Costa, C Martínez; Villares, J M Moreno; Giner, C Pedrón; Maristany, C Pérez-Portabella; del Río, M T Pozas

    2007-01-01

    In current medical practice, standardization of procedures has become a desirable objective. The Spanish Society of Parenteral and Enteral Nutrition (SENPE) has undertaken a considerable effort to create clinical practice guidelines or documents of consensus and quality gold standards in artificial nutrition. As a result the SENPE group of standardization has put together a document called "Consensus of Paediatric Parenteral Nutrition" supported by the Spanish Society of Gastroenterology, Hepatology and Nutrition (SEGHNP) and by the Spanish Society of Hospital Pharmacies (SEFH). This is a reduced version of our work. The complete version is available at www.nutricionhospitalaria.com and www.senpe.com. This document covers many aspects such as paediatric patient indications, vascular access, macro and micro nutrients needs; also preparation in special situations, components, forms of prescription, possibilities for standardization of the elaboration and prescription, elaboration, administration, monitoring, complications and side effects. Much research has been done, incorporating current publications, books and clinical practice guidelines such as those published by the American Society for Parenteral and Enteral Nutrition (ASPEN) and by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) in collaboration with the European Society for Clinical Nutrition and Metabolism (ESPEN). PMID:18051997

  5. [Cholestatic icterus during parenteral nutrition and the therapeutic effect of enteral feeding--case report].

    PubMed

    Havel, E; Sobotka, L; Bedrna, J; Hladík, P; Manák, J; Bláha, V; Adámek, P; Vyroubal, P; Zadák, Z

    2003-08-01

    An acute operation was made on a 56-year woman for inflammatory perforation of colon. A series of repeated operations followed due to relapsing iatrogenic intestinal fistula and peritonitis. From the day 70 the patient was treated at the Intensive Metabolic Care Unit of the Gerontological and Metabolic Clinic of Faculty Hospital in Hradec Králové. Having cured the septic shock the authors prepared the patient to a reconstruction operation on alimentary tract by administering parenteral nutrition, treating the wounds and by motion rehabilitation. From day 150 on the patient was treated with low doses of enteral nutrition into the segment of intestine between the fistulas, in connection with the subsequent decrease of two-month lasting hyperbilirubinemia of 200-260 mumol/l. A successful reconstruction of the alimentary tract was performed on the day 205 of the treatment with the time lapse of 146 days after the last surgical intervention. A three-fold anastomosis on small intestine and a resection of the fistula on the transversal colon was made. The post-operation fistula was healed-up conservatively, while the parenteral nutrition continued, as verified on day 246 by enteroclysis. The paper draws attention to the importance of conservative metabolic care in the therapy of dishiscences of intestinal anastomoses not treated by acute surgery in time. A favourable additive effect of enteral nutrition on the persisting cholestasis during parenteral nutrition is discussed. PMID:14518096

  6. Study of teduglutide effectiveness in parenteral nutrition-dependent short-bowel syndrome subjects.

    PubMed

    Vipperla, Kishore; O'Keefe, Stephen J

    2013-11-01

    Loss of intestinal absorptive capacity from congenital defect, surgical resection or mucosal disease results in short bowel syndrome (SBS)-associated intestinal failure. In the past, few medical management options were available besides dietary modification, controlling diarrhea or high stomal output, and providing parenteral fluid, electrolyte and nutrient support (parenteral support). Recent research on strategies to enhance the intestinal absorptive capacity focused on glucagon-like peptide-2, an intestinotrophic hormone that has been shown to increase the villus height and crypt depth, and decrease gastric motility and intestinal secretory losses. STEPS is a Phase III randomized double-blinded controlled trial in which teduglutide, a recombinant analog of glucagon-like peptide-2, or placebo was given subcutaneously to SBS patients for 24 weeks. A clinically meaningful response, defined as a 20-100% reduction in parenteral support volume, was achieved in 63% of the treatment group compared with 30% in the placebo group (p = 0.002) without an increase in serious side effects. Teduglutide offers a new targeted approach to SBS-associated intestinal failure management. Its specific role in clinical practice remains to be evaluated. PMID:24134154

  7. Lipid emulsions in parenteral nutrition of intensive care patients: current thinking and future directions

    PubMed Central

    Jensen, Gordon L.; Koletzko, Berthold V.; Singer, Pierre; Wanten, Geert J. A.

    2010-01-01

    Background Energy deficit is a common and serious problem in intensive care units and is associated with increased rates of complications, length of stay, and mortality. Parenteral nutrition (PN), either alone or in combination with enteral nutrition, can improve nutrient delivery to critically ill patients. Lipids provide a key source of calories within PN formulations, preventing or correcting energy deficits and improving outcomes. Discussion In this article, we review the role of parenteral lipid emulsions (LEs) in the management of critically ill patients and highlight important biologic activities associated with lipids. Soybean-oil-based LEs with high contents of polyunsaturated fatty acids (PUFA) were the first widely used formulations in the intensive care setting. However, they may be associated with increased rates of infection and lipid peroxidation, which can exacerbate oxidative stress. More recently developed parenteral LEs employ partial substitution of soybean oil with oils providing medium-chain triglycerides, ω-9 monounsaturated fatty acids or ω-3 PUFA. Many of these LEs have demonstrated reduced effects on oxidative stress, immune responses, and inflammation. However, the effects of these LEs on clinical outcomes have not been extensively evaluated. Conclusions Ongoing research using adequately designed and well-controlled studies that characterize the biologic properties of LEs should assist clinicians in selecting LEs within the critical care setting. Prescription of PN containing LEs should be based on available clinical data, while considering the individual patient’s physiologic profile and therapeutic requirements. PMID:20072779

  8. Omega-3 Fatty Acids in Modern Parenteral Nutrition: A Review of the Current Evidence

    PubMed Central

    Klek, Stanislaw

    2016-01-01

    Intravenous lipid emulsions are an essential component of parenteral nutrition regimens. Originally employed as an efficient non-glucose energy source to reduce the adverse effects of high glucose intake and provide essential fatty acids, lipid emulsions have assumed a larger therapeutic role due to research demonstrating the effects of omega-3 and omega-6 polyunsaturated fatty acids (PUFA) on key metabolic functions, including inflammatory and immune response, coagulation, and cell signaling. Indeed, emerging evidence suggests that the effects of omega-3 PUFA on inflammation and immune response result in meaningful therapeutic benefits in surgical, cancer, and critically ill patients as well as patients requiring long-term parenteral nutrition. The present review provides an overview of the mechanisms of action through which omega-3 and omega-6 PUFA modulate the immune-inflammatory response and summarizes the current body of evidence regarding the clinical and pharmacoeconomic benefits of intravenous n-3 fatty acid-containing lipid emulsions in patients requiring parenteral nutrition. PMID:26959070

  9. Growth and hepatic composition in the guinea pig after long-term parenteral hyperalimentation

    SciTech Connect

    Lu, C.J.H.; Redmond, D.; Baggs, R.B.; Schecter, A.; Gasiewicz, T.A.

    1986-08-01

    This study examined the feasibility of maintaining male Hartley guinea pigs on long-term hyperalimentation. Data from animals fed ad libitum, but infused with 0.9% saline, indicated that there was minimal effect from catheter implantation, sepsis, or the infusion of large volumes of fluid. This group compared with animals fed and watered ad libitum demonstrated a nearly identical growth rate serum chemistry, tissue weights, and hepatic composition and morphology. Animals infused with a total parenteral diet demonstrated growth rates of 4.06 +/- 1.46 g/day for up to 25 days. Loss of infused animals was due in varying degrees to sepsis, mechanical failure, improper placement of the cannula, loss of patency, and death from unknown causes. Morphological analysis of animals fed by total parenteral nutrition revealed an altered distribution and increased size of lipid droplets in hepatic parenchymal and Kupffer cells and glycogen accumulation by the parenchymal cells. Decreased hepatic content of total protein and lipid, as well as cytochrome P450, was also observed. Similarly, serum values of triglyceride were decreased in animals fed by the total parenteral diet. This study indicated that the guinea pig fed by hyperalimentation may be a useful animal model for a number of clinical and basic research applications.

  10. Enhanced Antimalarial Activity by a Novel Artemether-Lumefantrine Lipid Emulsion for Parenteral Administration

    PubMed Central

    Ma, Yufan; Lu, Tingli; Zhao, Wen; Wang, Ying; Chen, Ting; Mei, Qibing

    2014-01-01

    Artemether and lumefantrine (also known as benflumetol) are difficult to formulate for parenteral administration because of their low aqueous solubility. Cremophor EL as an emulsion excipient has been shown to cause serious side effects. This study reports a method of preparation and the therapeutic efficacies of novel lipid emulsion (LE) delivery systems with artemether, lumefantrine, or artemether in combination with lumefantrine, for parenteral administration. Their physical and chemical stabilities were also evaluated. Furthermore, the in vivo antimalarial activities of the lipid emulsions developed were tested in Plasmodium berghei-infected mice. Artemether, lumefantrine, or artemether in combination with lumefantrine was encapsulated in an oil phase, and the in vivo performance was assessed by comparison with artesunate for injection. It was found that the lumefantrine lipid emulsion (LUM-LE) and artemether-lumefantrine lipid emulsion (ARM-LUM-LE-3) (1:6) began to decrease the parasitemia levels after only 3 days, and the parasitemia inhibition was 90% at doses of 0.32 and 0.27 mg/kg, respectively, with immediate antimalarial effects greater than those of the positive-control group and constant antimalarial effects over 30 days. LUM-LE and ARM-LUM-LE-3 demonstrated the best performance in terms of chemical and physical stabilities and antiplasmodial efficacy, with a mean particle size of 150 nm, and they have many favorable properties for parenteral administration, such as biocompatibility, physical stability, and ease of preparation. PMID:24982079

  11. Parenteral iron therapy in obstetrics: 8 years experience with iron-sucrose complex.

    PubMed

    Perewusnyk, G; Huch, R; Huch, A; Breymann, C

    2002-07-01

    Fe is an essential component of haem in myoglobin and accounts for 70 % of haemoglobin. The balance of Fe, unlike that of other metals such as Na or Ca, is regulated solely by gastrointestinal absorption, which itself depends on the bioavailability of Fe in food, i.e. the chemical Fe species. Factors that maintain Fe homeostasis by modulating Fe transfer through the intestinal mucosa are found at the luminal, mucosal and systemic levels. Fe deficiency and its consequence, Fe-deficiency anaemia, form the commonest nutritional pathology in pregnant women. The current gold standard to detect Fe deficiency remains the serum ferritin value. Previously there was general consensus against parenteral Fe administration, i.e. parenteral Fe was only recommended for special conditions such as unresponsiveness to oral Fe, intolerance to oral Fe, severe anaemia, lack of time for therapy etc. However, especially in hospital settings, clinicians regularly face these conditions but are still worried about reactions that were described using Fe preparations such as Fe-dextrans. A widely used and safe alternative is the Fe-sucrose complex, which has become of major interest to prevent functional Fe deficiency after use of recombinant erythropoietin Numerous reports show the effectiveness and safety of the Fe-sucrose complex. Good tolerance to this Fe formulation is partly due to the low allergenic effect of the sucrose complex, partly due to slow release of elementary Fe from the complex. Accumulation of Fe-sucrose in parenchyma of organs is low compared with Fe-dextrans or Fe-gluconate, while incorporation into the bone marrow for erythropoiesis is considerably faster. Oral Fe is only started if haemoglobin levels are below 110 g/l. If levels fall below 100 g/l or are below 100 g/l at time of diagnosis, parenteral Fe-sucrose is used primarily. In cases of severe anaemia (haemoglobin <90 g/l) or non-response to parenteral Fe after 2 weeks, recombinant erythropoietin is considered in

  12. Multivitamin/Mineral Supplements

    MedlinePlus

    ... Nutrient recommendations: Dietary Reference Intakes (DRI) Online DRI tool Daily Value (DV) tables For more advice on buying dietary supplements: Office of Dietary Supplements Frequently Asked Questions: Which brand(s) ...

  13. Children and Dietary Supplements

    MedlinePlus

    ... NCCIH Clinical Digest for health professionals Children and Dietary Supplements Share: September 2012 © Matthew Lester Research has shown that many children use herbs and other dietary supplements. However, there are little data available on their ...

  14. A review of copper status of cattle in Canada and recommendations for supplementation

    PubMed Central

    Smart, Marion E.; Cymbaluk, Nadia F.; Christensen, David A.

    1992-01-01

    Primary and secondary copper deficiency has been identified in most Canadian provinces. Research has been done investigating the environmental and dietary factors that influence dietary copper availability and the effect of deficient copper status on the health and production of cattle. Across Canada, a high percentage of forages and grains are marginal to deficient in copper. In certain regions, high sulphates in the water and/or high molybdenum concentrations in the feed decrease dietary copper availability. The value of various oral and parenteral copper supplements in the treatment and prevention of copper deficiency is discussed. ImagesFigure 1. PMID:17423962

  15. Vitamins and trace elements: practical aspects of supplementation.

    PubMed

    Berger, Mette M; Shenkin, Alan

    2006-09-01

    The role of micronutrients in parenteral nutrition include the following: (1) Whenever artificial nutrition is indicated, micronutrients, i.e., vitamins and trace elements, should be given from the first day of artificial nutritional support. (2) Testing blood levels of vitamins and trace elements in acutely ill patients is of very limited value. By using sensible clinical judgment, it is possible to manage patients with only a small amount of laboratory testing. (3) Patients with major burns or major trauma and those with acute renal failure who are on continuous renal replacement therapy or dialysis quickly develop acute deficits in some micronutrients, and immediate supplementation is essential. (4) Other groups at risk are cancer patients, but also pregnant women with hyperemesis and people with anorexia nervosa or other malnutrition or malabsorption states. (5) Clinicians need to treat severe deficits before they become clinical deficiencies. If a patient develops a micronutrient deficiency state while in care, then there has been a severe failure of care. (6) In the early acute phase of recovery from critical illness, where artificial nutrition is generally not indicated, there may still be a need to deliver micronutrients to specific categories of very sick patients. (7) Ideally, trace element preparations should provide a low-manganese product for all and a manganese-free product for certain patients with liver disease. (8) High losses through excretion should be minimized by infusing micronutrients slowly, over as long a period as possible. To avoid interactions, it would be ideal to infuse trace elements and vitamins separately: the trace elements over an initial 12-h period and the vitamins over the next 12-h period. (9) Multivitamin and trace element preparations suitable for most patients requiring parenteral nutrition are widely available, but individual patients may require additional supplements or smaller amounts of certain micronutrients

  16. The effects of long-term total parenteral nutrition on gut mucosal immunity in children with short bowel syndrome: a systematic review

    PubMed Central

    Duran, Beyhan

    2005-01-01

    Background Short bowel syndrome (SBS) is defined as the malabsorptive state that often follows massive resection of the small intestine. Most cases originate in the newborn period and result from congenital anomalies. It is associated with a high morbidity, is potentially lethal and often requires months, sometimes years, in the hospital and home on total parenteral nutrition (TPN). Long-term survival without parenteral nutrition depends upon establishing enteral nutrition and the process of intestinal adaptation through which the remaining small bowel gradually increases its absorptive capacity. The purpose of this article is to perform a descriptive systematic review of the published articles on the effects of TPN on the intestinal immune system investigating whether long-term TPN induces bacterial translocation, decreases secretory immunoglobulin A (S-IgA), impairs intestinal immunity, and changes mucosal architecture in children with SBS. Methods The databases of OVID, such as MEDLINE and CINAHL, Cochran Library, and Evidence-Based Medicine were searched for articles published from 1990 to 2001. Search terms were total parenteral nutrition, children, bacterial translocation, small bowel syndrome, short gut syndrome, intestinal immunity, gut permeability, sepsis, hyperglycemia, immunonutrition, glutamine, enteral tube feeding, and systematic reviews. The goal was to include all clinical studies conducted in children directly addressing the effects of TPN on gut immunity. Results A total of 13 studies were identified. These 13 studies included a total of 414 infants and children between the ages approximately 4 months to 17 years old, and 16 healthy adults as controls; and they varied in design and were conducted in several disciplines. The results were integrated into common themes. Five themes were identified: 1) sepsis, 2) impaired immune functions: In vitro studies, 3) mortality, 4) villous atrophy, 5) duration of dependency on TPN after bowel resection

  17. Comparison of the effects of enteral feeding with continuous and intermittent parenteral nutrition on hepatic triglyceride secretion in human beings

    SciTech Connect

    Isabel-Martinez, L.; Skinner, C.; Parkin, A.; Hall, R.I.

    1989-03-01

    Plasma triglyceride turnover was measured during steady-state conditions in 22 postoperative patients. Nine had received nutritional support with an enteral regimen, seven had received an equivalent regimen as continuous parenteral nutrition, and six received the same parenteral regimen as a cyclical infusion. After 5 days of nutritional support, each patient received an intravenous bolus of tritiated glycerol. Plasma radiolabeled triglyceride content was measured during the subsequent 24 hours. The data were analyzed by means of a simple deterministic model of plasma triglyceride kinetics and compared with the results obtained by stochastic analysis. The rates of hepatic triglyceride secretion obtained by deterministic analysis were higher than those obtained by the stochastic approach. However, the mode of delivery of the nutritional regimen did not affect the rate of hepatic triglyceride secretion regardless of the method of analysis. The results suggest that neither complete nutritional bypass of the gastrointestinal tract nor interruption of parenteral nutrition in an attempt to mimic normal eating has any effect on hepatic triglyceride secretion. Any beneficial effect that enteral feeding or cyclical parenteral nutrition may have on liver dysfunction associated with standard parenteral nutrition appears to be unrelated to changes in hepatic triglyceride secretion.

  18. Pediatric parenteral nutrition-associated liver disease and cholestasis: Novel advances in pathomechanisms-based prevention and treatment.

    PubMed

    Orso, Giuseppe; Mandato, Claudia; Veropalumbo, Claudio; Cecchi, Nicola; Garzi, Alfredo; Vajro, Pietro

    2016-03-01

    Parenteral nutrition constitutes a life-saving therapeutic tool in patients unable to ingest/absorb oral or enteral delivered nutrients. Liver function tests abnormalities are a common therapy-related complication, thus configuring the so-called Parenteral Nutrition Associated Liver Disease (PNALD) or cholestasis (PNAC). Although the damage is frequently mild, and resolves after discontinuation of parenteral nutrition, in some cases it progresses into cirrhotic changes, especially in neonates and infants. We present a literature review focusing on the pathogenetic mechanisms-driven prevention and therapies for the cases where parenteral nutrition cannot be discontinued. Ursodeoxycholic acid has been proposed in patients with cholestatic hepatopathy, but its efficacy needs to be better established. Little evidence is available on efficacy of anti-oxidants, antibiotics, probiotics and anti TNFα. Lipid emulsions based on fish oil with a high content of long-chain polyunsaturated fatty acids ω-3 appear effective both in decreasing intrahepatic inflammation and in improving biliary flow. Most recent promising variations such as soybean/MCT/olive/fish oil emulsion [third generation lipid emulsion (SMOFlipid)] are under investigation. In conclusion, we remark the emergence of a number of novel pathomechanisms underlying the severe liver impairment damage (PNALD and PNAC) in patients treated with parenteral nutrition. Only few traditional and innovative therapeutic strategies have hitherto been shown promising. PMID:26698410

  19. Benefits and Risks of Iron Supplementation in Anemic Neonatal Pigs

    PubMed Central

    Lipiński, Paweł; Starzyński, Rafał R.; Canonne-Hergaux, François; Tudek, Barbara; Oliński, Ryszard; Kowalczyk, Paweł; Dziaman, Tomasz; Thibaudeau, Olivier; Gralak, Mikołaj A.; Smuda, Ewa; Woliński, Jarosław; Usińska, Agnieszka; Zabielski, Romuald

    2010-01-01

    Iron deficiency is a common health problem. The most severe consequence of this disorder is iron deficiency anemia (IDA), which is considered the most common nutritional deficiency worldwide. Newborn piglets are an ideal model to explore the multifaceted etiology of IDA in mammals, as IDA is the most prevalent deficiency disorder throughout the early postnatal period in this species and frequently develops into a critical illness. Here, we report the very low expression of duodenal iron transporters in pigs during the first days of life. We postulate that this low expression level is why the iron demands of the piglet body are not met by iron absorption during this period. Interestingly, we found that a low level of duodenal divalent metal transporter 1 and ferroportin, two iron transporters located on the apical and basolateral membrane of duodenal absorptive enterocytes, respectively, correlates with abnormally high expression of hepcidin, despite the poor hepatic and overall iron status of these animals. Parenteral iron supplementation by a unique intramuscular administration of large amounts of iron dextran is current practice for the treatment of IDA in piglets. However, the potential toxicity of such supplemental iron implies the necessity for caution when applying this treatment. Here we demonstrate that a modified strategy for iron supplementation of newborn piglets with iron dextran improves the piglets’ hematological status, attenuates the induction of hepcidin expression, and minimizes the toxicity of the administered iron. PMID:20805566

  20. [Protein-energy wasting and nutritional supplementation in chronic hemodialysis].

    PubMed

    Bozzoli, Laura; Sabatino, Alice; Regolisti, Giuseppe; Morabito, Santo; Donadio, Carlo; Cupisti, Adamasco; Piotti, Giovanni; Fiaccadori, Enrico

    2015-01-01

    Protein Energy Wasting (PEW) is a pathological condition characterized by a progressive reduction of protein and energy stores. PEW has a high prevalence among patients with CKD/ESRD (Chronic Kidney Disease/End Stage Renal Disease) and is closely associated with adverse clinical outcomes and increased rate of hospitalization, complications and mortality. The multifactorial pathogenesis of PEW is complex. A key role is played both by the reduced intake of nutrients and the condition of hypercatabolism/reduced anabolism typical of renal patients. The approach to prevent or treat PEW has several milestones such as reduction of potential risk factors, improvement in lifestyle and correction of any factor related to dialysis. It also needs a periodic assessment of nutritional status by using biochemical markers, body and muscle mass variables, nutritional scores and instrumental methods, aiming for an early diagnosis. In case of reduced protein and energy intake, the administration of nutrients during dialysis, or the use of oral supplements specific for renal patients are the first nutritional interventions recommended. In fact, oral nutritional supplementation represents the most effective nutritional approach to PEW prevention and treatment. It is simple and safe and it has a positive impact on quality of life and survival of haemodialysis patients. In the case of failure of oral supplementation, nutritional support should be enhanced by using intradialytic parenteral nutrition (IDPN). If the patient has difficulty in swallowing or IDPN is insufficient, total enteral nutrition should be considered. PMID:26480252

  1. Tissue-specific accumulation of hepatic zinc metallothionein following parenteral iron loading

    SciTech Connect

    McCormick, C.C.

    1984-05-01

    The synthesis in various tissues of the unique metal-binding protein, metallothionein, can be influenced by the administration of certain trace elements. Zinc and cadmium, both of which bind to metallothionein, are most widely recognized as potent inducers. Preliminary results in our laboratory suggested that iron loading causes a marked accumulation of hepatic zinc metallothionein. In this report the effects of parenteral iron administration on metallothionein concentration in various tissues are presented. Male chicks (300-350 g) received (ip) either a single injection (+1 Fe) of iron (10 mg Fe/kg, as FeCl/sub 3/), two injections (+2 Fe) given 24-hr apart, three injections (+3 Fe) each given 24-hr apart, or an equivalent volume of 0.9% saline (control). Twenty-four hours following the final injection, chicks were killed and tissues analyzed for cytoplasmic zinc and metallothionein (Zn-MT). The parenteral administration of ferric iron, FeCl/sub 3/, resulted in a marked tissue-specific accumulation of zinc as metallothionein. In chicks given +2 Fe, hepatic Zn-MT increased more than 10-fold with a third injection (+3 Fe) causing no further change. The concentration of Zn-MT in renal and pancreatic tissue was unaffected by iron loading. An increase in hepatic Zn-MT was evident prior to detectable changes in total hepatic iron. The administration of other ferrous iron compounds at a similar rate produced comparable changes in hepatic Zn-MT. Feeding excess dietary iron, however, had no effect on liver Zn-MT levels even though similar hepatic iron concentrations were attained. Results indicated that parenteral administration, but not feeding, of various iron compounds causes a marked increase in zinc metallothionein, specifically in liver tissue.

  2. [Analysis of adverse reactions and pharmacovigilance research to parenterally administered shuxuening].

    PubMed

    Yang, Wei; Xiang, Yong-Yang; Xie, Yan-Ming; Shen, Hao

    2013-09-01

    Parenterally administered Shuxuening is a commonly used Chinese medicine. There is a need to understand the characteristics of adverse drug reactions (ADRs) to it. 9 601 ADR cases reports were collected from the national adverse drug reaction monitoring center reported between January, 2005 and December, 2012. These included 326 serious ADR cases, accounting for 3.93% of the total. It was found that ADR reports increased annually from 2005, reaching a peak in the third quarter of 2009. The number of ADR cases reports were greatest in the third quarter of each year. ADRs in patients aged 60-74, accounted for 3 348 (34.87%) of all cases. 9 391(97.81%) cases were administered by intravenous infusion. In 8 431 cases, the dosage was in accordance with instructions. 61.61% ADR cases occurred on first administration. The ten most frequent symptoms were, rashes, itching, dizziness, palpitations, chills, allergic reactions, shortness of breath, nausea, phlebitis and vomiting. Systemic damage mainly affected the skin and its accessories damage, or the nervous system damage. Through the use of proportional reporting ratio (PRR) and Bayesian confidence propagation neural network (BCPNN) and propensity score applying generalized boosted models (GBM) to control for 17 confounding factors, analysis of the 10 kinds of ADRs found that for the ADR signals of dizziness, palpitations, phlebitis, and vomiting, BCPNN found that dizziness and phlebitis were early warning signals. This research found that in the 60-89 age group, higher dosages of parenterally administered Shuxuening gave rise to more phlebitis. This study provides important information for parenterally administered Shuxuening research, and guidance for its risk management. PMID:24471322

  3. A randomized, double blind comparative study of prophylactic parenteral nutritional support with or without glutamine in autologous stem cell transplantation for hematological malignancies -- three years' follow-up.

    PubMed

    Sykorova, A; Horacek, J; Zak, P; Kmonicek, M; Bukac, J; Maly, J

    2005-01-01

    Forty-four adult autologous transplant patients with hematological malignancies were randomized to receive either prophylactic parenteral nutrition PN (P group), or PN given ad hoc (C group). In each group, they were further randomized to receive standard PN (B group), or PN with 0.5 g glutamine/kg as L-Ala-L-Gln (A group). The overall survival (OS), disease-free survival (DFS) and event-free survival (EFS) in groups C vs. P and A vs. B were compared during follow-up with median 38 months. The final outcome rates in C/P/A/B groups, respectively (OS 65/81/63/85%, EFS 45/53/33/65% and DFS 56/50/35/77%), were not significantly different, apart from A < B in DFS rate (p=0.03, Fisher's exact test). Also in survival analysis (logrank test), no significant difference between groups C and P was found but generally worse parameters were observed for A vs. B group: for DFS (p=0.04) and EFS (p=0.01) the difference was significant, and for OS (p=0.09) it was borderline. In the three years' follow-up, no clinically useful benefit of prophylactic PN in autologous transplant patients was proven. Also, glutamine supplementation was not helpful, and was even connected with apparently worse long-term outcome. PMID:16284692

  4. Towards a Mobile-Based Platform for Traceability Control and Hazard Analysis in the Context of Parenteral Nutrition: Description of a Framework and a Prototype App

    PubMed Central

    2016-01-01

    Background The parenteral nutrient (PN) mixtures may pose great risks of physical, microbiological, and chemical contamination during their preparation, storage, distribution, and administration. These potential hazards must be controlled under high levels of excellence to prevent any serious complications for the patients. As a result, management control and traceability of any of these medications is of utmost relevance for the patient care, along with ensuring treatment continuity and adherence. Objective The aim of this study is to develop a mobile-based platform to support the control procedures and traceability services in the domain of parenteral nutrient (PN) mixtures in an efficient and nonintrusive manner. Methods A comprehensive approach combining techniques of software engineering and knowledge engineering was used for the characterization of the framework. Local try-outs for evaluation were performed in a number of application areas, carrying out a test/retest monitoring to detect possible errors or conflicts in different contexts and control processes throughout the entire cycle of PN. From these data, the absolute and relative frequencies (percentages) were calculated. Results A mobile application for the Android operating system was developed. This application allows reading different types of tags and interacts with the local server according to a proposed model. Also, through an internal caching mechanism, the availability of the system is preserved even in the event of problems with the network connection. A set of 1040 test traces were generated for the assessment of the system under various environments tested. Among those, 102 traces (9.81%) involved conflictive situations that were properly taken care of in this paper by suggesting solutions to overcome them. Conclusions A mobile oriented system was generated and tested in order to allow enhanced control and quality management of PN mixtures that is easy to integrate into the daily praxis of

  5. American Society of Parenteral and Enteral Nutrition Presidential Address: food for thought: it's more than nutrition.

    PubMed

    Winkler, Marion F

    2007-01-01

    Three issues were highlighted in the 30(th) Presidential Address to the society: (1) A.S.P.E.N.'s unique interdisciplinary structure; (2) support of the A.S.P.E.N. Rhoads Research Foundation; and (3) the meaning of food from the perspective of the patient who is receiving life-sustaining home enteral or parenteral nutrition. A.S.P.E.N., founded as a multidisciplinary society in the 1970s has evolved into an interdisciplinary society with an expanded and diverse membership of health care professionals and scientists with overlapping interests in clinical nutrition and metabolism. A.S.P.E.N. envisions an environment in which every patient receives safe, efficacious, and high quality patient care. The society is committed to advancing the science and practice of nutrition support therapy. In support of this direction, the A.S.P.E.N. Rhoads Research Foundation exists to fund research grants, promote evidence-based practice, and foster training and mentorship in nutrition and metabolic research. The scientific advances and technologic innovations that have enabled our profession to provide enteral and parenteral nutrition to patients has caused practitioners to forget that the meaning of food extends beyond nutrient value. Some individuals receiving long term enteral nutrition or home parenteral nutrition have expressed feelings of anger, anxiety, and depression resulting from the inability to eat normally, from losses of independence, and control of body functions. The ritual of eating may be altered when the enteral or intravenous feedings provide nourishment and, for some, the loss of the eating function is a distressing experience, especially given the cultural focus on social gatherings and meals. The emotional meaning attributed to food, and changes in food preferences and eating behaviors, may become a source of conflict for individuals who have substantial dietary restrictions, or for those individuals dependent on enteral or parenteral nutrition therapy. The

  6. Right atrial thrombus associated with subclavian catheter developed due to total parenteral nutrition application

    PubMed Central

    Sahin, Nursel; Basarici, Ibrahim; Erbasan, Ozan

    2016-01-01

    Central venous catheterization as a frequent routine clinical procedure may have significant complications. Mechanical complications may occur during catheter placement, whereas thromboembolic and infectious complications can be seen during follow-up. Total parenteral nutrition (TPN) associated central venous catheterizations may result in early mechanical complications and thrombotic and infectious complications in the long term. This paper describes a patient diagnosed as mitochondrial neurogastrointestinal encephalomyopathy requiring long-term central venous catheterization for TPN implementation, who had an infected thrombus on the catheter tip resected by cardiac surgery. PMID:27212985

  7. Oral Rehydration Therapy and Feeding Replaces Total Parenteral Nutrition: A Clinical Vignette.

    PubMed

    Wright, Scott Mitchell; Noon, Muhammad Jawad; Greenough, William Bates

    2016-02-01

    A 27-year-old patient with spina bifida and a high output loss of water and electrolytes from her ileostomy was successfully liberated from dependency on total parenteral nutrition and intravenous fluid and electrolyte replacement by the use of a rice-based oral rehydration therapy (ORT). This allowed her to return home to the care of her mother. We suggest that ORT can be effective in the context of modern high-technology settings, as well as in resource-poor situations. PMID:25982236

  8. Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma.

    PubMed Central

    Kudsk, K A; Croce, M A; Fabian, T C; Minard, G; Tolley, E A; Poret, H A; Kuhl, M R; Brown, R O

    1992-01-01

    To investigate the importance of route of nutrient administration on septic complications after blunt and penetrating trauma, 98 patients with an abdominal trauma index of at least 15 were randomized to either enteral or parenteral feeding within 24 hours of injury. Septic morbidity was defined as pneumonia, intra-abdominal abscess, empyema, line sepsis, or fasciitis with wound dehiscence. Patients were fed formulas with almost identical amounts of fat, carbohydrate, and protein. Two patients died early in the study. The enteral group sustained significantly fewer pneumonias (11.8% versus total parenteral nutrition 31.%, p less than 0.02), intra-abdominal abscess (1.9% versus total parenteral nutrition 13.3%, p less than 0.04), and line sepsis (1.9% versus total parenteral nutrition 13.3%, p less than 0.04), and sustained significantly fewer infections per patient (p less than 0.03), as well as significantly fewer infections per infected patient (p less than 0.05). Although there were no differences in infection rates in patients with injury severity score less than 20 or abdominal trauma index less than or equal to 24, there were significantly fewer infections in patients with an injury severity score greater than 20 (p less than 0.002) and abdominal trauma index greater than 24 (p less than 0.005). Enteral feeding produced significantly fewer infections in the penetrating group (p less than 0.05) and barely missed the statistical significance in the blunt-injured patients (p = 0.08). In the subpopulation of patients requiring more than 20 units of blood, sustaining an abdominal trauma index greater than 40 or requiring reoperation within 72 hours, there were significantly fewer infections per patient (p = 0.03) and significantly fewer infections per infected patient (p less than 0.01). There is a significantly lower incidence of septic morbidity in patients fed enterally after blunt and penetrating trauma, with most of the significant changes occurring in the

  9. Long-term home parenteral nutrition: it takes an interdisciplinary approach.

    PubMed

    Winkler, Marion; Guenter, Peggi

    2014-01-01

    Home parenteral nutrition (HPN) is indicated for adults and children who cannot digest and absorb food and who are able to receive therapy safely outside of a hospital. How successful this therapy is depends on the patient's support system and ability to learn and independently administer medically complex procedures. Transition to home is facilitated by identifying all necessary therapies, obtaining information to demonstrate medical necessity, establishing central venous access, reaching goal infusion rate, identifying who will write HPN orders, and coordinating care among all home care providers. An interdisciplinary team provides the most successful process to ensure safe HPN. PMID:25191822

  10. Parenteral Administration of l-Arginine Enhances Fetal Survival and Growth in Sheep Carrying Multiple Fetuses123

    PubMed Central

    Lassala, Arantzatzu; Bazer, Fuller W.; Cudd, Timothy A.; Datta, Sujay; Keisler, Duane H.; Satterfield, M. Carey; Spencer, Thomas E.; Wu, Guoyao

    2011-01-01

    The frequency of multiple fetuses has increased in human pregnancies due to assisted reproductive technologies. This translates into a greater proportion of premature and low-birth weight infants in the United States and worldwide. In addition, improvements in sheep breeding have resulted in new breeds with increased litter size but reduced fetal survival and birth weight. Currently, there are no treatments for preventing fetal growth restriction in humans or sheep (an established model for studying human fetal physiology) carrying multiple fetuses. In this work, Booroola Rambouillet ewes (FecB+/−) with 2–4 fetuses were fed a diet providing 100% of NRC-recommended nutrient requirements. Between d 100 and 121 of gestation, ewes received an i.v. bolus injection of either saline solution or 345 μmol arginine-HCl/kg body weight 3 times daily. The arginine treatment reduced (P < 0.05) the percentage of lambs born dead by 23% while increasing (P = 0.05) the percentage of lambs born alive by 59%. The i.v. administration of arginine enhanced (P < 0.05) the birth weights of quadruplets by 23% without affecting maternal body weight. The improved pregnancy outcome was associated with an increase in maternal plasma concentrations of arginine, ornithine, cysteine, and proline, as well as a decrease in circulating levels of ammonia and β-hydroxybutyrate. These novel results indicate that parenteral administration of arginine to prolific ewes ameliorated fetal mortality and growth retardation. Our findings provide support for experiments to assess the clinical use of arginine to enhance fetal growth and survival in women gestating multiple fetuses. PMID:21430253

  11. Toll Like Receptor 4 Dependent Kupffer Cell Activation and Liver Injury in a Novel Mouse Model of Parenteral Nutrition

    PubMed Central

    El Kasmi, Karim C.; Anderson, Aimee L.; Devereaux, Michael W.; Fillon, Sophie A.; Harris, J. Kirk; Lovell, Mark A.; Finegold, Milton J.; Sokol, Ronald J.

    2011-01-01

    Infants with intestinal failure who are parenteral nutrition (PN)-dependent may develop cholestatic liver injury and cirrhosis (PN-associated liver injury: PNALI). The pathogenesis of PNALI remains incompletely understood. We hypothesized that intestinal injury with increased intestinal permeability combined with administration of PN promotes LPS-TLR4 signaling dependent Kupffer cell activation as an early event in the pathogenesis of PNALI. We developed a mouse model in which intestinal injury and increased permeability were induced by oral treatment for 4 days with dextran sulphate sodium (DSS) followed by continuous infusion of soy lipid-based PN solution through a central venous catheter for 7 (PN/DSS7d) and 28 (PN/DSS28d) days. Liver injury and cholestasis were evaluated by serum AST, ALT, bile acids, total bilirubin, and by histology. Purified Kupffer cells were probed for transcription of pro-inflammatory cytokines. PN/DSS7d mice showed elevated portal vein LPS levels, evidence of hepatocyte injury and cholestasis, and increased Kupffer cell expression of IL6, TNFα, and TGFβ. Serological markers of liver injury remained elevated in PN/DSS28d mice associated with focal inflammation, hepatocyte apoptosis, peliosis, and Kupffer cell hypertrophy and hyperplasia. PN infusion without DSS pre-treatment or DSS pre-treatment alone did not result in liver injury or Kupffer cell activation. Suppression of the intestinal microbiota with broad spectrum antibiotics or ablation of TLR4 signaling in TLR4 mutant mice resulted in significantly reduced Kupffer cell activation and markedly attenuated liver injury in PN/DSS7d mice. Conclusion These data suggest that intestinal-derived LPS activates Kupffer cells through TLR4 signaling in early stages of PNALI. PMID:22120983

  12. Assessment of Aprotinin Loaded Microemulsion Formulations for Parenteral Drug Delivery: Preparation, Characterization, in vitro Release and Cytotoxicity Studies.

    PubMed

    Okur, Neslihan Üstündağ; Özdemir, Derya İlem; Kahyaoğlu, Şennur Görgülü; Şenyiğit, Zeynep Ay; Aşıkoğlu, Makbule; Genç, Lütfi; Karasulu, H Yeşim

    2015-01-01

    The object of the current study was to prepare novel microemulsion formulations of aprotinin for parenteral delivery and to compare in vitro characteristics and release behaviour of different Technetium-99m ((99m)Tc)-Aprotinin loaded microemulsion formulations. In addition, cytotoxicity of microemulsion formulation was evaluated with cell culture studies on human immortalized pancreatic duct epithelial-like cells. For this aim, firstly, pseudo-ternary phase diagrams were plotted to detect the formulation region and optimal microemulsions were characterized for their thermodynamic stability, conductivity, particle size, zeta potential, viscosity, pH and in vitro release properties. For in vitro release studies aprotinin was labelled with (99m)Tc and labelling efficiency, radiochemical purity and stability of the radiolabeled complex were determined by several chromatography techniques. Radiolabeling efficiency of (99m)Tc-Aprotinin was found over than 90% without any significant changes up to 6 hours after labelling at room temperature. After that, in vitro release studies of (99m)Tc-Aprotinin loaded microemulsions were performed with two different methods; dissolution from diffusion cells and dialysis bags. Both methods showed that release rate of (99m)Tc- Aprotinin from microemulsion could be controlled by microemulsion formulations. Drug release from the optimized microemulsion formulations was found lower compared to drug solution at the end of six hours. According to stability studies, the optimized formulation was found to be stable over a period of 12 months. Also, human immortalized pancreatic duct epithelial-like cells were used to evaluate the cytotoxicity of optimum formulation. Developed microemulsion did not reveal cytotoxicity. In conclusion the present study indicated that the M1-APT microemulsion is appropriate for intravenous application of aprotinin. PMID:26306401

  13. Hexapeptides from human milk prevent the induction of oxidative stress from parenteral nutrition in the newborn guinea pig

    PubMed Central

    Miloudi, Khalil; Tsopmo, Apollinaire; Friel, James K.; Rouleau, Thérèse; Comte, Blandine; Lavoie, Jean-Claude

    2016-01-01

    INTRODUCTION In preterm neonates, peroxides contaminating total parenteral nutrition (TPN) contribute to oxidative stress, which is suspected to be a strong inducer of hepatic complications related to prematurity. Recently, others reported that hexapeptides derived from human milk (HM) exerted free radical–scavenging activities in vitro. Therefore, the aim of this study was to assess the capacity of these hexapeptides to limit the generation of peroxides in TPN and to prevent TPN-induced hepatic oxidative stress. METHODS At 3 d of life, guinea pigs were infused, through a catheter in jugular vein, with TPN containing or not peptide-A (YGYTGA) or peptide-B (ISELGW). Peroxide concentrations were measured in TPN solutions, whereas glutathione, glutathionyl-1,4-dihydroxynonenal (GS-HNE) and mRNA levels of interleukin-1 (IL-1) and tumor necrosis factor-α (TNFα) were determined in liver after 4 d of infusion. RESULTS The addition of peptide-A to TPN allowed a reduction in peroxide contamination by half. In vivo, peptide-A or peptide-B corrected the hepatic oxidative status induced by TPN. Indeed, both peptides lowered the hepatic redox potential of glutathione and the level of GS-HNE, a marker of lipid peroxidation. As compared with animals infused with TPN without peptide, the hepatic mRNA levels of IL-1 and TNFα were lower in animals infused with TPN containing peptide-A or peptide-B. DISCUSSION These results suggest that the addition of YGYTGA or ISELGW to TPN will reduce oxidative stress in newborns. The reduction in mRNA of two proinflammatory cytokines could be important for the incidence of hepatic complications related to TPN. PMID:22337230

  14. Persistent left superior vena cava: A possible contraindication to chemotherapy and total parenteral nutrition in cancer patients

    PubMed Central

    IOVINO, FRANCESCO; AURIEMMA, PASQUALE PIO; VISCOVO, LUCA DEL; SCAGLIARINI, SARA; DI NAPOLI, MARILENA; DE VITA, FERDINANDO

    2012-01-01

    Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly. Awareness of this condition may be useful when placement of left-side transvenous subclavian or internal jugular catheters is required. This anomaly may be detected only by chest radiograph following placement of the catheter. The primary endpoints of this study were to analyze the prevalence of PLSVC, measurement of its diameters and the outcome of cancer patients with this anomaly undergoing placement of a long term catheter for nutrition and chemotherapy at the Department of Surgery, of the Second University of Naples, Naples, Italy. A total of 600 consecutive adult patients with hematological or solid tumors admitted to our surgery department for implantation of a central venous catheter (CVC) were considered. The CVC was routinely implanted in the left internal jugular vein under ultrasound guidance. Four cases of PLSVC (0.6% of patients) were observed and confirmed using cine magnetic resonance imaging (MRI). In all cases, the CVC was not removed. Three patients underwent chemotherapy and one patient was subjected to total parenteral nutrition. In the three patients undergoing chemotherapy, dynamic ECG and echocardiography were performed at the end of the treatment. No disturbances of the cardiac rhythm or thrombosis were detected, and heart ejection fraction (EF) was not affected. In conclusion, although PLSVC may be a risky condition, no complications occurred in our study. Thus, PLSVC should not be regarded as a strict contraindication to infusion of chemotherapy or hyperosmolar nutritional solutions. However, further research is needed to confirm our data. PMID:23205097

  15. High rates of resolution of cholestasis in parenteral nutrition-associated liver disease with fish oil-based lipid emulsion monotherapy

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Our research was conducted to determine factors leading to resolution of cholestasis in patients with parenteral nutrition-associated liver disease treated with fish-oil-based lipid emulsion (FOLE). We used a prospective observational study of 57 infants <6 months of age with parenteral nutrition-as...

  16. Parenteral magnesium load testing with /sup 28/Mg in weanling and young adult rats

    SciTech Connect

    Caddell, J.L.; Calhoun, N.R.; Howard, M.P.; Patterson, K.Y.; Smith, J.C. Jr.

    1981-06-01

    A sound diagnostic test for Mg deficiency is needed. This is a report of the parenteral Mg load test conducted in weanling and young adult rats fed a purified basal diet containing 3 mg magnesium/100 g with 150 mg of added magnesium/100 g (control) or 0 added magnesium (deficient). Weanlings were studied at about 1 week of dietary treatment and young adults at 2 weeks. The protocol included: a) a 6-hour preload urinary collection; b) an intraperitoneal load of 15 mg of magnesium/kg (weanlings) or 12 mg/kg (young adults) with 2 microCi 28Mg given simultaneously with each load; c) a 6-hour postload urinary collection; d) chemical analysis of selected tissues and urine for Mg; and e) 28Mg counting 6 and 24 hours postload. Controls all excreted large amounts of Mg pre- and postload, retaining less than 26% of nonradioactive loads. They had high urinary 28Mg counts. In Mg-deficient animals, the concentration of Mg in bone more than halved. These animals avidly conserved Mg and retained over 85% of nonradioactive Mg loads. Their 28Mg activity in vital organs was 3--6 times greater than in controls. We concluded that the parenteral Mg load test reliably identifies severe Mg deficiency.

  17. Carnitine levels in skeletal muscle of malnourished patients before and after total parenteral nutrition.

    PubMed

    Sandstedt, S; Larsson, J; Cederblad, G

    1986-11-01

    Carnitine is necessary for the transport of long-chain fatty acids across the mitochondrial membrane. Carnitine is derived from the diet and from endogenous synthesis from lysine and methionine. About 98% of the body's carnitine pool is located in skeletal muscle tissue. Skeletal muscle carnitine levels were determined in two groups of malnourished patients, eight patients with anorexia nervosa with a weight loss of 32.4% +/- 1.8 (mean +/- SEM) and six surgical patients with major gastrointestinal disorders and a weight loss of 15.2% +/- 2.7. Their hepatic and kidney functions were normal. On admission, the muscle carnitine levels were 16.9 +/- 4.0 mumol/g dry weight (mean +/- SD) for the surgical patients and 20.8 +/- 5.0 mumol/g dry weight for the anorexia nervosa patients, which corresponded to carnitine levels seen in healthy subjects. No statistical significance was found between the two groups. Total parenteral nutrition was given to the surgical patients for 2 weeks and to the anorexia nervosa patients for 3-5 weeks. No statistical difference in muscle carnitine levels was found in either group after nutritional support. These malnourished patients had no decreased muscle carnitine levels on admission and maintained them during several weeks of total parenteral nutrition. PMID:16831776

  18. Construction and Characterization of Human Rotavirus Recombinant VP8* Subunit Parenteral Vaccine Candidates

    PubMed Central

    Wen, Xiaobo; Cao, Dianjun; Jones, Ronald W.; Li, Jianping; Szu, Shousun; Hoshino, Yasutaka

    2012-01-01

    Two currently licensed live oral rotavirus vaccines (Rotarix® and RotaTeq®) are highly efficacious against severe rotavirus diarrhea. However, the efficacy of such vaccines in selected low-income African and Asian countries is much lower than that in middle or high-income countries. Additionally, these two vaccines have recently been associated with rare case of intussusception in vaccinated infants. We developed a novel recombinant subunit parenteral rotavirus vaccine which may be more effective in low-income countries and also avert the potential problem of intussusception. Truncated recombinant VP8* (ΔVP8*) protein of human rotavirus strain Wa P[8], DS-1 P[4] or 1076 P[6] expressed in E. coli was highly soluble and was generated in high yield. Guinea pigs hyperimmunized intramuscularly with each of the ΔVP8* proteins (i.e., (P[8], P[4] or P[6]) developed high levels of homotypic as well as variable levels of heterotypic neutralizing antibodies. Moreover, the selected ΔVP8* proteins when administered to mice at a clinically relevant dosage, route and schedule, elicited high levels of serum anti-VP8* IgG and/or neutralizing antibodies. Our data indicated that the ΔVP8* proteins may be a plausible additional candidate as new parenteral rotavirus vaccines. PMID:22885016

  19. The Meaning of Parenteral Hydration to Family Caregivers and Patients with Advanced Cancer Receiving Hospice Care

    PubMed Central

    Cohen, Marlene Z; Torres-Vigil, Isabel; Burbach, Beth E.; de Rosa, Allison; Bruera, Eduardo

    2012-01-01

    Context In the U.S., patients with advanced cancer who are dehydrated or have decreased oral intake virtually always receive parenteral hydration in acute care facilities but rarely in the hospice setting. Objectives To describe the meaning of hydration for terminally ill cancer patients in home hospice care and for their primary caregivers. Methods Phenomenological interviews were conducted at two time points with 85 patients and 84 caregivers enrolled in a randomized, double-blind, controlled trial examining the efficacy of parenteral hydration in patients with advanced cancer receiving hospice care in the southern U.S. Transcripts were analyzed hermeneutically by the interdisciplinary research team until consensus on the theme labels was reached. Results Patients and their family caregivers both saw hydration as meaning hope and comfort. Hope was the view that hydration might prolong a life of dignity and enhance quality of life by reducing symptoms such as fatigue and increasing patients’ alertness. Patients and caregivers also described hydration as improving patients’ comfort by reducing pain, enhancing the effectiveness of pain medication, and nourishing the body, mind and spirit. Conclusion These findings differ from traditional hospice beliefs that dehydration enhances patient comfort given that patients and their families in the study viewed fluids as enhancing comfort, dignity and quality of life. Discussion with patients and families about their preferences for hydration may help tailor care plans to meet specific patient needs. PMID:22459230

  20. Acute effects of oral or parenteral aspartame on catecholamine metabolism in various regions of rat brain.

    PubMed

    Yokogoshi, H; Wurtman, R J

    1986-03-01

    Hypertensive (SHR) and nonhypertensive [Wistar-Kyoto (WKY); Sprague-Dawley (SD)] strains of rats received the dipeptide sweetener aspartame (200 mg/kg) or, as a positive control, tyrosine (200 mg/kg) by gavage or parenterally, after a brief (2-h) fast. Two hours later, compared with those of saline controls brain levels of the norepinephrine metabolite 3-methoxy-4-hydroxyphenylethylethyleneglycol (MHPG) sulfate were significantly higher in the hypothalamus (WKY), locus coeruleus (SD and SHR) and brain stem (SHR) in tyrosine-treated animals, and in the locus coeruleus (SD) of those given aspartame. Brain norepinephrine levels were also higher, compared with those of saline-treated control rats, in the cerebral cortex (SD and SHR), amygdala (SD) and locus coeruleus (WKY) after tyrosine administration, and in the amygdala (SD) and cerebral cortex (SHR) after aspartame administration. In another study, oral aspartame was found to be at least as effective as the parenterally administered sweetener in raising regional brain levels of tyrosine or MHPG sulfate (i.e., compared with corresponding levels in saline-treated rats). Animals receiving oral aspartame also exhibited higher plasma tyrosine and phenylalanine ratios (i.e., the ratios of their plasma concentrations to the summed concentrations of other large neutral amino acids that compete with them for uptake into the brain), than animals receiving saline. PMID:3950762

  1. Study of Adverse Effect Profile of Parenteral Zoledronic Acid in Female Patients with Osteoporosis

    PubMed Central

    Kotian, Prem; Sreenivasan, Sushanth

    2016-01-01

    Introduction Osteoporosis is still a under recognized entity in the population. Osteoporosis-related fractures can be prevented if people at risk can be screened, diagnosed and treated early. Bisphosphonates remain the mainstay of osteoporosis treatment as they have multimodal action. Oral bisphosphonate therapy has, significant gastrointestinal side effects leading to noncompliance. Of late parenteral Zoledronic Acid is being used as once or twice yearly infusion for the treatment of osteoporosis. Aim Our article studies the side effect profile and tolerability of parenteral Zoledronic Acid, one of the most potent bisphosphonate used in clinical practice in patients with osteoporosis. Materials and Methods This study was done in KMC hospitals where 49 patients diagnosed with osteoporosis were included for the study. After obtaining a written informed consent each patient received one infusion of 5 mg Zoledronic Acid as per standard treatment protocol. Patient was monitored for clinical improvement and development of any adverse effects. Conclusion In our study all subjects reported significant pain relief after infusion of Zoledronic Acid. Zoledronic Acid had very few serious adverse effects that can be prevented through pre-infusion screening, maintaining good hydration and careful patient monitoring. In our population the patients only experienced mild symptoms of pyrexia, arthralgia myalgia and influenza like symptoms which resolved with symptomatic treatment. PMID:26894105

  2. Parenteral carbapenems.

    PubMed

    Shah, P M

    2008-01-01

    Among the many different structurally distinct classes of beta-lactams, the carbapenem class is regarded as that which is most potent and which has the widest spectrum of antimicrobial activity. Rapidly bactericidal, and demonstrating time-dependent killing, carbapenemes have a spectrum of antimicrobial activity that includes Gram-positive and Gram-negative aerobic and anaerobic pathogens. Their in-vitro activity includes extended-spectrum beta-lactamase (ESBL)-producing pathogens and carbapenems are currently considered to be the treatment of choice for serious infections due to ESBL-producing organisms. However, isolates acquiring resistance under treatment have been reported. Imipenem, meropenem and ertapenem are licensed in the European Community and panipenem and biapenem are also available in Japan and South Korea. Other carbapenemes are under development. PMID:18154543

  3. Family Living Supplement.

    ERIC Educational Resources Information Center

    Truitt, Debbie

    This family living supplement contains 125 supplemental ideas and strategies designed to help vocational home economics teachers increase student motivation and enrich the teaching process. Ideas and strategies are organized into seven sections. These are career planning, securing a job, and career success; managing financial resources, buying…

  4. Supplemental instruction in chemistry

    NASA Astrophysics Data System (ADS)

    Lundeberg, Mary A.

    This study was designed to measure some effects of supplemental instruction in chemistry. Supplemental instruction is a peer-led cooperative learning program that encourages students to develop conceptual understanding by articulating both understandings and misconceptions in a think-aloud fashion. Supplemental instruction was offered three hours weekly outside of class and lab time for students in four classes of General Organic and Biological Chemistry. Over a two-year period 108 students volunteered to participate in this program; 45 students did not participate. As measured by final grades in chemistry and responses to a questionnaire, supplemental instruction was effective in increasing students' achievement in chemistry. Further research is needed to determine the in-depth effects of supplemental instruction on students' learning, problem solving, and self-esteem.

  5. The use of dietary supplements by athletes.

    PubMed

    Maughan, Ronald J; Depiesse, Frederic; Geyer, Hans

    2007-01-01

    Many athletes use dietary supplements as part of their regular training or competition routine, including about 85% of elite track and field athletes. Supplements commonly used include vitamins, minerals, protein, creatine, and various "ergogenic" compounds. These supplements are often used without a full understanding or evaluation of the potential benefits and risks associated with their use, and without consultation with a sports nutrition professional. A few supplements may be helpful to athletes in specific circumstances, especially where food intake or food choice is restricted. Vitamin and mineral supplements should be used only when a food-based solution is not available. Sports drinks, energy bars, and protein-carbohydrate shakes may all be useful and convenient at specific times. There are well-documented roles for creatine, caffeine, and alkalinizing agents in enhancing performance in high-intensity exercise, although much of the evidence does not relate to specific athletic events. There are potential costs associated with all dietary supplements, including the risk of a positive doping result as a consequence of the presence of prohibited substances that are not declared on the label. PMID:18049988

  6. Why Take a Prenatal Supplement?

    MedlinePlus

    ... Newsroom Dietary Guidelines Communicator’s Guide Why take a prenatal supplement? You are here Home / Audience / Adults / Moms/ Moms-to-Be / Dietary Supplements Why take a prenatal supplement? Print Share During pregnancy, your needs increase ...

  7. Enteral feeding induces diet-dependent mucosal dysfunction, bacterial overgrowth and necrotizing enterocolitis in preterm parenterally-fed pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Preterm neonates have an immature gut and metabolism and may benefit from a period of total parenteral nutrition (TPN) before enteral food introduction. Conversely, delayed enteral feeding may inhibit gut maturation and sensitize to necrotizing enterocolitis (NEC). Intestinal mass and NEC lesions we...

  8. Gluconeogenesis is not acutely regulated by either plasma glucose or plasma insulin concentration in parenterally fed ELBW infants

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Parenterally fed ELBW infants often exhibit erratic regulation of plasma glucose levels in response to changes in glucose infusion rate. This apparent dysregulation could be the result of an inappropriate insulin secretory response, incomplete suppression of glucose production, or an inadequate chan...

  9. Parenteral Nutrition Additive Shortages: The Short-Term, Long-Term and Potential Epigenetic Implications in Premature and Hospitalized Infants

    PubMed Central

    Hanson, Corrine; Thoene, Melissa; Wagner, Julie; Collier, Dean; Lecci, Kassandra; Anderson-Berry, Ann

    2012-01-01

    Nutrition support practitioners are currently dealing with shortages of parenteral nutrition micronutrients, including multivitamins (MVI), selenium and zinc. A recent survey from the American Society of Enteral and Parenteral Nutrition (ASPEN) indicates that this shortage is having a profound effect on clinical practice. A majority of respondents reported taking some aggressive measures to ration existing supplies. Most premature infants and many infants with congenital anomalies are dependent on parenteral nutrition for the first weeks of life to meet nutritional needs. Because of fragile health and poor reserves, they are uniquely susceptible to this problem. It should be understood that shortages and rationing have been associated with adverse outcomes, such as lactic acidosis and Wernicke encephalopathy from thiamine deficiency or pulmonary and skeletal development concerns related to inadequate stores of Vitamin A and D. In this review, we will discuss the current parenteral shortages and the possible impact on a population of very low birth weight infants. This review will also present a case study of a neonate who was impacted by these current shortages. PMID:23223000

  10. Gluconeogenesis is not regulated by either glucose or insulin in extremely low birth weight infants receiving total parenteral nutrition

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The objective was to determine potential factors regulating gluconeogenesis (GNG) in extremely low birth weight infants receiving total parenteral nutrition. Seven infants (birth weight, 0.824 +/- 0.068 kg; gestational age, 25.4 +/- 0.5 weeks; postnatal age, 3.3 +/- 0.2 days) were studied for 11 hou...

  11. Fish oil–based lipid emulsions in the treatment of parenteral nutrition-associated liver disease: An ongoing positive experience

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We previously reported the beneficial effect of fish oil-based lipid emulsions (FOLEs) as monotherapy in the treatment of parenteral nutrition-associated liver disease (PNALD). In this report, we share our ongoing experience at Texas Children's Hospital, Houston, in the use of FOLE in treatment of P...

  12. Vitamin A supplementation in late pregnancy can decrease the incidence of bronchopulmonary dysplasia in newborns.

    PubMed

    Babu, T Arun; Sharmila, V

    2010-12-01

    Bronchopulmonary dysplasia (BPD) is a chronic lung disease of infancy which is associated with prematurity and early lung injury resulting from mechanical ventilation. Oxygen toxicity, barotrauma, and volutrauma play key roles in its pathogenesis. Parenteral administration of Vitamin A to the newborn is the current recommended preventive therapy for BPD. Vitamin A has been found to upregulate genes necessary for fetal lung growth and increase surfactant production in animal models. Supplementation of Vitamin A in late pregnancy increases the cord blood vitamin A levels proportionately. Hence, we hypothesize that Vitamin A supplementation during late pregnancy can decrease the incidence of BPD in newborns. This can be an effective adjunct to postnatal preventive therapy. Vitamin A supplementation in late pregnancy carries no risk of teratogenicity unlike in early pregnancy. Moreover, vitamin A deficiency in pregnancy is associated with depressed immune function leading on to increased infectious morbidity and can cause intrauterine growth retardation, low birth weight and anemia in newborns. Combining antenatal Vitamin A supplementation to the mother with postnatal supplementation to the newborn can effectively prevent BPD better than the traditional postnatal preventive therapy alone. It will also treat the highly prevalent vitamin A deficiency in pregnant mothers and newborns of the developing world. PMID:20298108

  13. Patient-controlled oral analgesia versus nurse-controlled parenteral analgesia after caesarean section: a randomised controlled trial.

    PubMed

    Bonnal, A; Dehon, A; Nagot, N; Macioce, V; Nogue, E; Morau, E

    2016-05-01

    We assessed the effectiveness of early patient-controlled oral analgesia compared with parenteral analgesia in a randomised controlled non-inferiority trial of women undergoing elective caesarean section under regional anaesthesia. Seventy-seven women received multimodal paracetamol, ketoprofen and morphine analgesia. The woman having patient-controlled oral analgesia were administered four pillboxes on the postnatal ward containing tablets and instructions for self-medication, the first at 7 h after the spinal injection and then three more at 12-hourly intervals. Pain at rest and on movement was evaluated using an 11-point verbal rating scale at 2 h and then at 6-hourly intervals for 48 h. The pre-defined non-inferiority limit for the difference in mean pain scores (patient-controlled oral analgesia minus parenteral) was one. The one-sided 95% CI of the difference in mean pain scores was significantly lower than one at all time-points at rest and on movement, demonstrating non-inferiority of patient-controlled oral analgesia. More women used morphine in the patient-controlled oral analgesia group (22 (58%)) than in the parenteral group (9 (23%); p = 0.002). The median (IQR [range]) number of morphine doses in the patient-controlled oral analgesia group was 2 (1-3 [1-7]) compared with 1 (1-1 [1-2]); p = 0.006) in the parenteral group. Minor drug errors or omissions were identified in five (13%) women receiving patient-controlled oral analgesia. Pruritus was more frequent in the patient-controlled oral analgesia group (14 (37%) vs 6 (15%) respectively; p = 0.03), but no differences were noted for other adverse events and maternal satisfaction. After elective caesarean section, early patient-controlled oral analgesia is non-inferior to standard parenteral analgesia for pain management, and can be one of the steps of an enhanced recovery process. PMID:26931110

  14. Auditing the effect of experience and change on home parenteral nutrition related complications.

    PubMed

    Johnston, D A; Richards, J; Pennington, C R

    1994-12-01

    A prospective record of all patients receiving home parenteral nutrition (HPN) in Tayside since 1980 has been used to audit the effect of experience and specific policy changes on HPN related complications. Total HPN related complications fell significantly over the years from 1.59 complications per treatment year during the initial 5 years of HPN experience to the current rate of 0.36 complications per treatment year. Specific policy changes, such as modification of the glucose concentration of feed, could also be shown to produce a significant benefit in the reduction of complications. Increasing experience with HPN results in a fall in complication rates, however, continuous audit of HPN is essential to determine the effect of policy changes on complication rates. PMID:16843411

  15. Urinary excretion of enzymes following repeated parenteral administration of cadmium to rats

    SciTech Connect

    Bonner, F.W.; King, L.J.; Parke, D.V.

    1980-06-01

    The effect of daily parenteral administration of cadmium (0.75, 1.5, and 3.0 mg/kg) on the urinary excretion of enzymes has been studied in the young male rat. Aspartate aminotransferase, alkaline phosphatase, ..gamma..-glutamyl transpeptidase, and leucine aminopeptidase all showed an initial significant increase around the second day of dosage, the intensity of which was dose related. A second phase of enzymuria occurred later, the onset of which was dose related. High-dose-group animals (3.0 mg/kg) exhibited this increase around Day 15, while the median (1.5 mg/kg) and low- (0.75 mg/kg)dose-group animals developed enzymuria around Days 21 and 38, respectively. This second phase of elevated enzyme levels in the urine was persistent, and is believed to represent the development of renal damage.

  16. Kounis syndrome secondary to simultaneous oral amoxicillin and parenteral ampicillin use in a young man.

    PubMed

    Bezgin, Tahir; Geçmen, Çetin; Özkan, Birol; Alici, Gökhan; Kalkan, Mehmet Emin; Kargin, Ramazan; Esen, Ali Metin

    2013-03-01

    The concurrence of acute coronary syndrome with allergy or hypersensitivity as well as with anaphylactic or anaphylactoid reactions is increasingly encountered in daily clinical practice. There are several reports associating mast cell activation with acute cardiovascular events in adults. This was first described by Kounis as 'allergic angina syndrome',progressing to 'allergic myocardial infarction'. The main mechanism proposed is the vasospasm of coronary arteries. We present a case of a 28-year-old man who was admitted to our hospital with thoracic pain and dyspnoea. The symptoms recurred after simultaneous use of 1 g amoxicillin/clavulanic acid orally and 1 g ampicillin/sulbactam parenterally for tonsillitis the night before presentation and on the morning of admission. PMID:23152096

  17. Viral hepatitis B and C outbreak related to parenteral treatment at an oncological department in Slovakia.

    PubMed

    Kološová, A; Gašparovič, J

    2016-06-01

    The Regional Public Health Authority was notified about four cases of viral hepatitis (B and C) among patients with pre-event history of hospitalization at an oncological ward. An outbreak investigation was commenced in response. Forty-seven cases of viral hepatitis B and C in 39 patients hospitalized during the period from September 2009 to July 2010 were registered. We found an association between parenteral treatment and disease (hepatitis B: χ(2) = 49.53; P < 0.001; hepatitis C: χ(2) = 22.42; P < 0.001). Despite using disposable materials, there remains a risk of transmission of bloodborne virus infections in hospitals due to poor adherence to standard procedures. PMID:26944899

  18. Outpatient parenteral antimicrobial therapy with ceftriaxone for acute tonsillopharyngitis: efficacy, patient satisfaction, cost effectiveness, and safety

    PubMed Central

    Al Alawi, Samah; Abdulkarim, Somaya; Elhennawy, Hazem; Al-Mansoor, Anwar; Al Ansari, Ahmed

    2015-01-01

    Background Outpatient parenteral antimicrobial therapy (OPAT) is the administration of intravenous antimicrobial therapy to patients in an outpatient setting. It may be used for patients who have infections that require parenteral treatment but who are otherwise stable enough to not require admission as inpatients. Objective We aimed to review the treatment of patients with acute tonsillopharyngitis at the OPAT health care clinic in the Bahrain Defense Force Royal Medical Services (BDF-RMS), with regard to efficacy, patient satisfaction, cost effectiveness, and safety. Methods A retrospective case notes review was conducted for all patients admitted to the OPAT clinic in the BDF-RMS with acute tonsillopharyngitis treated with ceftriaxone, between March 2012 and March 2014. Results In the period between March 2012 and March 2014, 97 patients with acute tonsillopharyngitis were treated with ceftriaxone for a minimum of 3 days at the OPAT clinic. In total, 94.8% of patients completed the prescribed course of ceftriaxone. Total cure was achieved in 89.7% of patients. Usage of the OPAT clinic led to cost savings of 10,693 BD, while total bed days saved were 301 over the 2-year period examined by this study. Participants in the program expressed high satisfaction rates, and the average (± standard deviation) score on a patient satisfaction survey was 4.41 (± 0.31) out of a total of 5. This study highlights the efficacy, patient satisfaction, cost effectiveness, and safety of the OPAT clinic service for the treatment of acute tonsillopharyngitis with ceftriaxone. We found a 45.5% drop in admission rate for acute tonsillopharyngitis after starting the OPAT service clinic and that 301 bed days were saved through this treatment. Conclusion This study showed that the management of acute tonsillopharyngitis with ceftriaxone in the OPAT clinic is safe, clinically effective, and cost effective, with low rates of complications/readmissions and high levels of patient

  19. Parenteral administration of attenuated Salmonella Typhimurium ΔznuABC is protective against salmonellosis in piglets.

    PubMed

    Ruggeri, J; Pesciaroli, M; Gaetarelli, B; Scaglione, F E; Pregel, P; Ammendola, S; Battistoni, A; Bollo, E; Alborali, G L; Pasquali, P

    2014-07-01

    A major cause of salmonellosis in humans is the contamination of pork products. Infection in pigs can be controlled using bio-security programs, but they are not sufficient in countries where a high level of infection is recorded. In this context, the use of vaccines can represent a valid supplementary method of control. Recently, we have demonstrated that an attenuated strain of Salmonella enterica serovar Typhimurium (Salmonella Typhimurium ΔznuABC) is protective against systemic and enteric salmonellosis in mouse and pig infection models, candidating this strain as an oral attenuated vaccine. In this study, we compared the efficacy of this attenuated Salmonella Typhimurium strain when administered orally or parenterally. Furthermore, in order to reproduce a pseudo-natural infection model, vaccinated pigs were allocated in the same pen with animals shedding virulent Salmonella Typhimurium. Animals were monitored weekly after vaccination and contact with infected piglets. Diarrhea and ataxia were recorded and Salmonella shedding was tested individually through bacterial culture. After four weeks of cohousing, piglets were euthanized, after which lymph nodes reactivity and gross lesions of the gut sections were scored at necropsy. Organs were submitted to microbiological and histological analyses. The data reported herein show that parenterally vaccinated animals do not shed the attenuated strain, and at the same time the absence of symptoms and decrease in virulent strain shedding in feces from day 6 after challenge demonstrated protection against infection induced by virulent Salmonella Typhimurium. In conclusion, our findings suggest that this is an alternative route of Salmonella Typhimurium ΔznuABC administration, without ignoring the advantages associated with oral vaccination. PMID:24907486

  20. Retrospective Evaluation of Parenteral Nutrition in Alpacas: 22 Cases (2002–2008)

    PubMed Central

    Clore, E.R.S.; Freeman, L.M.; Bedenice, D.; Buffington, C.A. Tony; Anderson, D.E.

    2013-01-01

    Background Parenteral nutrition is an important method of nutritional support in hospitalized animals, but minimal information has been published on its use in camelids. Hypothesis/Objectives The purpose of this study was to characterize the use of total parenteral nutrition (TPN) in alpacas, evaluate the formulations used, and determine potential complications. Animals Twenty-two alpacas hospitalized at the Tufts Cummings School for Veterinary Medicine (site 1: n = 8) and the Ohio State University Veterinary Teaching Hospital (site 2: n = 14). Methods A retrospective analysis of all alpacas that received TPN between 2002 and 2008 was performed to assess clinical indications, clinical and clinicopathologic data, and outcome. Results The most common underlying diseases in animals receiving TPN were gastrointestinal dysfunction (n = 16), hepatic disease (n = 2), and neoplasia (n = 2). Several metabolic abnormalities were identified in animals (n = 20/22) before TPN was initiated, including lipemia (n = 12/22), hyperglycemia (11/22), and hypokalemia (n = 11/22). Median age was significantly lower for site 1 cases (0.1 years; range, 0.01–11.0) compared with those from site 2 (4.9 years; range, 0.1–13.7; P = .03). Animals at site 2 also had a longer duration of hospitalization (P = .01) and TPN administration (P = .004), as well as higher survival rate (P < .02). Twenty-one of 22 alpacas developed at least 1 complication during TPN administration. Metabolic complications were most prevalent (n = 21/22) and included hyperglycemia (n = 8/21), lipemia (n = 7/21), hypokalemia (n = 3/21), and refeeding syndrome (n = 3/21). Conclusions and Clinical Importance TPN is a feasible method of nutritional support for alpacas when enteral feeding is not possible. Prospective studies are warranted to determine optimal TPN formulations for alpacas. PMID:21418323

  1. Guidelines for management of home parenteral support in adult chronic intestinal failure patients.

    PubMed

    Messing, Bernard; Joly, Francisca

    2006-02-01

    Management of home parenteral support in adult benign but chronic intestinal failure patients requires a nutrition support team using disease-specific pathways. Education of patients to ensure they self manage home parenteral nutrition (HPN) is cornerstone to obtain minimal rate of technical complications and improvement in quality of life. Nutritive mixtures, compounded by pharmacists in single "all-in-one" bags, must be tailored according to the nutritional and intestinal status of individual patients with definition of macronutrients and water-electrolyte needs, respectively. Each PN cycle should be complete in essential nutrients to be nutritionally efficient and should have sufficient amounts of amino acids, dextrose, water, minerals, and micronutrients to avoid deficiency. When the nutritional goal is achieved, a minimum number of PN cycles per week should be implemented, guided ideally by digestive balance(s) (In-Out) of macronutrients and minerals of individual patients. Indeed, HPN is, in most cases, a complementary nonexclusive mode of nutritional support. In short gut patients--who represent 75% of chronic intestinal failure patients--encouraging enteral feeding decrease PN delivery and the risk of metabolic liver disease associated with HPN. In short gut patients with no severe renal impairment, blood citrulline dosage, in association with the remnant anatomy, is a tool to delineate transient from permanent intestinal failure. The latter group includes candidates for trophic gut factors and rehabilitative or reconstructive surgery, including intestinal transplantation. Thus, outcome improvement for intestinal failure patients needs intestinal failure teams having expertise in all medical and surgical aspects of this field. PMID:16473071

  2. Outpatient parenteral antimicrobial therapy for orthopedic infections - a successful public healthcare experience in Brazil.

    PubMed

    Oliveira, Priscila Rosalba; Felix, Cassia da Silva; Carvalho, Vladimir Cordeiro de; Giovani, Arlete Mazzini; Reis, Rosangela Suarti Dos; Beraldo, Marisa; Albuquerque, Edmir Peralta; Ferreira, Walter Cintra; Silva, Jorge Dos Santos; Lima, Ana Lucia Lei

    2016-01-01

    Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT) started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42). Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies in other regions

  3. Vegetable Oil-Loaded Nanocapsules: Innovative Alternative for Incorporating Drugs for Parenteral Administration.

    PubMed

    Venturinil, C G; Bruinsmann, A; Oliveira, C P; Contri, R V; Pohlmann, A R; Guterres, S S

    2016-02-01

    An innovative nanocapsule formulation for parenteral administration using selected vegetable oils (mango, jojoba, pequi, oat, annatto, calendula, and chamomile) was developed that has the potential to encapsulate various drugs. The vegetable oil-loaded nanocapsules were prepared by interfacial deposition and compared with capric/caprylic triglyceride-loaded lipid core nanocapsules. The major objective was to investigate the effect of vegetable oils on particle size distribution and physical stability and to determine the hemolytic potential of the nanocapsules, considering their applicability for intravenous administration. Taking into account the importance of accurately determining particle size for the selected route of administration, different size characterization techniques were employed, such as Laser Diffraction, Dynamic Light Scattering, Multiple Light Scattering, Nanoparticle Tracking Analysis, and Transmission Electronic Microscopy. Laser diffraction studies indicated that the mean particle size of all nanocapsules was below 300 nm. For smaller particles, the laser diffraction and multiple light scattering data were in agreement (D[3,2]-130 nm). Dynamic light scattering and nanoparticle tracking analysis, two powerful techniques that complement each other, exhibited size values between 180 and 259 nm for all nanoparticles. Stability studies demonstrated a tendency of particle creaming for jojoba-nanocapsules and sedimentation for the other nanoparticles; however, no size variation occurred over 30 days. The hemolysis test proved the hemocompatibility of all nanosystems, irrespective of the type of oil. Although all developed nanocapsules presented the potential for parenteral administration, jojoba oil-loaded nanocapsules were selected as the most promising nanoformulation due to their low average size and high particle size homogeneity. PMID:27433581

  4. Clinical, social, and economic impacts of home parenteral nutrition dependence in short bowel syndrome.

    PubMed

    Winkler, Marion F; Smith, Carol E

    2014-05-01

    Home parenteral nutrition (HPN) provides nourishment and hydration to patients with short bowel syndrome and intestinal failure and is thus a life-sustaining therapy for these patients. However, measures of quality of life (QOL) are lower among the HPN-dependent population than among patients with other intestinal diseases who do not require HPN. Multiple factors contribute to lower QOL in HPN-dependent patients, including fears surrounding the increased risk of HPN-associated adverse events, such as catheter-related complications, parenteral nutrition-associated liver disease, and metabolic bone disease. In addition, HPN-dependent patients report impaired sleep and daytime fatigue because of pump noises, equipment alarms, and nocturia. Psychosocial burdens on families of HPN-dependent patients include decreased social activities, disrupted family relationships and friendships, and depression. These families also face imposing financial constraints, including decreased employment and large out-of-pocket expenses for insurance premiums and nonreimbursed copayments, medications, and supplies. Furthermore, HPN technology and HPN-related complications and sequelae contribute to the rapid overall increase in the costs of healthcare systems. Additionally, family caregivers provide unpaid healthcare services for patients who require HPN, often to the detriment of their own physical and mental well-being. Nonetheless, patients dependent on HPN and their caregivers often demonstrate considerable resilience and are frequently able to normalize their response to illness and disability. Interventions that may improve QOL among HPN-dependent patients and caregivers include patient education, affiliation with support groups, treatment of concomitant symptoms, and pharmacotherapies that decrease HPN requirements. PMID:24418898

  5. Nitrite and Nitrate Concentrations and Metabolism in Breast Milk, Infant Formula, and Parenteral Nutrition

    PubMed Central

    Jones, Jesica A.; Ninnis, Janet R.; Hopper, Andrew O.; Ibrahim, Yomna; Merritt, T. Allen; Wan, Kim-Wah; Power, Gordon G.; Blood, Arlin B.

    2015-01-01

    Dietary nitrate and nitrite are sources of gastric NO, which modulates blood flow, mucus production, and microbial flora. However, the intake and importance of these anions in infants is largely unknown. Nitrate and nitrite levels were measured in breast milk of mothers of preterm and term infants, infant formulas, and parenteral nutrition. Nitrite metabolism in breast milk was measured after freeze-thawing, at different temperatures, varying oxygen tensions, and after inhibition of potential nitrite-metabolizing enzymes. Nitrite concentrations averaged 0.07 ± 0.01 μM in milk of mothers of preterm infants, less than that of term infants (0.13 ± 0.02 μM) (P < .01). Nitrate concentrations averaged 13.6 ± 3.7 μM and 12.7 ± 4.9 μM, respectively. Nitrite and nitrate concentrations in infant formulas varied from undetectable to many-fold more than breast milk. Concentrations in parenteral nutrition were equivalent to or lower than those of breast milk. Freeze-thawing decreased nitrite concentration ∼64%, falling with a half-life of 32 minutes at 37°C. The disappearance of nitrite was oxygen-dependent and prevented by ferricyanide and 3 inhibitors of lactoperoxidase. Nitrite concentrations in breast milk decrease with storage and freeze-thawing, a decline likely mediated by lactoperoxidase. Compared to adults, infants ingest relatively little nitrite and nitrate, which may be of importance in the modulation of blood flow and the bacterial flora of the infant GI tract, especially given the protective effects of swallowed nitrite. PMID:23894175

  6. Validating hyperbilirubinemia and gut mucosal atrophy with a novel ultramobile ambulatory total parenteral nutrition piglet model.

    PubMed

    Jain, Ajay K; Wen, Joy X; Arora, Sumit; Blomenkamp, Keith S; Rodrigues, Jonathan; Blaufuss, Timothy A; Liou, Victor; Burrin, Douglas G; Long, John P; Teckman, Jeffery H

    2015-02-01

    Total parenteral nutrition (TPN) provides all nutrition intravenously. Although TPN therapy has grown enormously, it causes significant complications, including gut and hepatic dysfunction. Current models use animal tethering which is unlike ambulatory human TPN delivery and is cost prohibitive. We hypothesize that using ultramobile infusion pumps, TPN can be delivered cost-effectively, resulting in classical gut and hepatic injury, and we thus aim to establish a new model system. Neonatal pigs (n=8) were implanted with jugular vein and duodenal catheters. Animals were fitted in dual-pocket jackets. An ultramobile ambulatory pump was placed in one pocket and connected to the jugular vein or duodenal catheter. Isocaloric TPN or swine formula was placed in the other pocket. Rigorous Wifi-based video and scheduled monitoring was performed. After 14days, the animals were euthanized. The mean (±SD) daily weight gain (in grams) for enteral-fed control (EN) vs TPN animals was 102.4±10.8 and 91.03±12.1 respectively (P<.05). Total parenteral nutrition resulted in significant conjugated bilirubin elevation and hepatomegaly. Mean (±SD) serum conjugated bilirubin (in μmol/L) was 1.5±0.7 for EN and 6.3±2.8 for TPN (P<.05). Marked gut atrophy was noted with TPN. The mean (±SD) gut weight as a percent of body weight was 4.30±0.26 for EN and 2.62±0.48 for TPN (P<.05). Surgical sites healed well. All animals remained completely mobile. We thus established that TPN can be successfully delivered using ultramobile pumps and believe that this remains the first such description of an ambulatory piglet TPN model system. In addition to cholestasis and gut atrophy, classical TPN-induced injury was documented. PMID:25649660

  7. Glutamate prevents intestinal atrophy via luminal nutrient sensing in a mouse model of total parenteral nutrition

    PubMed Central

    Xiao, Weidong; Feng, Yongjia; Holst, Jens J.; Hartmann, Bolette; Yang, Hua; Teitelbaum, Daniel H.

    2014-01-01

    Small intestine luminal nutrient sensing may be crucial for modulating physiological functions. However, its mechanism of action is incompletely understood. We used a model of enteral nutrient deprivation, or total parenteral nutrition (TPN), resulting in intestinal mucosal atrophy and decreased epithelial barrier function (EBF). We examined how a single amino acid, glutamate (GLM), modulates intestinal epithelial cell (IEC) growth and EBF. Controls were chow-fed mice, T1 receptor-3 (T1R3)-knockout (KO) mice, and treatment with the metabotropic glutamate receptor (mGluR)-5 antagonist MTEP. TPN significantly changed the amount of T1Rs, GLM receptors, and transporters, and GLM prevented these changes. GLM significantly prevented TPN-associated intestinal atrophy (2.5-fold increase in IEC proliferation) and was dependent on up-regulation of the protein kinase pAkt, but independent of T1R3 and mGluR5 signaling. GLM led to a loss of EBF with TPN (60% increase in FITC-dextran permeability, 40% decline in transepithelial resistance); via T1R3, it protected EBF, whereas mGluR5 was associated with EBF loss. GLM led to a decline in circulating glucagon-like peptide 2 (GLP-2) during TPN. The decline was regulated by T1R3 and mGluR5, suggesting a novel negative regulator pathway for IEC proliferation not previously described. Loss of luminal nutrients with TPN administration may widely affect intestinal taste sensing. GLM has previously unrecognized actions on IEC growth and EBF. Restoring luminal sensing via GLM could be a strategy for patients on TPN.—Xiao, W., Feng, Y., Holst, J. J., Hartmann, B., Yang, H., Teitelbaum, D. H. Glutamate prevents intestinal atrophy via luminal nutrient sensing in a mouse model of total parenteral nutrition. PMID:24497581

  8. Effect of oral and parenteral administration of B6 vitamers on the lymphopenia produced by feeding ammonia caramel or 2-acetyl-4(5)-(1,2,3,4-tetrahydroxy)butylimidazole to rats.

    PubMed

    Gobin, S J; Paine, A J

    1989-10-01

    The ability of B6 vitamers to prevent the lymphopenic effects of ammonia caramel fed to rats has been evaluated. Diets containing 10 ppm pyridoxine or pyridoxal prevented the lymphopenia produced in rats consuming an 8% (w/v) solution of ammonia caramel, whereas the dietary content of pyridoxamine needed to be increased to 20 ppm to have the same effect. In contrast to the results of the enteral administration of the individual B6 vitamers, pyridoxamine was found to be the most effective vitamer in preventing the ammonia caramel-induced lymphopenia when administered parenterally. However, all the nutritionally active forms of vitamin B6 were able to prevent the depression of the peripheral blood lymphocyte count, which resulted from ingestion of ammonia caramel by rats. The proposal that oral administration of pyridoxine may prevent the intestinal absorption of the lymphopenic constituent of ammonia caramel, 2-acetyl-4(5)-(1,2,3,4-tetrahydroxy)butylimidazole (THI), is discredited, since THI was found to reduce the lymphocyte count after parenteral administration in rats fed 0.04 ppm pyridoxone in the diet and that increased amounts of dietary pyridoxine (10 ppm) could still prevent this effect. These findings further emphasise the important relationship between dietary vitamin B6 content and the lymphopenic effects of ammonia caramel/THI in the rat. PMID:2606399

  9. 32 CFR 651.24 - Supplemental EAs and supplemental EISs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Supplemental EAs and supplemental EISs. As detailed in § 651.5(g) and in 40 CFR 1502.9(c), proposed actions may... 32 National Defense 4 2011-07-01 2011-07-01 false Supplemental EAs and supplemental EISs. 651.24 Section 651.24 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY...

  10. 32 CFR 651.24 - Supplemental EAs and supplemental EISs.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Supplemental EAs and supplemental EISs. As detailed in § 651.5(g) and in 40 CFR 1502.9(c), proposed actions may... 32 National Defense 4 2014-07-01 2013-07-01 true Supplemental EAs and supplemental EISs. 651.24 Section 651.24 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY...

  11. 32 CFR 651.24 - Supplemental EAs and supplemental EISs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Supplemental EAs and supplemental EISs. As detailed in § 651.5(g) and in 40 CFR 1502.9(c), proposed actions may... 32 National Defense 4 2010-07-01 2010-07-01 true Supplemental EAs and supplemental EISs. 651.24 Section 651.24 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY...

  12. 32 CFR 651.24 - Supplemental EAs and supplemental EISs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Supplemental EAs and supplemental EISs. As detailed in § 651.5(g) and in 40 CFR 1502.9(c), proposed actions may... 32 National Defense 4 2013-07-01 2013-07-01 false Supplemental EAs and supplemental EISs. 651.24 Section 651.24 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY...

  13. 32 CFR 651.24 - Supplemental EAs and supplemental EISs.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Supplemental EAs and supplemental EISs. As detailed in § 651.5(g) and in 40 CFR 1502.9(c), proposed actions may... 32 National Defense 4 2012-07-01 2011-07-01 true Supplemental EAs and supplemental EISs. 651.24 Section 651.24 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY...

  14. Herbal Products and Supplements

    MedlinePlus

    ... and prescription medicines just because they come from nature. Although herbal health products and supplements are advertised as “natural,” their ingredients aren’t necessarily natural to the human body. They may have strong effects on your ...

  15. Supplements to Textbook Materials.

    ERIC Educational Resources Information Center

    Holmes, Ken

    1994-01-01

    Describes the many kinds of materials that English teachers can draw upon to enrich and expand students' experiences with literature. Outlines ancillary materials used to supplement the study of William Shakespeare's "Julius Caesar." (HB)

  16. FDA 101: Dietary Supplements

    MedlinePlus

    ... professionals. As its resources permit, FDA also reviews product labels and other product information, such as package inserts, ... the address or phone number listed on the product's label. Dietary supplement firms are required to forward reports ...

  17. Using Dietary Supplements Wisely

    MedlinePlus

    ... as diabetes, cancer, or cardiovascular disease. Sources of Science-Based Information It’s important to look for reliable ... e-mail Email Address Related Topics Know the Science: How Medications and Supplements Can Interact Safe Use ...

  18. Vitamin supplementation in pregnancy.

    PubMed

    2016-07-01

    Ensuring that a woman is well-nourished, both before and during pregnancy, is crucial for the health of the woman and that of the unborn child.(1) Maternal deficiency in key nutrients has been linked to pre-eclampsia, restricted fetal growth, neural tube defects, skeletal deformity and low birth weight.(1,2) Many nutritional supplements containing vitamins, minerals and other micronutrients are heavily marketed to women for all stages of pregnancy. However, much of the evidence for vitamin supplementation in pregnancy comes from studies carried out in low-income countries,(3) where women are more likely to be undernourished or malnourished than within the UK population. The challenges lie in knowing which supplements are beneficial and in improving uptake among those at most need. Here we summarise current UK guidance for vitamin supplementation in pregnancy and review the evidence behind it. PMID:27405305

  19. Breastfeeding: Vitamin D Supplementation

    MedlinePlus

    ... Breastfeeding Micronutrient Malnutrition State and Local Programs Vitamin D Supplementation Recommend on Facebook Tweet Share Compartir While ... provide infants with an adequate intake of vitamin D. Most breastfed infants are able to synthesize additional ...

  20. Dietary Supplements for Toddlers

    MedlinePlus

    ... about which supplements are needed and the amounts. Iron Deficiency Iron deficiency does occur among some young children and ... need to receive at least 15 milligrams of iron a day in their food, but many fail ...

  1. Iron supplements (image)

    MedlinePlus

    The mineral iron is an essential nutrient for humans because it is part of blood cells, which carry oxygen to all body cells. There is no conclusive evidence that iron supplements contribute to heart attacks.

  2. Effects of arginine supplementation on splenocyte cytokine mRNA expression in rats with gut-derived sepsis

    PubMed Central

    Shang, Huey-Fang; Hsu, Chun-Sen; Yeh, Chiu-Li; Pai, Man-Hui; Yeh, Sung-Ling

    2005-01-01

    AIM: To investigate the effects of arginine (Arg)-enriched diets before sepsis and/or Arg-containing total parenteral nutrition (TPN) after sepsis or both on cytokine mRNA expression levels in splenocytes of rats with gut-derived sepsis. METHODS: Rats were assigned to four experimental groups. Groups 1 and 2 were fed with a semipurified diet, while groups 3 and 4 had part of the casein replaced by Arg which provided 2% of the total calories. After the rats were fed with these diets for 10 d, sepsis was induced by cecal ligation and puncture (CLP), at the same time an internal jugular vein was cannulated. All rats were maintained on TPN for 3 d. Groups 1 and 3 were infused with conventional TPN, while groups 2 and 4 were supplemented with Arg which provided 2% of the total calories in the TPN solution. All rats were killed 3 d after CLP to examine their splenocyte subpopulation distribution and cytokine expression levels. RESULTS: Plasma interleukin (IL)-2, IL-4, tumor necrosis factor-α (TNF-α) and interferon (IFN-γ) were not detectable 3 d after CLP. There were no differences in the distributions of CD45Ra+, CD3+, CD4+, and CD8+ cells in whole blood and splenocytes among the four groups. The splenocyte IL-2 mRNA expression in the Arg-supplemented groups was significantly higher than that in group 1. IL-4 mRNA expression in groups 3 and 4 was significantly higher than that in groups 1 and 2. The mRNA expression of IL-10 and IFN-γ was significantly higher in group 4 than in the other three groups. There was no difference in TNF-α mRNA expression among the four groups. CONCLUSION: The influence of Arg on the whole blood and splenic lymphocyte subpopulation distribution is not obvious. However, Arg administration, especially before and after CLP, significantly enhances the mRNA expression levels of Th1 and Th2 cytokines in the spleen of rats with gut-derived sepsis. PMID:16437653

  3. Stability of hydrophilic vitamins mixtures in the presence of electrolytes and trace elements for parenteral nutrition: a nuclear magnetic resonance spectroscopy investigation.

    PubMed

    Uccello-Barretta, Gloria; Balzano, Federica; Aiello, Federica; Falugiani, Niccolò; Desideri, Ielizza

    2015-03-25

    In total parenteral nutrition (TPN), especially in the case of preterm infants, simultaneous administration of vitamins and trace elements is still a problematic issue: guidelines put in evidence the lack of specific documentation. In this work NMR spectroscopy was applied to the study of vitamins (pyridoxine hydrochloride, thiamine nitrate, riboflavin-5'-phosphate and nicotinamide) stability in presence of salts and trace elements. Vitamins in D2O were first analyzed by (1)H NMR spectroscopy in absence of salts and trace elements; changes in chemical shifts or in diffusion coefficients, measured by NMR DOSY technique, were analyzed. The effects of salts and trace elements on single vitamins and on their admixtures were then investigated by performing quantitative analyses during 48h. Selected vitamins are subject to intermolecular interactions. No degradative effects were observed in presence of salts and trace elements. Only riboflavin-5'-phosphate is subject to precipitation in presence of divalent cations; however, at low concentration and in presence of other vitamins this effect was not observed. Solutions analyzed, in the condition of this study, are stable for at least 48h and vitamins and trace elements can be administered together in TPN. PMID:25560848

  4. Phospholipid-rich particles in commercial parenteral fat emulsions. An overview.

    PubMed

    Bach, A C; Férézou, J; Frey, A

    1996-01-01

    In parenteral nutrition, the infusion of a fat EMU supplies both concentrated energy and covers the essential fatty acid requirements, the basic objective being to mimic as well as possible the input of chylomicrons into the blood. This objective is well met by the TAGRP of the EMU, which behave as true chylomicrons. However, commercial EMU also contain an excess of emulsifier in the form of PLRP. The number of these PLRP depends directly on the PL/TAG ratio of the EMU. They differ from the TAGRP by their composition (PL vs TAG and PL), their structure (PL in bilayer versus monolayer), and their granulometry (mean diameter 70-100 nm for PL vs 200-500 nm). The metabolic fate of the PLRP is similar in several ways to that of the TAGRP: exchanges of PL with the PL of the different cellular membranes and of the lipoproteins; captation of free CH from these same structures; and enrichment in apolipoproteins. However, because the TAGRP are the preferred substrates of the lipolytic enzymes, their clearance is much more rapid (half-life < 1 h) than that of the PLRP. As the infusion is continued, the PLRP end up accumulating and being transformed into LP-X (free CH/PL = 1; half-life of several days). As soon as the EMU is infused, the PLRP enter into competition with the TAGRP, in the lipolysis process as well as for sites of binding and for catabolism. The sites for catabolism of the two types of PAR are not the same: adipose tissues and muscles utilize the fatty acids and monoacylglycerols released by the lipolysis of the TAGRP; hepatocytes take up their remnants; the RES and the hepatocytes participate in the catabolism of the PLRP and the LP-X. Thus, prolonged infusion of EMU rich in PLRP leads to a hypercholesterolemia, or at least a dyslipoproteinemia, due to elevated LP-X, associated with a depletion of cells in CH, stimulating thus tissue cholesterogenesis. However, parenteral nutrition has evolved towards the utilization of EMU with a low PL/TAG ratio (availability

  5. Early aggressive nutrition: parenteral amino acids and minimal enteral nutrition for extremely low birth weight (<1 000 g) infants.

    PubMed

    Adamkin, D H

    2007-08-01

    Postnatal growth failure in the extremely low birthweight infant is a morbidity that needs vigorous attention. The transition from intrauterine to the extrauterine environment should occur with minimal disruption in nutritional support. Early aggressive parenteral and enteral nutrition strategies may lead to reducing cumulative deficits of energy and protein that occur during the first weeks of life. These strategies decrease the degree of postnatal weight loss, reduce the age that birthweight is regained and the age that full enteral nutrition is achieved. Overall growth outcomes are also improved through discharge and beyond. This article provides clinical practicum to guide the use of early parenteral nutrition and both miminal enteral nutrition and advancing enteral nutrition. PMID:17947842

  6. Iron Supplementation Attenuates the Inflammatory Status of Anemic Piglets by Regulating Hepcidin.

    PubMed

    Pu, Yutian; Guo, Bingxiu; Liu, Dan; Xiong, Haitao; Wang, Yizhen; Du, Huahua

    2015-09-01

    Iron deficiency is common throughout the world and has been linked to immunity impairments. Using piglets to model human infants, we assessed the impact of systemic iron homeostasis on proinflammatory status. Artificially reared piglets were parenterally supplied with iron dextran by intramuscular administration at the age of 3 days. Relative to no iron supplementation (control), iron dextran-treated (FeDex) piglets increased hematological parameters as well as iron levels in serum and tissues from days 21 to 49. High expression of hepcidin was observed in FeDex-treated piglets, which correlated with suppressed expression of ferroportin in duodenum. Lower levels of proinflammatory cytokine (IL-6, TNF-α, IFN-γ, and IL-1β) transcripts were detected in ileum of FeDex-treated piglets, which indicated that iron supplementation could attenuate the increase of inflammatory cytokines caused by iron deficiency. Histopathological analysis of liver and duodenum proved the less inflammatory responses after iron supplementation. Hepcidin was highly stimulated by FeDex supplementation and attenuated the inflammation of anemia, which implied that hepcidin might had antiinflammatory function and is a candidate regulator of the cross-talk between iron regulation and inflammation. PMID:25774043

  7. Potential for human immunodeficiency virus parenteral transmission in the Middle East and North Africa: An analysis using hepatitis C virus as a proxy biomarker

    PubMed Central

    Mohamoud, Yousra A; Miller, F DeWolfe; Abu-Raddad, Laith J

    2014-01-01

    The Middle East and North Africa (MENA) region has endured several major events of infection parenteral transmission. Recent work has established the utility of using hepatitis C virus (HCV) as a proxy biomarker for assessing the epidemic potential for human immunodeficiency virus (HIV) parenteral transmission. In this review, we use data on the prevalence of HCV infection antibody (seroprevalence) among general population and high risk population groups to assess the potential for HIV parenteral transmission in MENA. Relatively low prevalence of HCV infection in the general population groups was reported in most MENA countries indicating that parenteral HIV transmission at endemic levels does not appear to be a cause for concern. Nonetheless, there could be opportunities for localized HIV outbreaks and transmission of other blood-borne infections in some settings such as healthcare facilities. Though there have been steady improvements in safety measures related to parenteral modes of transmission in the region, these improvements have not been uniform across all countries. More precautions, including infection control training programs, surveillance systems for nosocomial infections and wider coverage and evaluation of hepatitis B virus immunization programs need to be implemented to avoid the unnecessary spread of HIV, HCV, and other blood-borne pathogens along the parenteral modes of transmission. PMID:25278675

  8. Parenteral nutrition combined with rice soup can be a safe and effective intervention for congenital chylous ascites.

    PubMed

    Cao, Yi; Yan, Weihui; Lu, Lina; Tao, Yijing; Lu, Wei; Chen, Yingwei; Tang, Qingya; Cai, Wei

    2016-01-01

    Congenital chylous ascites in the neonatal period is a rare entity. Total parenteral nutrition (TPN), medium chain triglyceride (MCT)-based diet, octreotide and repeated paracentesis are regarded as appropriate medical treatment for congenital chylous ascites, and surgery is recommended when conservative therapy has failed. We present two cases in which ascites were confirmed via an abdominal sonogram and diagnostic paracentesis. In our clinical experience, rice soup combined with PN can be a safe and effective intervention. PMID:27440699

  9. A Patient With Parenteral Nutrition-Dependent Short Bowel Syndrome and Cardiovascular Disease With 4-Year Exposure to Teduglutide.

    PubMed

    Compher, Charlene; Levinson, Katherine Boothe; Cambor, Carolyn L; Stoner, Nancy; Boullata, Joseph I; Piarulli, Amanda; Kinosian, Bruce

    2016-07-01

    Clinical trials of the glucagon-like peptide 2 analogue teduglutide resulted in approval of the drug by the Food and Drug Administration in 2012 as a treatment for parenteral nutrition-dependent short bowel syndrome in adults. This report presents the case study of a man with short bowel syndrome caused by portal vein thrombosis who had 4 years exposure to the drug at the time of his death due to cardiovascular disease. PMID:25567782

  10. Supplements and sports.

    PubMed

    Jenkinson, David M; Harbert, Allison J

    2008-11-01

    Use of performance-enhancing supplements occurs at all levels of sports, from professional athletes to junior high school students. Although some supplements do enhance athletic performance, many have no proven benefits and have serious adverse effects. Anabolic steroids and ephedrine have life-threatening adverse effects and are prohibited by the International Olympic Committee and the National Collegiate Athletic Association for use in competition. Blood transfusions, androstenedione, and dehydroepiandrosterone are also prohibited in competition. Caffeine, creatine, and sodium bicarbonate have been shown to enhance performance in certain contexts and have few adverse effects. No performance benefit has been shown with amino acids, beta-hydroxy-beta-methylbutyrate, chromium, human growth hormone, and iron. Carbohydrate-electrolyte beverages have no serious adverse effects and can aid performance when used for fluid replacement. Given the widespread use of performance-enhancing supplements, physicians should be prepared to counsel athletes of all ages about their effectiveness, safety, and legality. PMID:19007050

  11. Ergogenic Aids and Supplements.

    PubMed

    Porrini, Marisa; Del Boʼ, Cristian

    2016-01-01

    Great interest is currently shown for the contribution of nutrition to optimize training and athletic performance, and a considerable debate exists about the potential ergogenic value of several dietary supplements. However, most of the products used by athletes do not provide sufficient scientific evidence regarding their efficacy in enhancing physical performance as well as their specificity of action and safety. For this reason, sport nutrition professionals need skills in evaluating the scientific value of papers and advertisements on ergogenic aids and supplements in order to support athletes in their choice. In the present chapter, the efficacy of some of the most popular supplements used by athletes and sport practitioners will be discussed. Particular attention will be devoted to amino acids and derivatives, caffeine and caffeinated energy drinks, and some antioxidants. PMID:27348226

  12. Response of layer and broiler strain chickens to parenteral administration of a live Salmonella Typhimurium vaccine.

    PubMed

    Groves, Peter J; Sharpe, Sue M; Cox, Julian M

    2015-07-01

    Responses to the parenteral administration of a live aroA deletion Salmonella serovar Typhimurium vaccine given to three brown egg layer strains and two broiler strains were studied. Twenty-five birds of each strain were reared together in floor pens to 6 weeks of age and then moved as individual strains to new floor pens and injected with 10(8) colony forming units (CFU) per bird of the vaccine bacteria intramuscularly or subcutaneously, 10(6) CFU per bird subcutaneously, or phosphate buffered saline (PBS) subcutaneously as a vaccination control. Three birds of one layer strain were injected intramuscularly with 0.5mg/ bird S. Typhimurium lipopolysaccharide (LPS) to evaluate whether response was similar for vaccine and endotoxin. Birds were weighed, and rectal temperatures recorded at the time of injection, then observed over 24 hours. Rectal temperatures were measured and blood samples collected for serum IL-6 assay at 3 hours post injection (PI). At 12 hours PI blood samples were drawn for analyses for plasma phosphorus (P), glucose (Glu), cholesterol (Cho), aspartate transaminase (AST), total protein (Ptn) and creatinine kinase (CK). Blood was sampled 14 days PI and tested for serum antibody to S. Typhimurium. Vaccination resulted in significant seroconversion by 14 days PI in all strains compared to the controls. The three layer strains exhibited a clinical malaise, evident within 90 minutes of injection, lasting for 12 hours, with complete recovery by 24 hours PI. Only the 10(8) CFU dose given subcutaneously produced an increase in rectal temperature 3 hours PI. Vaccination had no effect on IL-6 or Ptn. All vaccine doses increased P and the higher dose by either route decreased Cho in all bird strains. The 10(8) vaccine dose increased Glu and intramuscular injection markedly elevated CK only in the layer strains. The response was not completely congruous with that to LPS alone. The results highlight the need for consideration of differences in response of

  13. [Total parenteral nutrition and dialysis. Complementary importance in the therapy of acute renal insufficiency in aortic surgery].

    PubMed

    Trazzi, R; MArtello, L; Selva, S; Vaghi, G M

    1981-11-01

    The acute renal insufficiency (A.R.I.) consequent on surgical pathology of the aorta is in the Milan School, one of the most important postoperative complications and requires the use of total parenteral feeding (T.P.F.). Parenteral infusion of AAe and hypertonic glucose in patients with A.R.I. has given positive results, not only insofar as it improves the general nutritional state, but also because it facilitates recovery of renal function and improves survival. Reutilisation of endogenous nitrogen gives a synthesis of structural proteins to the benefit of metabolic homoeostasis and the patient's clinical condition. On the basis of recent nephrology studies on uraemic toxicity, the therapeutic problem of A.R.I. in surgical patients has been examined: early peritoneal dialysis associated with T.P.F. and the combination, in the postoperative stage, of parenteral feeding and periodic peritoneal dialysis. The average duration of this treatment has been personally found to be about 8-18 days. The example is given of a clinical case of A.R.I. in a patient operated by aneurysmectomy for rupture of an aneurysm of the abdominal aorta. PMID:6801545

  14. Parenteral adenoviral boost enhances BCG induced protection, but not long term survival in a murine model of bovine TB.

    PubMed

    Kaveh, Daryan A; Garcia-Pelayo, M Carmen; Webb, Paul R; Wooff, Esen E; Bachy, Véronique S; Hogarth, Philip J

    2016-07-25

    Boosting BCG using heterologous prime-boost represents a promising strategy for improved tuberculosis (TB) vaccines, and adenovirus (Ad) delivery is established as an efficacious boosting vehicle. Although studies demonstrate that intranasal administration of Ad boost to BCG offers optimal protection, this is not currently possible in cattle. Using Ad vaccine expressing the mycobacterial antigen TB10.4 (BCG/Ad-TB10.4), we demonstrate, parenteral boost of BCG immunised mice to induce specific CD8(+) IFN-γ producing T cells via synergistic priming of new epitopes. This induces significant improvement in pulmonary protection against Mycobacterium bovis over that provided by BCG when assessed in a standard 4week challenge model. However, in a stringent, year-long survival study, BCG/Ad-TB10.4 did not improve outcome over BCG, which we suggest may be due to the lack of additional memory cells (IL-2(+)) induced by boosting. These data indicate BCG-prime/parenteral-Ad-TB10.4-boost to be a promising candidate, but also highlight the need for further understanding of the mechanisms of T cell priming and associated memory using Ad delivery systems. That we were able to generate significant improvement in pulmonary protection above BCG with parenteral, rather than mucosal administration of boost vaccine is critical; suggesting that the generation of effective mucosal immunity is possible, without the risks and challenges of mucosal administration, but that further work to specifically enhance sustained protective immunity is required. PMID:27317453

  15. Fish oil-based lipid emulsions prevent and reverse parenteral nutrition-associated liver disease: the Boston experience.

    PubMed

    de Meijer, Vincent E; Gura, Kathleen M; Le, Hau D; Meisel, Jonathan A; Puder, Mark

    2009-01-01

    Parenteral nutrition-associated liver disease (PNALD) is the most prevalent and most severe complication of long-term parenteral nutrition. Its underlying pathophysiology, however, largely remains to be elucidated. The currently approved parenteral lipid emulsions in the United States contain safflower or soybean oils, both rich in omega-6 polyunsaturated fatty acids (PUFAs). Mounting evidence indicates that the omega-6 PUFAs originating from plant oils in these lipid emulsions may play a role in the onset of liver injury. Fish oil-based lipid emulsions, in contrast, are primarily composed of omega-3 PUFAs, thus providing a promising alternative. The authors review the literature on the role of lipid emulsions in the onset of PNALD and discuss prevention and treatment strategies using a fish oil-based lipid emulsion. They conclude that a fish oil-based emulsion is hepatoprotective in a murine model of PNALD, and it appears to be safe and efficacious for the treatment of this type of liver disease in children. A prospective randomized trial that is currently under way at the authors' institution will objectively determine the place of fish oil monotherapy in the prevention of PNALD. PMID:19571170

  16. Supplemental Report: Application of Emission Spectroscopy to Monitoring Technetium

    SciTech Connect

    Spencer, W.A.

    2000-07-27

    This report provides supplemental information to an earlier report BNF-98-003-0199, ''Evaluation of Emission Spectroscopy for the On-Line Analysis of Technetium''. In this report data is included from real Hanford samples as well as for solutions spiked with technetium. This supplemental work confirms the ability of ICP-ES to monitor technetium as it breaks through an ion exchange process.

  17. Supplement use by Young Athletes

    PubMed Central

    McDowall, Jill Anne

    2007-01-01

    This paper reviews studies of supplement use among child and adolescent athletes, focusing on prevalence and type of supplement use, as well as gender comparisons. Supplement use among adult athletes has been well documented however there are a limited number of studies investigating supplement use by child and adolescent athletes. A trend in the current literature revealed that the most frequently used supplements are in the form of vitamin and minerals. While health and illness prevention are the main reasons for taking supplements, enhanced athletic performance was also reported as a strong motivating factor. Generally, females are found to use supplements more frequently and are associated with reasons of health, recovery, and replacing an inadequate diet. Males are more likely to report taking supplements for enhanced performance. Both genders equally rated increased energy as another reason for engaging in supplement use. Many dietary supplements are highly accessible to young athletes and they are particularly vulnerable to pressures from the media and the prospect of playing sport at increasingly elite levels. Future research should provide more direct evidence regarding any physiological side effects of taking supplements, as well as the exact vitamin and mineral requirements for child and adolescent athletes. Increased education for young athletes regarding supplement use, parents and coaches should to be targeted to help the athletes make the appropriate choices. Key pointsSupplement use among the child and adolescent athlete population is widespread with the most frequently used supplement being a form of vitamin/mineral supplement.The effects of supplement use on the growth and development of children and adolescents remain unclear and thus use of supplements by this population should be discouraged.It is likely that there is a misunderstanding as to the role of vitamins and minerals in the diet, their function in maintaining overall health, their role

  18. Proteomic analysis of plasma from rats following total parenteral nutrition-induced liver injury.

    PubMed

    Tsai, Jai-Jen; Kuo, Hsing-Chun; Lee, Kam-Fai; Tsai, Tung-Hu

    2015-11-01

    Total parenteral nutrition (TPN) is provided as the primary nitrogen source to manage patients with intestinal failure who were not able to sustain themselves on enteral feeds. The most common complication of long-term TPN use is hepatitis. A proteomic approach was used to identify proteins that are differentially expressed in the plasma of rats following TPN-related acute liver injury. Six male rats were randomly assigned to either the saline infusion control group or the TPN infusion group. Our results demonstrate that TPN infusion in rats resulted in hepatic dysfunction and hepatocyte apoptosis. Five proteins that were differentially expressed between TPN infusion and normal rats were determined and validated in vivo. Fascinatingly, the proteomic differential displays, downregulated proteins included peroxiredoxin 2 (PRDX2), alpha-1-antiproteinase (A1AT), and fibrinogen gamma chain (FIBG), which were involved in oxidative stress, inflammatory respondence and cells apoptosis. After TPN infusion, two protein spots showed increased expression, namely, the glucagon receptor (GLR) protein and apolipoprotein A-1 (APOA1), which may mediate the effects of TPN administration on glycogen and lipid metabolism. In this study, proteomic analysis suggested TPN-related acute liver injury could be involved in limiting cellular protection mechanisms against oxidative stress-induced apoptosis. On the basis of the results, we also give molecular evidences replying TPN-related hepatitis. PMID:26314240

  19. [Parenteral iron therapy in chronic kidney disease or chronic heart failure].

    PubMed

    Eisenga, Michele F; Diepenbroek, Adry; Swinkels, Dorine W; Bakker, Stephan J L; van der Meer, Peter; Gaillard, Carlo A J M

    2015-01-01

    Iron deficiency and anaemia occur frequently in patients with chronic kidney disease (CKD) or chronic heart failure (CHF) and are associated with lower quality of life and higher mortality. Treating anaemia with erythropoietic growth factors produces no improvement. In recent years, the focus has therefore shifted to correction of iron deficiency. Chronic inflammation in CKD increases the production of hepcidin, which blocks iron absorption from the intestine and leads to less efficient re-use of iron from the macrophages. In absolute iron deficiency the body's iron stores are depleted, whereas in functional iron deficiency the supply of iron is not sufficient to meet demand from the bone marrow. Normal or high ferritin levels do not exclude iron deficiency at tissue level. The iron saturation fraction is a more useful indicator. Parenteral iron therapy ameliorates in CHF the symptoms of iron deficiency, irrespective of the effect on haemoglobin levels. The long-term effects of intravenous iron on mortality and morbidity are still unknown. PMID:26374719

  20. Candida parapsilosis fungemia associated with parenteral nutrition and contaminated blood pressure transducers.

    PubMed

    Weems, J J; Chamberland, M E; Ward, J; Willy, M; Padhye, A A; Solomon, S L

    1987-06-01

    During the period September 1983 through May 1985, Candida parapsilosis was isolated from intravascular sites (blood or vascular catheter tips) in 12 patients at a pediatric hospital. Of 205 patients with cultures of any site positive for Candida species, 32 (16%) had cultures positive for C. parapsilosis. In contrast, of 23 patients with intravascular cultures positive for Candida species, 12 (51%) had cultures positive for C. parapsilosis (P less than 0.001, Fisher's exact test). The 12 patients with intravascular cultures positive for C. parapsilosis were more likely to have received central venous nutrition therapy (10 of 12 versus 7 of 23; P less than 0.01, Mantel-Haenzel chi-square test) and had a longer duration of exposure to blood pressure transducers (P less than 0.08, paired t test) than the 23 ward- and age-matched controls. C. parapsilosis was isolated from 11 (32%) of 34 in-use and stored blood pressure transducers. After ethylene oxide sterilization of blood pressure transducers was begun, in-use pressure transducers showed no growth of C. parapsilosis. This study emphasizes the role of C. parapsilosis as a nosocomial pathogen associated with invasive devices and parenteral nutrition; it also emphasizes the importance of adhering to recommended procedures for sterilizing blood pressure transducers. PMID:3110206

  1. DNA Vaccines: Protective Immunizations by Parenteral, Mucosal, and Gene-Gun Inoculations

    NASA Astrophysics Data System (ADS)

    Fynan, Ellen F.; Webster, Robert G.; Fuller, Deborah H.; Haynes, Joel R.; Santoro, Joseph C.; Robinson, Harriet L.

    1993-12-01

    Plasmid DNAs expressing influenza virus hemagglutinin glycoproteins have been tested for their ability to raise protective immunity against lethal influenza challenges of the same subtype. In trials using two inoculations of from 50 to 300 μg of purified DNA in saline, 67-95% of test mice and 25-63% of test chickens have been protected against a lethal influenza challenge. Parenteral routes of inoculation that achieved good protection included intramuscular and intravenous injections. Successful mucosal routes of vaccination included DNA drops administered to the nares or trachea. By far the most efficient DNA immunizations were achieved by using a gene gun to deliver DNA-coated gold beads to the epidermis. In mice, 95% protection was achieved by two immunizations with beads loaded with as little as 0.4 μg of DNA. The breadth of routes supporting successful DNA immunizations, coupled with the very small amounts of DNA required for gene-gun immunizations, highlight the potential of this remarkably simple technique for the development of subunit vaccines.

  2. Pharmacokinetics of gentamicin following single-dose parenteral administration to goats.

    PubMed

    Garg, S K; Verma, S P; Uppal, R P

    1995-01-01

    The disposition kinetics of parenterally administered gentamicin (5 mg kg-1) has been studied in Gaddi goats. The serum concentration-time profile was described by bi-exponential and mono-exponential equations following intravenous (i.v.), intramuscular (i.m.) and subcutaneous (s.c.) administration with elimination half-life values of 0.96 +/- 0.09, 2.37 +/- 0.47 and 3.56 +/- 0.39 h, respectively. The apparent volume of distribution following i.v. administration (Vdarea: 0.26 +/- 0.041 kg-1) reflected limited extracellular distribution of the drug. The bioavailability was higher following i.m. administration (96.3%) compared to s.c. (76.9%). In view of the significantly longer biological half-life and larger area under the curve values, the s.c. route may be preferred. It is concluded that a suitable and practical dosage recommendation for gentamicin in goats would be 3.35 mg kg-1 body weight given s.c. at 12 h intervals. PMID:7552201

  3. A risk for obstruction of the airways in the parenteral use of levomepromazine with benzodiazepine.

    PubMed

    Hatta, K; Takahashi, T; Nakamura, H; Yamashiro, H; Endo, H; Kito, K; Saeki, T; Masui, K; Yonezawa, Y

    1998-07-01

    Arrhythmogenic effects of phenothiazines appear to be associated with sudden death, whereas respiratory complications have received little attention. In this report we describe 5 cases with accompanying obstruction of the airways after intramuscular injections of levomepromazine (LPZ), a potent sedative phenothiazine, in combination with intravenous injections of benzodiazepine (BZ) during a 3-month period in a psychiatric intensive care unit. Two out of 5 cases were unpredictable because obstruction of the airways occurred 2 hours or more after the last injection. As compared with patients who received parenteral (intravenous or intramuscular) injections during the same period, the dose of intramuscular LPZ was significantly large in the 5 cases with obstruction of the airways. All 5 of these cases received intramuscular LPZ 0.52 mg/kg or more. In contrast, there was no patient with obstruction of the airways who received only intramuscular LPZ, the combination of LPZ and HDL, or BZ and HDL. The occurrence of obstruction of the airways among patients who received both intramuscular LPZ and intravenous BZ was significantly higher than among patients who received other drug regimes. These preliminary results suggest that the intramuscular use of LPZ with intravenous BZ may be a risk for obstruction of the airways. PMID:9754846

  4. [Parenteral S-adenosylmethionine compared to placebos in the treatment of alcoholic liver diseases].

    PubMed

    Diaz Belmont, A; Dominguez Henkel, R; Uribe Ancira, F

    1996-01-01

    The improvements in the knowledge of the action of ethanol over the hepatic cell, its direct action over the cell, and the intracytoplasmatic structures membranes, point out the possibilities of use of sulfo-adenosil-L-metionina (SAMe); as an util drug inn the treatment of the altered metilation reactions, that take place in those membranes, facilitating their physiological functions. The primary end point in this study was to demonstrate the therapeutic worth os SAMe, by parenteral route in 45 patients with alcoholic liver disease, which were determined by clinical laboratory and hepatic function test, label qith 32 points or more of the discriminatory function index. Divided into two groups, placebo-SAMe, randomized, double blind. As well as total plasmatic and reduced glutation and lipoperoxidation index, indirect form as malondehaldehyde. Were determined at the first visit anf after 8 and 15 days of treatment. Comparing the results of both groups there were a significative favorable results for the group treatment with SAMe and this confirms the utility of this drug in the treatment of patients with alcoholic liver disease with a discriminatory function index (Maddrey index), of 32 points or more. PMID:8679834

  5. Long- and medium-chain triglycerides during parenteral nutrition in critically ill patients.

    PubMed

    Delafosse, B; Viale, J P; Pachiaudi, C; Normand, S; Goudable, J; Bouffard, Y; Annat, G; Bertrand, O

    1997-04-01

    Due to their special metabolic pathway, medium-chain triglycerides (MCT) have been claimed to be oxidized more extensively, compared with long-chain triglycerides (LCT), when administered as a parenteral nutritional support. This enhanced lipid oxidation rate of MCT emulsions could be particularly disclosed in hyperglycemic and hyperinsulinemic conditions. In an attempt to further elucidate this question, we measured substrate oxidation rates in critically ill patients liable to experience such metabolic conditions, that is to say postoperative patients after esophageal resection receiving 1.5 times their measured energy expenditure (n = 12) or after liver transplantation (n = 8). These patients received either LCT or MCT-LCT emulsions. The metabolic measurements were performed simultaneously by two methods, namely indirect calorimetry and isotopic methods based on natural abundance of nutrients. Although both groups of patients were hyperglycemic and hyperinsulinemic, the measured carbohydrate and lipid oxidation rates were not different with whatever type of lipid was administered. The MCT-LCT emulsions did not offer clear-cut advantages over LCT emulsions in critically ill patients when lipid energetic fate was considered. PMID:9142873

  6. Homotypic and heterotypic immune responses to group A rotaviruses in parenterally immunized sheep.

    PubMed

    Beards, G M; King, J A; Mazhar, S; Landon, J; Desselberger, U

    1993-01-01

    Immune responses to human rotaviruses were investigated in sheep with a view to obtaining antibodies for passive immunotherapy of humans. Eighteen adult sheep with previous natural exposure to rotavirus serotypes G3 and G6 were immunized parenterally with purified preparations of either individual rotavirus serotypes G1, G2, G3, G4 and G8, or a mixture thereof. Two additional sheep were kept as control animals with the flock. The antibody responses were measured on serial serum samples by neutralization tests. The homotypic antibody response ranged from 100-fold (rarely) up to 100,000-fold increases in titre. Heterotypic responses against serotypes G3 and G6 were demonstrated in 7/12 and 15/18 sheep, respectively, but the increases in titre were lower than the homotypic responses, ranging from 10- to 100-fold in most cases and were 1000-fold in two sheep. Interestingly, no heterotypic response against the human rotavirus serotypes was raised after 3 months; moderate titres of cross-neutralizing antibodies for the human serotypes were only observed after a third inoculation. PMID:8382420

  7. Gamma irradiated micro system for long-term parenteral contraception: An alternative to synthetic polymers.

    PubMed

    Puthli, S; Vavia, P

    2008-11-15

    An injectable system of levonorgestrel (LNG) was developed using biodegradable polymer of natural origin. The parenteral system was optimized for particle size and higher drug loading. The microparticulate system was characterised by scanning electron microscopy, encapsulation efficiency, moisture content, IR, DSC, XRD, residual solvent content, sterility testing, test of abnormal toxicity and test for pyrogens. The microparticles were sterilised by gamma irradiation (2.5Mrad). The system was injected intramuscularly in rabbits and the blood levels of LNG were determined using radioimmunoassay technique. An optimized drug to polymer ratio of 0.3-1.0 (w/w ratio) gave improved drug loading of about 52%. In vivo studies in rabbits showed that the drug was released in a sustained manner for a period of 1 month. The AUC(0-t) was found to be 9363.6+/-2340pg/mLday(-1) with MRT calculated to be about 16 days and Kel of 0.01day(-1). LNG levels were maintained between 200 and 400pg/mL. In vivo release exhibited an initial burst effect which was not observed in the in vitro dissolution. This promising "Progestin-only" long-term contraceptive with improved user compliance is an alternative to the synthetic expensive polymeric carriers. PMID:18760352

  8. Organic solvents for pharmaceutical parenterals and embolic liquids: a review of toxicity data.

    PubMed

    Mottu, F; Laurent, A; Rufenacht, D A; Doelker, E

    2000-01-01

    Non-aqueous solvents have long been used in subcutaneous or intramuscular pharmaceutical formulations to dissolve water-insoluble drugs. In recent years, the need for these vehicles was increased since the drug discovery process has yielded many poorly water-soluble drugs. Besides, preparations containing embolic materials dissolved in undiluted non-aqueous water-miscible solvents have been proposed for the intravascular treatment of aneurysms, arteriovenous malformations, or tumors. These organic solvents, regarded as chemically and biologically inert, may show pharmacological and toxicological effects. Therefore, knowledge of tolerance and activity of non-aqueous solvents is essential before they can be administered, especially when given undiluted. This paper focuses on thirteen organic solvents reported as possible vehicles for injectable products and details toxicological data when they have been administered intravascularly. These solvents can be subdivided into three groups according to their description in the literature either for intravenous pharmaceutical parenterals or for intravascular embolic liquids: well-documented organic solvents (propylene glycol, polyethylene glycols, ethanol), solvents described in specific applications (dimethyl sulfoxide, N-methyl-2-pyrrolidone, glycofurol, Solketal, glycerol formal, acetone), and solvents not reported in intravascular applications but potentially useful (tetrahydrofurfuryl alcohol, diglyme, dimethyl isosorbide, ethyl lactate). This review of the literature shows that toxicity data on intravascular organic solvents are insufficient because they concern solvents diluted with water and because of the lack of comparative evaluation using the same methodologies. PMID:11107838

  9. Amino acid dosing in parenteral nutrition for very low birth weight preterm neonates: an outcome assessment.

    PubMed

    Kamarudin, Nor Aini; Manan, Mohamed Mansor; Zulkifly, Hanis Hanum; Neoh, Chin Fen; Ali, Salmiah Mohd; Ming, Long Chiau

    2016-01-01

    This study aimed to investigate the effects of parenteral nutrition (PN) administration of amino acids (AA) on physical changes among very low birth weight infants in a local hospital setting in Malaysia. A retrospective study was carried out at a hospital in Malaysia. Records of neonates prescribed PN in the neonatal unit in 2012 were screened for eligibility. A total of 199 premature neonates received PN support in the year 2012 and, of these, 100 fulfilled the inclusion criteria. The median value of AA intake on the first day of PN was 2.00 (<28 weeks group); 1.00 (28-31 weeks group) and 0.75 (>31 weeks group). Neonates in the <28 weeks group were more likely to receive AA at an earlier time and higher initial dose compared with the other age groups. The study also found that there was no statistically significant difference in the dose of AA on the first day of PN administration and that the significant variations in nutritional parameters among the subjects did not lead to differences in physical outcomes. This study identified that when PN is provided in the local hospital setting, it is likely that the current nutritional practices are inadequate to achieve the standard growth recommendations. Our findings call for a need to optimize AA and calorie intake since growth restriction is a morbidity which will affect the infants' growth and development. Current prescriptions for PN in this hospital need to be reviewed in order to improve patient outcomes. PMID:26965762

  10. Outpatient parenteral antibiotic therapy in a renal transplant population: A single-center experience.

    PubMed

    Harrison, Jade; Hossain, Mohammad Ayaz; Morsy, Mohamed; Ghazanfar, Abbas

    2015-11-01

    Outpatient parenteral antimicrobial therapy (OPAT) is a well-established method in medical specialties. Its use in renal transplant recipients has not been thoroughly explored. No guidelines within this patient subset exist. This study describes OPAT outcomes within a UK teaching hospital renal transplant population. Renal function, mapped by estimated glomerular filtration rate (eGFR), and clinical response to infection were collected retrospectively. A total of 635 antimicrobial episodes were administered to nine renal transplant patients over 12 discrete OPAT courses during the study period. Eleven of 12 OPAT courses (91.67%) produced a clinical improvement in infection. One course was terminated due to immunosuppressive-related neutropenia. No patient required admission due to failure of OPAT or adverse events. There was no significant change in graft function throughout the OPAT courses compared with baseline renal function (ANOVA, P = 0.06). One minor line infection was reported. This was treated conservatively and did not interrupt the OPAT. OPAT is safe and clinically effective in our renal transplant recipients with no significant deterioration in eGFR. The incidence of adverse events, specifically line complications, was lower in our population than those reported in the literature. Future work should develop OPAT guidelines designed for transplant recipients to outline the degree of monitoring required. PMID:26586048

  11. Role of parenteral iron in transfusion requirements after total hip replacement. A pilot study.

    PubMed

    Muñoz, M; Naveira, E; Seara, J; Palmer, J H; Cuenca, J; García-Erce, J A

    2006-04-01

    An important percentage of patients undergoing total hip replacement (THR) receive allogeneic blood transfusion (ABT) to avoid the risks of acute anaemia. However, concerns about the risks of ABT have led to the search for alternatives, such as stimulation of erythropoiesis. We prospectively investigated the effect of postoperative administration of 300 mg of intravenous iron sucrose on ABT requirements in THR patients (group 2; n = 24). A previous series of 22 THR patients served as the control group (group 1). All patients were operated on by the same surgeon, using the same implant, and a set of clinical data was gathered. No adverse reactions to iron administration were observed. The group-given iron showed a trend to a lower transfusion rate (46 vs. 73%; P = 0.067) and lower transfusion index (0.96 vs. 1.68 units/patient; P = 0.038). Moreover, amongst the non-transfused patients, admission haemoglobin levels were lower in those coming from the iron group than those from the control group (12.7 +/- 0.9 vs. 14.0 +/- 1.2 g dL(-1), respectively; P = 0.017). Postoperative parenteral iron administration could be a safe and effective way to reduce ABT requirements in the THR patients. A large, randomized controlled trial to confirm these results is warranted. PMID:16623920

  12. Particulate matter test in small volume parenterals: critical aspects in sampling methodology.

    PubMed

    Pavanetto, F; Conti, B; Genta, I; Ponci, R; Montanari, L; Grassi, M

    1989-06-01

    The following critical steps of the particulate matter test sampling methodology for small volume parenteral products (SVPs), conduct by light blockage method, were considered: 1) reliability of the small volume aspirator sampler for different sample volumes; 2) particulate matter distribution inside each ampoule in liquid products (8 liquid SVPs tested); 3) influence of the sample preparation method on the evaluation of the final contamination of the sample. Nine liquid SVPs were tested by preparing samples following the three U.S.P. XXI methods: 1) unit as it is (direct analysis), II) unit diluted, III) sample obtained by combining several units. Particles counts were performed by a HIAC/ROYCO model 3000 counter fitted with a small volume sampler. The validation of the sampler shows that it should be improved. A more accurate and strict validation than the one stated by U.S.P. XXI is suggested. The particulate matter distribution in liquid products is found to be uniform inside the ampoule in the size range greater than or equal to 2 microns-greater than or equal to 10 microns; the analysis can be performed examining only a portion of the whole content. The three sample preparation methods lead to significantly different contamination results. The particulate control test should be conduct by direct analysis, as it is carried out under the same conditions as for product use. The combining method (III) is suggested for products of less than 2 ml volume that cannot be examined by direct analysis. PMID:2803449

  13. Home parenteral nutrition and the psyche: Psychological challenges for patient and family.

    PubMed

    Stern, Julian

    2006-08-01

    The paper discusses the case histories of three patients who have faced the emotional implications of being initiated onto long-term parenteral nutrition (PN). In each case the patient's personal and family history, relationship to their illness and the presence or relative absence of resentments and grievances have influenced their ability to tolerate the training and the transition to home PN (HPN). In addition, the emotional importance of food and feeding from a developmental and social perspective is explored, together with the numerous psychological and social 'losses' experienced by all patients on PN and the adaptations required within the family setting. The 'meaning' of PN to the individual and the need for both internal and external support are identified and, based on clinical experience, a number of features are described that may be indicative of the relative abilities of different patients to cope with HPN. Finally, the role of a dedicated Psychological Medicine Unit closely allied to a nutrition service is discussed. PMID:16923306

  14. A nutrition support service web application to manage patients receiving parenteral nutrition.

    PubMed

    Mirtallo, Jay M; Hawksworth, Kim; Payne, Brett

    2009-01-01

    Parenteral nutrition (PN) is a complex therapy that requires expertise and experience to avoid errors in prescribing and management. Because of care coordination issues, one medical center has developed and implemented a Web-based application to manage PN patients. PN orders have already been programmed into the physician order entry system, but the nutrition support service (NSS) consult and daily PN management have been performed using paper forms. The Web system is developed for ease of use by clinicians and accessibility at any computer within the medical center. The database consists of 12 tables interrelated by the patient medical record number, admission number, or location. The NSS consult is the main table used to navigate to the other tables. Update of the laboratory and PN formula table must be done through the consult table. The system is compliant with the Health Insurance Portability and Accountability Act guidelines, and has been developed so that the forms that are required to be placed in the patient's permanent record can be printed. Demographic information and laboratory data are automatically populated via a link to the medical center's medication management system. At present, there are 1393 patients in the database and 21,000 pages are viewed each month during daily PN management by clinicians. Data can be easily retrieved for management reports. Data elements can be exported directly from the database to worksheets. This function has been used for projects designed to improve the efficiency of this PN system. PMID:19605799

  15. Non-surgical oncology – Guidelines on Parenteral Nutrition, Chapter 19

    PubMed Central

    Arends, J.; Zuercher, G.; Dossett, A.; Fietkau, R.; Hug, M.; Schmid, I.; Shang, E.; Zander, A.

    2009-01-01

    Reduced nutritional state is associated with unfavourable outcomes and a lower quality of life in patients with malignancies. Patients with active tumour disease frequently have insufficient food intake. The resting energy expenditure in cancer patients can be increased, decreased, or remain unchanged compared to predicted values. Tumours may result in varying degrees of systemic pro-inflammatory processes with secondary effects on all significant metabolic pathways. Therapeutic objectives are to stabilise nutritional state with oral/enteral nutrition and parenteral nutrition (PN) and thus to prevent or reduce progressive weight loss. The maintenance or improvement of quality of life, and the increase in the effectiveness and a reduction in the side-effects of antitumor therapy are further objectives. Indications for PN in tumour patients are essentially identical to those in patients with benign illnesses, with preference given to oral or enteral nutrition when feasible. A combined nutritional concept is preferred if oral or enteral nutrition are possible but not sufficient. There are generally no accepted standards for ideal energy and nutrient intakes in oncological patients, particularly when exclusive artificial nutrition is administered. The use of PN as a general accompaniment to radiotherapy or chemotherapy is not indicated, but PN is indicated in chronic severe radiogenic enteritis or after allogenic transplantation with pronounced mucositis or GvH-related gastrointestinal damage for prolonged periods, with particular attention to increased risk of bleeding and infection. No PN is necessary in the terminal phase. PMID:20049066

  16. Medical intelligence in Sweden. Vitamin B12: oral compared with parenteral?

    PubMed Central

    Nilsson, M; Norberg, B; Hultdin, J; Sandstrom, H; Westman, G; Lokk, J

    2005-01-01

    Background: Sweden is the only country in which oral high dose vitamin B12 has gained widespread use in the treatment of deficiency states. Objective: The aim of the study was to describe prescribing patterns and sales statistics of vitamin B12 tablets and injections in Sweden 1990–2000. Design, setting, and sources: Official statistics of cobalamin prescriptions and sales were used. Results: The use of vitamin B12 increased in Sweden 1990–2000, mainly because of an increase in the use of oral high dose vitamin B12 therapy. The experience, in statistical terms a "total investigation", comprised 1 000 000 patient years for tablets and 750 000 patient years for injections. During 2000, 13% of residents aged 70 and over were treated with vitamin B12, two of three with the tablet preparation. Most patients in Sweden requiring vitamin B12 therapy have transferred from parenteral to oral high dose vitamin B12 since 1964, when the oral preparation was introduced. Conclusion: The findings suggest that many patients in other post-industrial societies may also be suitable for oral vitamin B12 treatment. PMID:15749797

  17. In vitro hemorheological effects of parenteral agents used in peripheral arterial disease

    NASA Astrophysics Data System (ADS)

    Biro, Katalin; Sandor, Barbara; Toth, Andras; Koltai, Katalin; Papp, Judit; Rabai, Miklos; Toth, Kalman; Kesmarky, Gabor

    2014-05-01

    Peripheral arterial disease (PAD) is a frequent manifestation of systemic atherosclerosis. In PAD hemorheological parameters were defined as risk factors in a number of studies and several therapeutic agents were tried in these conditions. Our study aims to investigate and compare the in vitro hemorheological effects of various drugs generally used in the parenteral treatment of intermittent claudication and critical limb ischemia. Blood samples of healthy male volunteers were incubated with iloprost, alprostadil, pentoxifylline, sulodexide or pentosan polysulfate at calculated therapeutic serum concentration. Hematocrit (Hct) was determined by microhematocrit centrifuge. Plasma and apparent whole blood viscosities (WBV) were evaluated by capillary viscometer. Red blood cell aggregation was measured by LORCA (laserassisted optical rotational cell analyzer) aggregometer, and LORCA ektacytometer was used for measuring erythrocyte deformability at 37°C. Iloprost, alprostadil, and pentoxifylline incubation did not have any significant effect on plasma and apparent WBV. Elongation index increased in samples incubated with alprostadil at low shear stresses 0.95 and 0.53 Pa (p < 0.05). Sulodexide significantly improved WBV and Hct/WBV ratio (p < 0.05). Incubation with pentosan polysulfate resulted in higher WBV, lower Hct/WBV ratio and deterioration in the aggregation parameters (p < 0.05). Sulodexide may have beneficial effect on a macrorheological parameter; alprostadil may improve a microrheological parameter. Hemorheological alterations could be important in PAD patients with hampered vasodilator capacity.

  18. Influence of parenteral nutrition on phospholipid metabolism in posttraumatic rat lungs.

    PubMed

    Bahrami, S; Gasser, H; Redl, H; Strohmaier, W; Schlag, G

    1986-01-01

    In the current investigation, we studied two groups of rats--one group supplied exogenous phospholipid precursors (carbohydrate plus fat emulsion group) and the other given only calories (carbohydrate group)--to evaluate the effects on surfactant composition by normocaloric alimentation, using a hypovolemic-traumatic shock model. The total phospholipid (PHL) contents of lung tissue were similar in both groups. However, we found differences in the dipalmitoylphosphatidylcholine fraction (DPPC--the most important component of surfactant material) in both lung tissue and lavage fluid. With lipid emulsion, there was an increased fraction of saturated lecithins (mainly DPPC) both in lung tissue and lavage fluid, similar to former studies with hypocaloric alimentation. In this model, those findings suggest that the PHL pattern does not depend on the quantity of caloric supply, but, rather, on the infusion composition. The enhanced DPPC content is further reflected in improved surfactant status: lipid in parenteral nutrition (PN) may exert a direct salutary effect on lung mechanics. PMID:3099005

  19. Successful Combined Treatment with Total Parenteral Nutrition Fluid Extravasation Injuries in Preterm Infants

    PubMed Central

    Cho, Ky Young; Lee, Soo Jung; Burm, Jin Sik

    2007-01-01

    Extravasation injuries in the neonatal intensive care unit are not rare during parenteral hyperalimentation. There have been many different methods of management. We report five premature infants with wounds of hyperalimentation fluid extravasation managed by the antibacterial ointment (Terramycin ophthalmic ointment™) and sesame oil and a antiinflammatory herbal mixture (MEBO™). The mean gestational age of patients was 31+2 weeks (range, 28+4 to 35+6 weeks), and the mean weight at extravasation was 1,930 g (range, 1,140 to 2,680 g). Extravasation occurred within the mean of 32 days (range, 17 to 50 days). The method of dressing was application of a thick layer of this mixture covered by vaseline and wet gauze renewed at an interval of 8-12 hr after irrigating the wounds thoroughly with normal saline. The mean duration of dressing was 30 days (range, 20-50 days). The wounds had healed completely leaving a small size of contracture without functional abnormality. We conclude that this therapy may be considered for an alternative treatment and warrants clinical trials for the confirmation of the local management of extravasation injury. PMID:17596679

  20. Physiological effects of enteral and parenteral feeding on pancreaticobiliary secretion in humans.

    PubMed

    O'Keefe, Stephen J D; Lee, Ronzo B; Anderson, Frank P; Gennings, Chris; Abou-Assi, Souheil; Clore, John; Heuman, Douglas; Chey, William

    2003-01-01

    In the nutritional management of digestive disorders, it is important to know the relative secretory and metabolic responses to enteral and parenteral feeding. Twenty-seven healthy volunteers were studied while receiving either oral drinks or duodenal infusions of a complex formula diet, duodenal or intravenous infusions of elemental (protein as free amino acids, low fat) formulae, or saline. Pancreaticobiliary secretory responses were measured by nasoduodenal polyethylene glycol perfusion and aspiration, while monitoring blood hormone and nutrient levels. Diets were matched for protein (1.5 g x kg(-1) x d(-1)) and energy (40 kcal x kg(-1) x d(-1)). Compared with placebo, all oroenteral diets stimulated amylase, lipase, trypsin, and bile acid secretion and increased plasma concentrations of gastrin and cholecystokinin, whereas intravenous feeding did not. The complex formula produced a similar response whether given as drinks or duodenal infusions. Changing the duodenal formula to elemental reduced enzyme secretion by 50%, independently of CCK. Higher increases in plasma insulin, glucose, and amino acids were noted with intravenous feeding. Delivering food directly to the intestine by a feeding tube does not reduce pancreaticobiliary secretion. Enteral "elemental" formulae diminish, but only intravenous feeding avoids pancreatic stimulation. Intravenous administration impairs metabolic clearance. PMID:12488233

  1. Oral and parenteral immunization of chickens (Gallus gallus) against West Nile virus with recombinant envelope protein

    USGS Publications Warehouse

    Fassbinder-Orth, C. A.; Hofmeister, E.K.; Weeks-Levy, C.; Karasov, W.H.

    2009-01-01

    West Nile virus (WNV) causes morbidity and mortality in humans, horses, and in more than 315 bird species in North America. Currently approved WNV vaccines are designed for parenteral administration and, as yet, no effective oral WNV vaccines have been developed. WNV envelope (E) protein is a highly antigenic protein that elicits the majority of virus-neutralizing antibodies during a WNV immune response. Leghorn chickens were given three vaccinations (each 2 wk apart) of E protein orally (20 ??g or 100 ??g/dose), of E protein intramuscularly (IM, 20 ??g/dose), or of adjuvant only (control group) followed by a WNV challenge. Viremias were measured post-WNV infection, and three new enzyme-linked immunosorbent assays were developed for quantifying IgM, IgY, and IgA-mediated immune response of birds following WNV infection. WNV viremia levels were significantly lower in the IM group than in both oral groups and the control group. Total WNV E protein-specific IgY production was significantly greater, and WNV nonstructural 1-specific IgY was significantly less, in the IM group compared to all other treatment groups. The results of this study indicate that IM vaccination of chickens with E protein is protective against WNV infection and results in a significantly different antibody production profile as compared to both orally vaccinated and nonvaccinated birds. ?? 2009 American Association of Avian Pathologists.

  2. Total parenteral nutrition (TPN) at home: prototype high-tech home care nursing.

    PubMed

    Davis, J H

    1996-01-01

    Current economic and demographic trends in the United States indicate the demand for complex treatments, such as infusion therapies at home, will continue to escalate. In light of the increasingly acute and autonomous nature of home health practice, examination of home care nursing process affecting patient care outcomes is crucial. This study explored the cognitive, technical, and interpersonal components included in total parenteral nutrition (TPN) home care nursing. The purpose of this study was to evaluate psychometrically the Schmele Instrument to Measure the Process of Nursing Practice in Home Health (SIMP-H) so that it may be used to examine high-tech home care nursing process. Home visits must be observed to identify the specific cognitive, technical, and interpersonal components included in high-tech home care nursing that are important for patient care outcomes. This study captured high-tech home care nursing process on videotape, which provided a medium for evaluating interobserver reliability for the SIMP-H. Results revealed an interobserver reliability coefficient of .72. PMID:9025400

  3. Safety of parenteral nutrition in patients receiving a ventricular assist device.

    PubMed

    Scurlock, Corey; Pinney, Sean P; Lin, Hung-Mo; Potenza, Matthew; Weiss, Aaron J; Zaidi, Neeha; Anyanwu, Anelechi; Mechanick, Jeffrey I

    2014-01-01

    Patients with advanced heart failure and poor nutritional status are predisposed to higher rates of infection, bleeding, and mortality. We have increasingly used perioperative parenteral nutrition (PN) in ventricular assist device (VAD) patients and now report our initial experience. We performed a retrospective review of 43 consecutive patients who received implantable VADs from 2006 to 2009. We compared outcomes for patients receiving PN for >7 days perioperatively vs ≤7 days. In addition, we compared patients who received preoperative enteral nutrition (EN) with those who did not. Fourteen patients received perioperative PN in addition to EN for >7 days compared with 29 patients who received either PN for ≤7 days or EN alone. Univariate analysis showed no differences in infection, bleeding, thrombus, stroke, length of stay, or mortality. Multivariate stepwise regression including EN, preoperative PN, Interagency Registry for Mechanically Assisted Circulation score, age, gender, and VAD indication showed that only EN was associated with infection. Prolonged use of perioperative PN appears to be safe and well tolerated in patients undergoing VAD implantation. Preoperative EN, while increasing infection risk, seems to have no harmful effect on survival. PMID:24658517

  4. Psychology: Teacher Supplement.

    ERIC Educational Resources Information Center

    Stark, Rebecca

    This supplement provides teachers with tests, quizzes, answers to questions in the text, and general teaching information for using the student text, "Psychology," by Rebecca Stark. Quizzes included are on the topics of human development; the nervous system; the brain; cognitive development; sensation and perception; conditioning; learning;…

  5. Speechreading with Tactile Supplements.

    ERIC Educational Resources Information Center

    Plant, Geoff

    1988-01-01

    Reviewed is the historical development of tactile aids to supplement speechreading by hearing-impaired individuals, from early use of bone conduction vibrators driven by hearing aids, to multichannel tactile aids representing the full speech spectrum and tactile speechreading aids complementing visual cues. Adequate training in use of tactile…

  6. Supplemental TV Taped Problems.

    ERIC Educational Resources Information Center

    Squires, Robert G.; Frank, David V.

    1983-01-01

    Videotapes were developed as supplemental material for a course in chemical engineering thermodynamics. Describes the course, videotapes produced (includes list by topics as related to course content), and effectiveness of the tapes. Although no significant improvement in test performance was noted, students indicated they learned material faster…

  7. Lead in calcium supplements.

    PubMed

    Scelfo, G M; Flegal, A R

    2000-04-01

    Intercalibrated measurements of lead in calcium supplements indicate the importance of rigorous analytical techniques to accurately quantify contaminant exposures in complex matrices. Without such techniques, measurements of lead concentrations in calcium supplements may be either erroneously low, by as much as 50%, or below the detection limit needed for new public health criteria. In this study, we determined the lead content of 136 brands of supplements that were purchased in 1996. The calcium in the products was derived from natural sources (bonemeal, dolomite, or oyster shell) or was synthesized and/or refined (chelated and nonchelated calcium). The dried products were acid digested and analyzed for lead by high resolution-inductively coupled plasma-mass spectrometry. The method's limit of quantitation averaged 0.06 microg/g, with a coefficient of variation of 1.7% and a 90-100% lead recovery of a bonemeal standard reference material. Two-thirds of those calcium supplements failed to meet the 1999 California criteria for acceptable lead levels (1.5 microg/daily dose of calcium) in consumer products. The nonchelated synthesized and/or refined calcium products, specifically antacids and infant formulas, had the lowest lead concentrations, ranging from nondetectable to 2.9 microg Pb/g calcium, and had the largest proportion of brands meeting the new criteria (85% of the antacids and 100% of the infant formulas). PMID:10753088

  8. Lead in calcium supplements.

    PubMed Central

    Scelfo, G M; Flegal, A R

    2000-01-01

    Intercalibrated measurements of lead in calcium supplements indicate the importance of rigorous analytical techniques to accurately quantify contaminant exposures in complex matrices. Without such techniques, measurements of lead concentrations in calcium supplements may be either erroneously low, by as much as 50%, or below the detection limit needed for new public health criteria. In this study, we determined the lead content of 136 brands of supplements that were purchased in 1996. The calcium in the products was derived from natural sources (bonemeal, dolomite, or oyster shell) or was synthesized and/or refined (chelated and nonchelated calcium). The dried products were acid digested and analyzed for lead by high resolution-inductively coupled plasma-mass spectrometry. The method's limit of quantitation averaged 0.06 microg/g, with a coefficient of variation of 1.7% and a 90-100% lead recovery of a bonemeal standard reference material. Two-thirds of those calcium supplements failed to meet the 1999 California criteria for acceptable lead levels (1.5 microg/daily dose of calcium) in consumer products. The nonchelated synthesized and/or refined calcium products, specifically antacids and infant formulas, had the lowest lead concentrations, ranging from nondetectable to 2.9 microg Pb/g calcium, and had the largest proportion of brands meeting the new criteria (85% of the antacids and 100% of the infant formulas). Images Figure 1 Figure 2 PMID:10753088

  9. Examples of Dietary Supplement Interactions

    MedlinePlus

    ... the risk of bruising and bleeding. Supplement: Goldenseal Root Possible drug-supplement interaction with: Cyclosporine. Can decrease ... using the liver's cytochrome P450 enzyme system. Goldenseal root may decrease how quickly the liver breaks down ...

  10. Weight Loss Nutritional Supplements

    NASA Astrophysics Data System (ADS)

    Eckerson, Joan M.

    Obesity has reached what may be considered epidemic proportions in the United States, not only for adults but for children. Because of the medical implications and health care costs associated with obesity, as well as the negative social and psychological impacts, many individuals turn to nonprescription nutritional weight loss supplements hoping for a quick fix, and the weight loss industry has responded by offering a variety of products that generates billions of dollars each year in sales. Most nutritional weight loss supplements are purported to work by increasing energy expenditure, modulating carbohydrate or fat metabolism, increasing satiety, inducing diuresis, or blocking fat absorption. To review the literally hundreds of nutritional weight loss supplements available on the market today is well beyond the scope of this chapter. Therefore, several of the most commonly used supplements were selected for critical review, and practical recommendations are provided based on the findings of well controlled, randomized clinical trials that examined their efficacy. In most cases, the nutritional supplements reviewed either elicited no meaningful effect or resulted in changes in body weight and composition that are similar to what occurs through a restricted diet and exercise program. Although there is some evidence to suggest that herbal forms of ephedrine, such as ma huang, combined with caffeine or caffeine and aspirin (i.e., ECA stack) is effective for inducing moderate weight loss in overweight adults, because of the recent ban on ephedra manufacturers must now use ephedra-free ingredients, such as bitter orange, which do not appear to be as effective. The dietary fiber, glucomannan, also appears to hold some promise as a possible treatment for weight loss, but other related forms of dietary fiber, including guar gum and psyllium, are ineffective.

  11. A survey of the current clinical practice of psychiatrists and accident and emergency specialists in the United Kingdom concerning vitamin supplementation for chronic alcohol misusers.

    PubMed

    Hope, L C; Cook, C C; Thomson, A D

    1999-01-01

    Although it is well known that B-vitamin deficiencies directly affecting the brain are common in alcohol misuse, no concise guidelines on the use of vitamin supplements in alcohol misusers currently exist in the UK. The purpose of this study was to assess current practice and opinion among UK physicians. Questionnaires were completed by a total of 427 physicians comprising Accident and Emergency (A&E) specialists and psychiatrists, with a response rate of 25%. The main findings were that vitamin deficiency was perceived as being uncommon amongst alcohol misusers (<25%) and there was no consensus as to which B vitamins are beneficial in treatment or the best method of administration of B-vitamin supplementation. The majority of psychiatrists favoured oral administration for prophylaxis against the Wernicke-Korsakoff syndrome in chronic alcohol misusers and parenteral therapy in patients with signs of Wernicke-Korsakoff syndrome. Whilst only just over half the A&E specialists expressed a preference, most favoured parenteral therapy in both cases. Most respondents did not currently have a unit policy/protocol on the management of vitamin supplementation in chronic alcohol misusers. Overall, the findings suggest that there is wide variation in current practice and highlight the need for guidelines in this area. PMID:10659721

  12. Herbs, Supplements and Alternative Medicines

    MedlinePlus

    ... not been able to prove that dietary or herbal supplements (including omega-3 supplements, cinnamon, and other herbs) ... of people with diabetes used some type of herbal therapy , while another study found that 31 percent used dietary supplements . Certain ethnic groups, such as Hispanics, Native Americans, ...

  13. Supplemental tooth in primary dentition

    PubMed Central

    Mohan, Ravi Prakash Sasankoti; Verma, Sankalp; Singh, Udita; Agarwal, Neha

    2014-01-01

    An extra tooth causing numerical excess in dentition is described as supernumerary tooth, and the resultant condition is termed as hyperdontia. Hyperdontia is more commonly seen in the permanent dentition than primary one. Supernumerary tooth which resembles tooth shape and supplements for occlusion is called as supplemental tooth. We present a case with supplemental tooth in primary dentition. PMID:24913075

  14. Vitamin and Mineral Supplement Fact Sheets

    MedlinePlus

    ... Tables Online DRI Tool Daily Value (DV) Tables Vitamin and Mineral Supplement Fact Sheets Search the list ... Supplements: Background Information Botanical Dietary Supplements: Background Information Vitamin and Mineral Fact Sheets Botanical Supplement Fact Sheets ...

  15. [ERGOGENIC SPORT SUPPLEMENTS FOR ATHLETES].

    PubMed

    Arieli, Rakefet; Lahav, Yair

    2016-06-01

    Use of performance-enhancing supplements occurs at all levels of sports, from recreational athletes to professional athletes. Although some supplements do enhance athletic performance, many have no proven benefits and have adverse effects. Nutritional supplements are categorized into the following categories: I. Apparently Effective. II. Possibly Effective. III. Too Early To Tell. IV. Apparently Ineffective. This article will review 4 ergogenic supplements which are categorized in the first category--"Apparently Effective"--1) Buffer agents 2) Creatine 3) Caffeine and 4 Nitric Oxide. Given the widespread use of performance enhancing supplements, physicians, and dietitians should be prepared to counsel athletes about their effectiveness, safety and legality. PMID:27544991

  16. Effective Nutritional Supplement Combinations

    NASA Astrophysics Data System (ADS)

    Cooke, Matt; Cribb, Paul J.

    Few supplement combinations that are marketed to athletes are supported by scientific evidence of their effectiveness. Quite often, under the rigor of scientific investigation, the patented combination fails to provide any greater benefit than a group given the active (generic) ingredient. The focus of this chapter is supplement combinations and dosing strategies that are effective at promoting an acute physiological response that may improve/enhance exercise performance or influence chronic adaptations desired from training. In recent years, there has been a particular focus on two nutritional ergogenic aids—creatine monohydrate and protein/amino acids—in combination with specific nutrients in an effort to augment or add to their already established independent ergogenic effects. These combinations and others are discussed in this chapter.

  17. Nutrition and nutritional supplementation

    PubMed Central

    Manissier, Patricia

    2009-01-01

    Skin acts as a natural barrier between internal and external environments thus plays an important role in vital biological functions such as protection against mechanical/chemical damages, micro-organisms, ultraviolet damage. Nutrition has a critical impact on strengthening skin’s capabilities to fight against these multiple aggressions. Nutritional deficiencies are often associated with skin health disorders, while diets can either positively or negatively influence skin condition. More recently, the concept of nutritional supplementation has emerged as a new strategy in the daily practice of dermatology as well as a complementary approach to topical cosmetics in the field of beauty. Focusing on human clinical data, this paper proposes to illustrate the link between skin health and nutrition and to exemplify the beneficial actions of nutritional supplementation in skin health and beauty. PMID:20808515

  18. Parenteral Adjuvant Effects of an Enterotoxigenic Escherichia coli Natural Heat-Labile Toxin Variant

    PubMed Central

    Braga, Catarina J. M.; Rodrigues, Juliana F.; Medina-Armenteros, Yordanka; Farinha-Arcieri, Luís E.; Ventura, Armando M.; Boscardin, Silvia B.; Sbrogio-Almeida, Maria E.; Ferreira, Luís C. S.

    2014-01-01

    Native type I heat-labile toxins (LTs) produced by enterotoxigenic Escherichia coli (ETEC) strains exert strong adjuvant effects on both antibody and T cell responses to soluble and particulate antigens following co-administration via mucosal routes. However, inherent enterotoxicity and neurotoxicity (following intra-nasal delivery) had reduced the interest in the use of these toxins as mucosal adjuvants. LTs can also behave as powerful and safe adjuvants following delivery via parenteral routes, particularly for activation of cytotoxic lymphocytes. In the present study, we evaluated the adjuvant effects of a new natural LT polymorphic form (LT2), after delivery via intradermal (i.d.) and subcutaneous (s.c.) routes, with regard to both antibody and T cell responses. A recombinant HIV-1 p24 protein was employed as a model antigen for determination of antigen-specific immune responses while the reference LT (LT1), produced by the ETEC H10407 strain, and a non-toxigenic LT form (LTK63) were employed as previously characterized LT types. LT-treated mice submitted to a four dose-base immunization regimen elicited similar p24-specific serum IgG responses and CD4+ T cell activation. Nonetheless, mice immunized with LT1 or LT2 induced higher numbers of antigen-specific CD8+ T cells and in vivo cytotoxic responses compared to mice immunized with the non-toxic LT derivative. These effects were correlated with stronger activation of local dendritic cell populations. In addition, mice immunized with LT1 and LT2, but not with LTK63, via s.c. or i.d. routes developed local inflammatory reactions. Altogether, the present results confirmed that the two most prevalent natural polymorphic LT variants (LT1 or LT2) display similar and strong adjuvant effects for subunit vaccines administered via i.d. or s.c. routes. PMID:24432018

  19. Patient-reported outcomes of parenteral somatostatin analogue injections in 195 patients with acromegaly

    PubMed Central

    Strasburger, Christian J; Karavitaki, Niki; Störmann, Sylvère; Trainer, Peter J; Kreitschmann-Andermahr, Ilonka; Droste, Michael; Korbonits, Márta; Feldmann, Berit; Zopf, Kathrin; Sanderson, Violet Fazal; Schwicker, David; Gelbaum, Dana; Haviv, Asi; Bidlingmaier, Martin; Biermasz, Nienke R

    2016-01-01

    Background Long-acting somatostatin analogues delivered parenterally are the most widely used medical treatment in acromegaly. This patient-reported outcomes survey was designed to assess the impact of chronic injections on subjects with acromegaly. Methods The survey was conducted in nine pituitary centres in Germany, UK and The Netherlands. The questionnaire was developed by endocrinologists and covered aspects of acromegaly symptoms, injection-related manifestations, emotional and daily life impact, treatment satisfaction and unmet medical needs. Results In total, 195 patients participated, of which 112 (57%) were on octreotide (Sandostatin LAR) and 83 (43%) on lanreotide (Somatuline Depot). The majority (>70%) of patients reported acromegaly symptoms despite treatment. A total of 52% of patients reported that their symptoms worsen towards the end of the dosing interval. Administration site pain lasting up to a week following injection was the most frequently reported injection-related symptom (70% of patients). Other injection site reactions included nodules (38%), swelling (28%), bruising (16%), scar tissue (8%) and inflammation (7%). Injection burden was similar between octreotide and lanreotide. Only a minority of patients received injections at home (17%) and 5% were self-injecting. Over a third of patients indicated a feeling of loss of independence due to the injections, and 16% reported repeated work loss days. Despite the physical, emotional and daily life impact of injections, patients were satisfied with their treatment, yet reported that modifications that would offer major improvement over current care would be ‘avoiding injections’ and ‘better symptom control’. Conclusion Lifelong injections of long-acting somatostatin analogues have significant burden on the functioning, well-being and daily lives of patients with acromegaly. PMID:26744896

  20. Prospective study of the aetiology of infusion phlebitis and line failure during peripheral parenteral nutrition.

    PubMed

    May, J; Murchan, P; MacFie, J; Sedman, P; Donat, R; Palmer, D; Mitchell, C J

    1996-08-01

    Four techniques of administering peripheral parenteral nutrition (PPN) were examined prospectively to investigate the role of mechanical trauma in the development of infusion phlebitis. Patients in group 1 (n = 15) were fed via a standard 18-G Teflon cannula which was removed on completion of the infusion and was rotated to the contralateral arm every day. Group 2 patients (n = 15) had a similar catheter sited in each forearm simultaneously, with rotation of the side of infusion each day. Patients in group 3 (n = 17) had a 15-cm Silastic rubber catheter inserted into a forearm vein and a standard cannula sited in the contralateral forearm, with alternation of infusion each day. Those in group 4 (n = 13) had a fine-bore 23-G silicone catheter sited in one arm only. Patients in groups 1, 2 and 3 were fed over 12-h cycles and those in group 4 for a 24-h continuous cycle. A total of 408 patient-days of PPN were given. Mean duration of PPN in groups 1-4 was 7.5, 9, 5.5 and 5 days respectively. Infusion phlebitis was not recorded in patients who had a daily change of cannula (group 1), but occurred in four patients in group 2, eight in group 3 and eight in group 4. Phlebitis scores were 0, 9, 15 and 12 for groups 1-4 respectively. Severe phlebitis and line occlusion occurred more frequently in patients with a 15-cm catheter (group 3) and in those fed continuously over 24 h (group 4). These results suggest that mechanical trauma is an important factor in the aetiology of infusion phlebitis. This can be minimized by reducing the time for which the vein wall is exposed to nutrient infusion and by reducing the amount of prosthetic material within the vein. PMID:8869311

  1. Effects of orally vs. parenterally administrated trimebutine on gastrointestinal and colonic motility in dogs.

    PubMed

    Buéno, L; Hondé, C; Pascaud, X; Junien, J L

    1987-01-01

    The influence of oral administration and intravenous infusion of trimebutine maleate (TMB) and N-desmethyl TMB (NDTMB), its main metabolite, was investigated in conscious dogs equipped with chronically implanted strain-gauges. In fasted dogs, TMB (10 to 20 mg/kg per os) delayed the occurrence of the next activity front on both stomach and duodenum by reinforcing the duration of the intestinal phase II. It also induced the occurrence of an additional migrating phase III. These effects were associated with a colonic stimulation generally followed by an inhibition. Comparatively NDTMB at similar dosages disrupted the antral cyclic phases which were replaced by continuous low amplitude contractions during 5-7 h. The MMC pattern persisted with a significant increase in the duration of phase II, and the colonic motility was inhibited during 4.3 to 6.7 h. Infused intravenously at a dose of 3 mg X kg-1 X h-1, TMB immediately inhibited the gastric cyclic contractions in fasted dogs. As for the oral route, the small bowel exhibited an increase in the duration of phase II frequently associated with the occurrence of an additional phase III. Furthermore an inhibition of the colonic motility was observed only at the end of the infusion and lasted at least 4 h. At similar dosage NDTMB had less pronounced inhibitory effects on gastric activity fronts and in contrast with TMB, the inhibitory effect on the colonic motility was observed as soon as the infusion of NDTMB started. These data demonstrate that orally administered TMB stimulates intestinal motility as previously described for i.v. route but in contrast to parenteral administration also stimulates antral and colonic motility.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3609630

  2. New Strategy to Reduce Hypertriglyceridemia During Parenteral Nutrition While Maintaining Energy Intake.

    PubMed

    Mateu-de Antonio, Javier; Florit-Sureda, Marta

    2014-09-11

    Background: Hypertriglyceridemia is a frequent metabolic complication associated with fat administration in parenteral nutrition (PN). No clear guidelines have been published on how to proceed once hypertriglyceridemia has been detected. A new strategy could be to substitute the initial fat emulsion with another emulsion with faster clearance. Our objective was to determine the effectiveness in reducing triglyceridemia values, maintaining the caloric intake, and improving nutrition parameters in patients who had moderate hypertriglyceridemia during PN when an olive oil-based fat emulsion (OOFE) was substituted with a multiple-source oil fat emulsion (MOFE). We also assessed the safety of this substitution in hepatic and glycemic profiles. Materials and Methods: We performed a retrospective, observational study that included 38 adult patients to whom OOFE in PN was substituted with MOFE when moderate hypertriglyceridemia (≥250-400 mg/dL) was detected. Results: Triglyceridemia values decreased in 36 (94.7%) patients. The mean reduction was 71 (88-22) mg/dL. Fat load was slightly reduced after substitution (-0.14 [-0.23 to 0] g/kg/d; P < .001), but total caloric intake increased from 22.5 (19.7-25.1) to 23.1 (19.8-26.8) kcal/kg/d (P = .053). After substitution, nutrition parameters improved, liver parameters remained unchanged, and insulin requirements increased. Conclusion: The substitution of OOFE with MOFE in patients with moderate hypertriglyceridemia during PN resulted in a reduction in triglyceridemia values of about 70 mg/dL. That allowed maintaining the caloric intake and improved nutrition parameters without affecting the hepatic profile. For some patients, insulin requirements increased moderately. (JPEN J Parenter Enteral Nutr. XXXX;xx:xx-xx). PMID:25214551

  3. Activities of oral and parenteral agents against penicillin-susceptible and -resistant pneumococci.

    PubMed

    Pankuch, G A; Visalli, M A; Jacobs, M R; Appelbaum, P C

    1995-07-01

    This study examined bacteriostatic and bactericidal activities of oral and parenteral antibiotics for penicillin-susceptible and intermediately and fully penicillin-resistant pneumococci. beta-Lactamase inhibitors did not affect beta-lactam results. The activities of ampicillin, amoxicillin +/- clavulanate, WY-49605, cefuroxime, cefpodoxime, cefdinir, cefixime, and cefaclor against two penicillin-susceptible, two intermediately penicillin-resistant, and two fully penicillin-resistant pneumococcal strains were tested. For all three groups, bacteriostatic values of amoxicillin and WY-49605 were lower than were those of other beta-lactams tested. Of the cephalosporins, cefdinir, cefuroxime, and cefpodoxime yielded the lowest bacteriostatic values. All beta-lactams were bactericidal (reduced original counts by > or = 3 log10 CFU/ml) at 1 dilution above bacteriostatic values, except for cefpodoxime (bactericidal at 2 dilutions above bacteriostatic values for one susceptible strain and one intermediately resistant strain), cefuroxime (bactericidal at 2 dilutions above bacteriostatic values for one intermediately resistant strain), and ampicillin (bactericidal at 2 dilutions above bacteriostatic values for one intermediately resistant strain). The activities of piperacillin, piperacillin-tazobactam, ticarcillin, ticarcillin-clavulanate, ampicillin, ampicillin-sulbactam, ceftriaxone, ceftazidime, and ciprofloxacin against four penicillin-susceptible, two intermediately penicillin-resistant, and four fully penicillin-resistant pneumococcal strains were evaluated. Bacteriostatic values of piperacillin, ampicillin, and ceftriaxone for all groups were lower than were those of ticarcillin and ceftazidime. Bacteriostatic values of ciprofloxacin were unaffected by penicillin susceptibility. All beta-lactams were bactericidal at 1 dilution above the bacteriostatic value, except for piperacillin (bactericidal at 2 dilutions above the bacteriostatic value for one intermediately

  4. Peripherally Inserted Central Venous Catheter Complications in Children Receiving Outpatient Parenteral Antibiotic Therapy (OPAT).

    PubMed

    Kovacich, Amanda; Tamma, Pranita D; Advani, Sonali; Popoola, Victor O; Colantuoni, Elizabeth; Gosey, Leslie; Milstone, Aaron M

    2016-04-01

    OBJECTIVE To identify the frequency of and risk factors associated with complications necessitating removal of the peripherally inserted central catheters (PICCs) in patients receiving outpatient parenteral antibiotic therapy (OPAT) and to determine the appropriateness of OPAT in children with OPAT-related complications. METHODS A retrospective cohort of children who had a PICC inserted at the Johns Hopkins Children's Center between January 1, 2003, and December 31, 2013, and were discharged from the hospital on OPAT was assembled. RESULTS A total of 1,465 PICCs were used to provide antibiotic therapy for 955 children after hospital discharge. Among these, 117 PICCs (8%) required removal due to a complication (4.6 of 1,000 catheter days). Children discharged to a long-term care facility were at increased risk of adverse PICC events (incidence risk ratio [IRR], 3.32; 95% confidence interval [CI], 1.79-6.17). For children receiving OPAT, age of the child (adjusted IRR [aIRR], 0.95; 95% CI, 0.92-0.98), noncentral PICC tip location (aIRR, 2.82; 95% CI, 1.66-4.82), and public insurance (aIRR, 1.63; 95% CI, 1.10-2.40) were associated with adverse PICC events. In addition, 34 patients (32%) with adverse events may not have required intravenous antibiotics at the time of hospital discharge. CONCLUSIONS Of children discharged with PICCs on OPAT during the study period, 8% developed a complication necessitating PICC removal. Children discharged to a long-term care facility had an increased rate of complication compared with children who were discharged home. With improved education regarding appropriate duration of antibiotic therapy and situations in which early conversion to enteral therapy should be considered, PICC-related complications may have been avoided in 32% of children. Infect. Control Hosp. Epidemiol. 2016;37(4):420-424. PMID:26961677

  5. Local tolerance testing of parenteral drugs: how to put into practice.

    PubMed

    Jochims, Karin; Kemkowski, Joerg; Nolte, Thomas; Bartels, Thomas; Heusener, Alexander

    2003-10-01

    Notwithstanding that there are national and international guidelines about local tolerance testing of parenteral drugs in animals, in particular to mention CPMP/SWP/2145/00 (Note for Guidance on Non-Clinical Local Tolerance Testing of Medicinal Products), very heterogeneous study designs have been established in the past. A working group including experts of the leading pharmaceutical industry from German-language countries, named "Arbeitskreis Lokale Verträglichkeit," has been intensively discussing the experimental procedures in detail for a period of six years and has been considering their pros and cons. This team of experts now feels confident to give some recommendations for study conduct besides describing different materials and methods for this type of toxicological study. Special knowledge from toxicologists as well as pathologists from our working group has been taken into account. This paper deals with choice of species, number of animals used, controls, administration sites, volumes, rate and frequency, length of observation period, termination, clinical, macroscopic and histopathological examinations and, finally, overall assessment criteria and conclusion. Our purpose is that this paper may be of value for: *The study director who is inexperienced in the conduction of local tolerance testing and who may need a standard design as his first step into this new field. *The well-versed study director who would like to know how others have done in the past, who may examine self-critically his own practice and who is open to our team's recommendations, tips and tricks from practice. *The specialist at a regulatory authority who, finally, reviews study reports, assesses their format and content and, above all, decides on the approval of a drug product. PMID:14550758

  6. Reduced parenteral nutrition requirements following anastomosis of a short residual colonic segment to a short jejunum.

    PubMed

    Smith, Katherine H; Saunders, John A; Nugent, Karen P; Jackson, Alan A; Stroud, Michael A

    2011-11-01

    A 22-year-old man suffered an acute small bowel infarct leading to extensive bowel resection, resulting in only 20 cm of jejunum to a jejunostomy, although he also had 50 cm of residual colon with a mucous fistula. The patient was out on long-term home parenteral nutrition (PN) but endured high stomal losses of 5-6 L per day and, despite all conventional measures, required 6.1 L of fluid (including PN) and 555 mmol sodium per day. Although body mass index was maintained, he suffered debilitating malaise and recurrent episodes of catheter-related sepsis and also developed persistently abnormal liver function tests. He was considered a potential intestinal transplant patient, but before taking that step, he opted for reanastomosis of his residual colon to his jejunum, ending in a colostomy. At surgery, only 30 cm of additional bowel lengthening could be achieved, but despite this, the patient's stomal losses reduced to 2.5 L per day, intravenous fluid requirements reduced to 4.1 L per day, and liver function normalized. The patient also gained 7.5 kg despite no change in PN caloric prescription, and his quality of life was dramatically enhanced. The case illustrates that even a small length of colon can grant significant improvements, probably via improvements in small bowel transit and adaptive changes, better sodium and water resorption with decreased hyperaldosteronism, and enhanced energy and nitrogen recovery. Reanastomosis of defunctioned colon should therefore always be considered a management option in short bowel syndrome. PMID:22042049

  7. Poor Prognostic Factors in Patients with Parenteral Nutrition-Dependent Pediatric Intestinal Failure

    PubMed Central

    Choi, Shin Jie; Lee, Kyung Jae; Choi, Jong Sub; Yang, Hye Ran; Chang, Ju Young; Ko, Jae Sung

    2016-01-01

    Purpose Parenteral nutrition (PN) not only provides nutritional support but also plays a crucial role in the treatment of children with intestinal failure. The aim of this study was to evaluate the clinical significance and clinical outcomes of long-term PN. Methods Retrospective cohort study was conducted using the medical records of patients treated at Seoul National University Children's Hospital. This study included 19 patients who received PN for over six months. Most patients received home PN. Results The indications for PN included short bowel syndrome, chronic intestinal pseudo-obstruction, and intractable diarrhea of infancy. The median age of PN initiation was 1.3 years, and the median treatment duration was 2.9 years. Two patients were weaned from PN; 14 continued to receive PN with enteral feedings; and 3 patients died. The overall survival rates at 2 and 5 years were 93.3% and 84.0%, respectively. The incidence of catheter-related bloodstream infections was 2.7/1,000 catheter-days and was associated with younger age at PN initiation and lower initial height Z-score. Six patients developed catheter-related central vein thrombosis, with an incidence of 0.25/1,000 catheter-days. Eleven patients experienced PN-associated liver disease (PNALD), and one patient underwent multi-visceral transplant. The patients with PNALD exhibited lower final heights and body weight Z-scores. All patients experienced micronutrient deficiencies transiently while receiving PN. Conclusion PN is an important and safe treatment for pediatric intestinal failure. PNALD was linked to final anthropometric poor outcomes. Micronutrient deficiencies were common. Anthropometric measurements and micronutrient levels must be monitored for successful PN completion. PMID:27066448

  8. Costs of Multidisciplinary Parenteral Nutrition Care Provided at a Distance via Mobile Tablets

    PubMed Central

    Kim, Heejung; Spaulding, Ryan; Werkowitch, Marilyn; Yadrich, Donna; Piamjariyakul, Ubolrat; Gilroy, Richard; Smith, Carol E.

    2014-01-01

    Background Determining the costs of healthcare delivery is a key step for providing efficient nutrition-based care. This analysis tabulates the costs of delivering home parenteral nutrition (HPN) interventions and clinical assessments through encrypted mobile technologies to increase patients’ access to healthcare providers, reduce their travel expenses, and allow early detection of infection and other complications. Methods A traditional cost-accounting method was used to tabulate all expenses related to mobile distance HPN clinic appointments, including (1) personnel time of multidisciplinary healthcare professionals, (2) supply of HPN intervention materials, and (3) equipment, connection, and delivery expenses. Results A total of 20 mobile distance clinic appointments were conducted for an average of 56 minutes each with 45 patients who required HPN infusion care. The initial setup costs included mobile tablet devices, 4G data plans, and personnel's time as well as intervention materials. The initial costs were on average $916.64 per patient, while the follow-up clinic appointments required $361.63 a month, with these costs continuing to decline as the equipment was used by multiple patients more frequently over time. Patients reported high levels of satisfaction with cost savings in travel expenses and rated the quality of care comparable to traditional in-person examinations. Conclusion This study provides important aspects of the initial cost tabulation for visual assessment for HPN appointments. These findings will be used to generate a decision algorithm for scheduling mobile distance clinic appointments intermittent with in-person visits to determine how to lower costs of nutrition assessments. To maximize the cost benefits, clinical trials must continue to collect clinical outcomes. PMID:25245253

  9. Parenteral Nutrition-Associated Cholestasis in Very Low Birth Weight Infants: A Single Center Experience

    PubMed Central

    Kim, Ah-Young; Lim, Ryoung-Kyoung; Han, Young-Mi; Park, Kyung-Hee

    2016-01-01

    Purpose Parenteral nutrition (PN)-associated cholestasis (PNAC) is one of the most common complications in very low birth weight infants (VLBWIs). The aim of this study is to evaluate the risk factors of PNAC in VBLWIs. Methods We retrospectively reviewed the medical records of 322 VLBWIs admitted to the neonatal intensive care unit of our hospital from July 1, 2009 to December 31, 2013. We excluded 72 dead infants; 6 infants were transferred to another hospital, and 57 infants were transferred to our hospital at 2 weeks after birth. The infants were divided into the cholestasis and the non-cholestasis groups. PNAC was defined as a direct bilirubin level of ≥2.0 mg/dL in infants administered with PN for ≥2 weeks. Results A total of 187 VLBWI were enrolled in this study; of these, 46 infants developed PNAC. Multivariate logistic regression analysis showed that the risk factors of PNAC in VLBWI were longer duration of antimicrobial use (odds ratio [OR] 4.49, 95% confidence interval [95% CI] 4.42-4.58), longer duration of PN (OR 2.68, 95% CI 2.41-3.00), long-term lack of enteral nutrition (OR 2.89, 95% CI 2.43-3.37), occurrence of necrotizing enterocolitis (OR 2.40, 95% CI 2.16-2.83), and gastrointestinal operation (OR 2.19, 95% CI 2.03-2.58). Conclusion The results of this study suggest that shorter PN, aggressive enteral nutrition, and appropriate antimicrobial use are important strategies in preventing PNAC. PMID:27066450

  10. Milk and Blood Pharmacokinetics of Tylosin and Tilmicosin following Parenteral Administrations to Cows

    PubMed Central

    Avci, Tulay; Elmas, Muammer

    2014-01-01

    The aim of this study is to determine the pharmacokinetics of tylosin and tilmicosin in serum and milk in healthy Holstein breed cows (n = 12) and reevaluate the amount of residue in milk. Following the intramuscular administration of tylosin, the maximum concentrations (Cmax) in serum and milk were found to be 1.30 ± 0.24 and 4.55 ± 0.23 µg/mL, the time required to reach the peak concentration (tmax) was found to be 2nd and 4th h, and elimination half-lives (t1/2β) were found to be 20.46 ± 2.08 and 26.36 ± 5.55 h, respectively. Following the subcutaneous administration of tilmicosin, the Cmax in serum and milk were found to be 0.86 ± 0.20 and 20.16 ± 1.13 µg/mL, the tmax was found to be 1st and 8th h, and the t1/2β were found to be 29.94 ± 6.65 and 43.02 ± 5.18 h, respectively. AUCmilk/AUCserum and Cmax-milk/Cmax-serum rates, which are indicators for determining the rate of drugs that pass into milk, were, respectively, calculated as 5.01 ± 0.72 and 3.61 ± 0.69 for tylosin and 23.91 ± 6.38 and 20.16 ± 1.13 for tilmicosin. In conclusion, it may be stated that milk concentration of tylosin after parenteral administration is higher than expected like tilmicosin and needs more withdrawal period for milk than reported. PMID:25177733

  11. Milk and blood pharmacokinetics of tylosin and tilmicosin following parenteral administrations to cows.

    PubMed

    Avci, Tulay; Elmas, Muammer

    2014-01-01

    The aim of this study is to determine the pharmacokinetics of tylosin and tilmicosin in serum and milk in healthy Holstein breed cows (n = 12) and reevaluate the amount of residue in milk. Following the intramuscular administration of tylosin, the maximum concentrations (C max) in serum and milk were found to be 1.30 ± 0.24 and 4.55 ± 0.23 µg/mL, the time required to reach the peak concentration (t max) was found to be 2nd and 4th h, and elimination half-lives (t 1/2β ) were found to be 20.46 ± 2.08 and 26.36 ± 5.55 h, respectively. Following the subcutaneous administration of tilmicosin, the C max in serum and milk were found to be 0.86 ± 0.20 and 20.16 ± 1.13 µg/mL, the t max was found to be 1st and 8th h, and the t 1/2β were found to be 29.94 ± 6.65 and 43.02 ± 5.18 h, respectively. AUCmilk/AUCserum and C max-milk/C max-serum rates, which are indicators for determining the rate of drugs that pass into milk, were, respectively, calculated as 5.01 ± 0.72 and 3.61 ± 0.69 for tylosin and 23.91 ± 6.38 and 20.16 ± 1.13 for tilmicosin. In conclusion, it may be stated that milk concentration of tylosin after parenteral administration is higher than expected like tilmicosin and needs more withdrawal period for milk than reported. PMID:25177733

  12. Vitamin supplementation and megadoses.

    PubMed

    Blair, K A

    1986-07-01

    Almost one-third of American adults regularly take vitamins and supplements. If taken incorrectly or in excess, these vitamins may be a potential health hazard. Vitamins are essential nutrients which, in combination with other nutrients (e.g., fats, carbohydrates and proteins), foster normal metabolism. Vitamins also interact with each other. For example, vitamin C participates in the metabolism of folic acid, and vitamin E facilitates the absorption and storage of vitamin A. Because the biological functions of vitamins are interrelated, a diet poor in vitamins, carbohydrates, fats and proteins is not necessarily enhanced by vitamin supplementation. When vitamins are taken in excess of the Recommended Dietary Allowances or the individual's needs, the vitamins no longer function as vitamins but instead act as drugs, with such pharmacological effects as clinical toxicities and the abnormal utilization of vitamins. There are six categories that require vitamin supplements and, in some cases, megadoses. These will be discussed in detail. In addition, a brief table showing the Recommended Dietary Allowances will be given which the nurse practitioner can use in assessing nutritional needs of the client so that necessary adjustments can be made. Finally, a brief review of the potential risks and benefits of megadoses in normal, healthy adults will be given. PMID:3737019

  13. Enteral but not parenteral antibiotics enhance gut function and prevent necrotizing enterocolitis in formula-fed newborn preterm pigs.

    PubMed

    Birck, Malene M; Nguyen, Duc Ninh; Cilieborg, Malene S; Kamal, Shamrulazhar S; Nielsen, Dennis S; Damborg, Peter; Olsen, John E; Lauridsen, Charlotte; Sangild, Per T; Thymann, Thomas

    2016-03-01

    Preterm infants are susceptible to infection and necrotizing enterocolitis (NEC) and are often treated with antibiotics. Simultaneous administration of enteral and parenteral antibiotics during the first days after preterm birth prevents formula-induced NEC lesions in pigs, but it is unknown which administration route is most effective. We hypothesized that only enteral antibiotics suppress gut bacterial colonization and NEC progression in formula-fed preterm pigs. Caesarean-delivered preterm pigs (90-92% of gestation) were fed increasing amounts of infant formula from birth to day 5 and given saline (CON) or antibiotics (ampicillin, gentamicin, and metronidazole) via the enteral (ENT) or parenteral (PAR) route (n = 16-17). NEC lesions, intestinal morphology, function, microbiology, and inflammatory mediators were evaluated. NEC lesions were completely prevented in ENT pigs, whereas there were high incidences of mild NEC lesions (59-63%) in CON and PAR pigs (P < 0.001). ENT pigs had elevated intestinal weight, villus height/crypt depth ratio, and goblet cell density and reduced gut permeability, mucosal adherence of bacteria, IL-8 levels, colonic lactic acid levels, and density of Gram-positive bacteria, relative to CON pigs (P < 0.05). Values in PAR pigs were intermediate with few affected parameters (reduced lactic acid levels and density and adherence of Gram-positive bacteria, relative to CON pigs, P < 0.05). There was no evidence of increased antimicrobial resistance following the treatments. We conclude that enteral, but not parenteral, administration of antibiotics reduces gut bacterial colonization, inflammation, and NEC lesions in newborn, formula-fed preterm pigs. Delayed colonization may support intestinal structure, function, and immunity in the immediate postnatal period of formula-fed preterm neonates. PMID:26680737

  14. Transition from parenteral to enteral nutrition induces immediate diet-dependent gut histological and immunological responses in preterm neonates.

    PubMed

    Siggers, Jayda; Sangild, Per T; Jensen, Tim K; Siggers, Richard H; Skovgaard, Kerstin; Støy, Ann Cathrine F; Jensen, Bent B; Thymann, Thomas; Bering, Stine B; Boye, Mette

    2011-09-01

    Necrotizing enterocolitis (NEC) in preterm infants develops very rapidly from a mild intolerance to enteral feeding into intestinal mucosal hemorrhage, inflammation, and necrosis. We hypothesized that immediate feeding-induced gut responses precede later clinical NEC symptoms in preterm pigs. Fifty-six preterm pigs were fed total parenteral nutrition (TPN) for 48 h followed by enteral feeding for 0, 8, 17, or 34 h with either colostrum (Colos, n = 20) or formula (Form, n = 31). Macroscopic NEC lesions were detected in Form pigs throughout the enteral feeding period (20/31, 65%), whereas most Colos pigs remained protected (1/20, 5%). Just 8 h of formula feeding induced histopathological lesions, as evidenced by capillary stasis and necrosis, epithelial degeneration, edema, and mucosal hemorrhage. These immediate formula-induced changes were paralleled by decreased digestive enzyme activities (lactase and dipeptidylpeptidase IV), increased nutrient fermentation, and altered expression of innate immune defense genes such as interleukins (IL-1α, IL-6, IL-18), nitric oxide synthetase, tight junction proteins (claudins), Toll-like receptors (TLR-4), and TNF-α. In contrast, the first hours of colostrum feeding induced no histopathological lesions, increased maltase activity, and induced changes in gene expressions related to tissue development. Total bacterial density was high after 2 days of parenteral feeding and was not significantly affected by diet (colostrum, formula) or length of enteral feeding (8-34 h), except that a few bacterial groups (Clostridium, Enterococcus, Streptococcus species) increased with time. We conclude that a switch from parenteral to enteral nutrition rapidly induces diet-dependent histopathological, functional, and proinflammatory insults to the immature intestine. Great care is required when introducing enteral feeds to TPN-fed preterm infants, particularly when using formula, because early feeding-induced insults may predispose to NEC

  15. Impact of New-Generation Lipid Emulsions on Cellular Mechanisms of Parenteral Nutrition–Associated Liver Disease123

    PubMed Central

    Burrin, Douglas G.; Ng, Ken; Stoll, Barbara; De Pipaón, Miguel Sáenz

    2014-01-01

    Parenteral nutrition (PN) is a life-saving nutritional support for a large population of hospitalized infants, and lipids make a substantial contribution to their energy and essential fatty acid (FA) needs. A challenge in the care of these infants is that their metabolic needs require prolonged PN support that increases the risk of PN-associated liver disease (PNALD). In recent years, the emergence of new parenteral lipid emulsions containing different source lipids and FA profiles has created nutritional alternatives to the first-generation, soybean oil–based lipid emulsion Intralipid. The limited U.S. introduction of the new-generation fish-oil emulsion Omegaven has generated promising results in infants with PNALD and spawned a renewed interest in how PN and lipid emulsions, in particular, contribute to this disease. Studies suggest that the lipid load and constituents, such as specific FAs, ratio of n–3 (ω-3) to n–6 (ω-6) long-chain polyunsaturated FAs, phytosterols, and vitamin E content, may be involved. There is an existing literature describing the molecular mechanisms whereby these specific nutrients affect hepatic metabolism and function via lipid and bile acid sensing nuclear receptors, such as peroxisome proliferator–activated receptor α, liver X receptor, and farnesoid X receptor, yet virtually no information as to how they interact and modulate liver function in the context of PN in pediatric patients or animal models. This article will review the recent development of parenteral lipid emulsions and their influence on PNALD and highlight some of the emerging molecular mechanisms that may explain the effects on liver function and disease. PMID:24425726

  16. Educational outcomes associated with providing a comprehensive guidelines program about nursing care of preterm neonates receiving total parenteral nutrition.

    PubMed

    Al-Rafay, Safy S; Al-Sharkawy, Sabah S

    2012-05-01

    Poor understanding or practice of Total Parenteral Nutrition (TPN) causes devastating complications. Therefore, good Neonatal Intensive Care Unit (NICU) nursing care for preterm neonates and close monitoring of complications is essential for successful TPN therapy. The study was conducted in NICU at Ain Shams University Hospital in Cairo, Egypt, using a quasi-experimental research design with prepost intervention assessments. Data was collected using a self-administered questionnaire sheet and an observation checklist (prepost format) and developed a comprehensive guidelines program about nursing care of TPN of preterm neonates. Results revealed that the program had a significant positive impact on nurses' knowledge and practice outcomes. PMID:21828243

  17. A Rare Case of Central Pontine Myelinolysis in Overcorrection of Hyponatremia with Total Parenteral Nutrition in Pregnancy.

    PubMed

    Janga, Kalyana C; Khan, Tazleem; Khorolsky, Ciril; Greenberg, Sheldon; Persaud, Priscilla

    2015-01-01

    A 42-year-old high risk pregnant female presented with hyponatremia from multiple causes and was treated with total parenteral nutrition. She developed acute hypernatremia due to the stage of pregnancy and other comorbidities. All the mechanisms of hyponatremia and hypernatremia were summarized here in our case report. This case has picture (graph) representation of parameters that led to changes in serum sodium and radiological findings of central pontine myelinolysis on MRI. In conclusion we present a complicated case serum sodium changes during pregnancy and pathophysiological effects on serum sodium changes during pregnancy. PMID:26798530

  18. A Rare Case of Central Pontine Myelinolysis in Overcorrection of Hyponatremia with Total Parenteral Nutrition in Pregnancy

    PubMed Central

    Janga, Kalyana C.; Khan, Tazleem; Khorolsky, Ciril; Greenberg, Sheldon; Persaud, Priscilla

    2015-01-01

    A 42-year-old high risk pregnant female presented with hyponatremia from multiple causes and was treated with total parenteral nutrition. She developed acute hypernatremia due to the stage of pregnancy and other comorbidities. All the mechanisms of hyponatremia and hypernatremia were summarized here in our case report. This case has picture (graph) representation of parameters that led to changes in serum sodium and radiological findings of central pontine myelinolysis on MRI. In conclusion we present a complicated case serum sodium changes during pregnancy and pathophysiological effects on serum sodium changes during pregnancy. PMID:26798530

  19. Palliative parenteral nutrition use in patients with intestinal failure as a consequence of advanced pseudomyxoma peritonei: a case series.

    PubMed

    Disney, B R; Karthikeyakurup, A; Ratcliffe, J; Jones, J; Deel-Smith, P; Fairhurst, A; Maleki, K; Cooper, S C

    2015-08-01

    Pseudomyxoma peritonei (PMP) is a rare condition complicated by intra-abdominal spread that can cause multilevel gastrointestinal (GI) obstruction. Parenteral nutrition (PN) use in the context of palliative care and malignancy remains controversial. We describe the use of palliative PN in three patients with progressive PMP causing multilevel GI obstruction and intestinal failure. All patients received > 90 days of PN. PN was safe in this cohort of patients. However, patient selection and the timing of intervention are important factors when considering the initiation of PN. PMID:26105107

  20. The metabolic consequences of infusing emulsions containing medium chain triglycerides for parenteral nutrition: a comparative study with conventional lipid.

    PubMed Central

    Dennison, A. R.; Ball, M.; Crowe, P. J.; White, K.; Hands, L.; Watkins, R. M.; Kettlewell, M.

    1986-01-01

    In order to test the hypothesis that medium chain triglycerides (MCT's) are a safe and potentially superior energy source during parenteral nutrition 13 patients were entered into a randomised cross over trial. They received either a long chain triglyceride emulsion (LCT) or a 50% medium chain (MCT)/50% LCT mixture as part of their energy supply. Nitrogen balance was significantly better when MCT/LCT was infused and the greater levels of plasma ketones and lower plasma triglyceride levels suggested that MCT was more readily metabolised in these patients. Routine haematology, biochemistry and liver function tests gave no indication of harmful side effects from MCT. PMID:3089123

  1. Spontaneous neural tube defects in splotch mice supplemented with selected micronutrients

    SciTech Connect

    Wlodarczyk, Bogdan J. . E-mail: bwlodarczyk@ibt.tamhsc.edu; Tang, Louisa S.; Triplett, Aleata; Aleman, Frank; Finnell, Richard H.

    2006-05-15

    Splotch (Sp/Sp) mice homozygous for a mutation in the Pax3 gene inevitably present with neural tube defects (NTDs), along with other associated congenital anomalies. The affected mutant embryos usually die by gestation days (E) 12-13. In the present study, the effect of modifier genes from a new genetic background (CXL-Sp) and periconceptional supplementation with selected micronutrients (folic acid, 5-formyltetrahydrofolate, 5-methyltetrahydrofolate, methionine, myoinositol, thiamine, thymidine, and {alpha}-tocopherol) was determined with respect to the incidence of NTDs. In order to explore how different exposure parameters (time, dose, and route of compound administration) modulate the beneficial effects of micronutrient supplementation, female mice received either short- or long-term nutrient supplements via enteral or parenteral routes. Embryos were collected on E12.5 and examined for the presence of anterior or posterior NTDs. Additionally, whole mount in situ hybridization studies were conducted in order to reveal/confirm normal expression patterns of the Pax3 gene during neurulation in the wild-type and Sp/Sp homozygous mutant mouse embryos utilized in this study. A strong Pax3 signal was demonstrated in CXL-Sp embryos during neural tube closure (E9.5 to E10.5). The intensity and spatial pattern of expression were similar to other Splotch mutant mice. Of all the micronutrients tested, only supplementation with folic acid or 5-methyltetrahydrofolate rescued the normal phenotype in Sp/Sp embryos. When the folate supplementation dose was increased to 200 mg/kg in the diet, the incidence of rescued splotch homozygotes reached 30%; however, this was accompanied by six-fold increased resorption rate.

  2. Anti-tumor effect of L-methionine-deprived total parenteral nutrition with 5-fluorouracil administration on Yoshida sarcoma-bearing rats.

    PubMed Central

    Goseki, N; Endo, M; Onodera, T; Kosaki, G

    1991-01-01

    L-methionine-deprived total parenteral nutrition (methionine-deprived TPN), infusing amino acid solution devoid of L-methionine and L-cysteine by the method of TPN as an only protein source, showed enhancement of the effect of several anti-cancer agents. In this study the combined effect of the methionine-deprived TPN with administration of 5-fluorouracil (5-FU) was examined in Yoshida Sarcoma (YS)-bearing rats, from aspects of effects on the tumor metastasis and the host animal's life span, in the following four groups treated with: methionine-deprived TPN with administration of 5-FU, methionine-deprived TPN without administration of 5-FU, L-methionine-contained TPN plus 5-FU, and L-methionine-contained TPN without 5-FU. In the first experiment, TPN was continued for 8 days in the four groups, and the anti-cancer effect of methionine-deprived TPN and administration of 5-FU based on both the growth of the primary tumor at the implanted site and the tumor metastasis was studied from the view point of pathologic findings of animals killed immediately after these treatments. In experiment 2 the survival period was examined after these treatments for 10 days with subsequent oral feeding until death. The results were as follows: proliferation of YS, transplanted subcutaneously, was markedly suppressed; particularly hematogenous metastasis, characteristic in YS, was prominently blunted then obtained an apparent longer survival period in rats treated with the methionine-deprived TPN with administration of 5-FU. PMID:1905913

  3. Efficacy of Targeted 5-day Combined Parenteral and Intramammary Treatment of Clinical Mastitis Caused by Penicillin-Susceptible or Penicillin-Resistant Staphylococcus aureus

    PubMed Central

    Taponen, S; Jantunen, A; Pyörälä, E; Pyörälä, S

    2003-01-01

    Combined parenteral and intramammary treatment of mastitis caused by Staphylococcus aureus was compared to parenteral treatment only. Cows with clinical mastitis (166 mastitic quarters) caused by S. aureus treated by veterinarians of the Ambulatory Clinic of the Faculty of Veterinary Medicine during routine farm calls were included. Treatment was based on in vitro susceptibility testing of the bacterial isolate. Procaine penicillin G (86 cases due to β-lactamase negative strains) or amoxycillin-clavulanic acid (24 cases due to β-lactamase positive strains) was administered parenterally and intramammarily for 5 days. Efficacy of treatments was assessed 2 and 4 weeks later by physical examination, bacteriological culture, determination of CMT, somatic cell count and NAGase activity in milk. Quarters with growth of S. aureus in at least one post-treatment sample were classified as non-cured. As controls we used 41 clinical mastitis cases caused by penicillin-susceptible S. aureus isolates treated with procaine penicillin G parenterally for 5 days and 15 cases due to penicillin-resistant isolates treated with spiramycin parenterally for 5 days from the same practice area. Bacteriological cure rate after the combination treatment was 75.6% for quarters infected with penicillin-susceptible S. aureus isolates, and 29.2% for quarters infected with penicillin-resistant isolates. Cure rate for quarters treated only parenterally with procaine penicillin G was 56.1% and that for quarters treated with spiramycin 33.3%. The difference in cure rates between mastitis due to penicillin-susceptible and penicillin-resistant S. aureus was highly significant. Combined treatment was superior over systemic treatment only in the β-lactamase negative group. PMID:14650544

  4. Supplementing National Menu Labeling

    PubMed Central

    White, Lexi C.

    2012-01-01

    The US Food and Drug Administration’s forthcoming national menu labeling regulations are designed to help curb the national obesity epidemic by requiring calorie counts on restaurants’ menus. However, posted calories can be easily ignored or misunderstood by consumers and fail to accurately describe the healthiness of foods. We propose supplemental models that include nutritional information (e.g., fat, salt, sugar) or specific guidance (e.g., “heart-healthy” graphics). The goal is to empower restaurant patrons with better data to make healthier choices, and ultimately to reduce obesity prevalence. PMID:23078494

  5. Special Supplement Introduction: Hallucinations

    PubMed Central

    Fernyhough, Charles; Waters, Flavie

    2014-01-01

    This Special Supplement presents reports from 11 working groups of the interdisciplinary International Consortium on Hallucination Research meeting in Durham, UK, September 2013. Topics include psychological therapies for auditory hallucinations, culture and hallucinations, hallucinations in children and adolescents, visual hallucinations, interdisciplinary approaches to the phenomenology of auditory verbal hallucinations (AVHs), AVHs in persons without need for care, a multisite study of the PSYRATS instrument, subtypes of AVHs, the Hearing Voices Movement, Research Domain Criteria for hallucinations, and cortical specialization as a route to understanding hallucinations. PMID:24936079

  6. Supplementing national menu labeling.

    PubMed

    Hodge, James G; White, Lexi C

    2012-12-01

    The US Food and Drug Administration's forthcoming national menu labeling regulations are designed to help curb the national obesity epidemic by requiring calorie counts on restaurants' menus. However, posted calories can be easily ignored or misunderstood by consumers and fail to accurately describe the healthiness of foods. We propose supplemental models that include nutritional information (e.g., fat, salt, sugar) or specific guidance (e.g., "heart-healthy" graphics). The goal is to empower restaurant patrons with better data to make healthier choices, and ultimately to reduce obesity prevalence. PMID:23078494

  7. IL-25 improves luminal innate immunity and barrier function during parenteral nutrition

    PubMed Central

    Heneghan, Aaron F; Pierre, Joseph F; Gosain, Ankush; Kudsk, Kenneth A

    2013-01-01

    Background Parenteral Nutrition (PN) increases risks of infections in critically injured patients. Recently, PN was shown to reduce intestine luminal levels of the Paneth cell antimicrobial molecule, secretory phospholipase A2 (sPLA2), and the goblet cell glycoprotein, MUC2. These molecules are critical factors for innate mucosal immunity and provide barrier protection. IL-4 and IL-13 regulate sPLA2 and MUC2 production through the IL-13 receptor. Since IL-25 stimulates IL-4 and IL-13 release and PN reduces luminal sPLA2 and MUC2, we hypothesized that adding IL-25 to PN would restore these innate immune factors and maintain barrier function. Methods 2 days after venous cannulation, male ICR mice were randomized to receive Chow (n=12), PN (n=9), or PN + 0.7 μg of exogenous IL-25 (n=11) daily for 5 days. Small intestine wash fluid (SIWF) was collected for analysis of sPLA2 activity, MUC2, and luminal levels of IL-4 and IL-13. Small intestinal tissue was harvested for analysis of tissue sPLA2 activity or immediate use in an ex vivo intestinal segment culture (EVISC) to assess susceptibility of the tissue segments to enteroinvasive E. coli. Results PN reduced luminal sPLA2 (p<0.0001) and MUC2 (p<0.002)compared with chow while the addition of IL-25 to PN increased luminal sPLA2 (p<0.0001) and MUC2 (p<0.02) compared to PN. Tissue IL-4 and IL-13 decreased with PN compared to chow (IL-4: p<0.0001)(IL-13: p<0.002), while IL-25 increased both cytokines compared to PN (IL-4: p<0.03)(IL-13: p<0.02). Tissue levels of sPLA2 were significantly decreased in PN compared to Chow, while IL-25 significantly increased tissue sPLA2 levels compared to PN alone. Functionally, more bacteria invaded the PN treated tissue compared to Chow (p<0.01), and the addition of IL-25 to PN decreased enteroinvasion to Chow levels (p<0.01). Conclusions PN impairs innate mucosal immunity by suppressing luminal sPLA2 activity and MUC2 density compared to Chow. PN also increases bacterial invasion in ex

  8. Canadian home total parenteral nutrition registry: Preliminary data on the patient population

    PubMed Central

    Raman, Maitreyi; Gramlich, Leah; Whittaker, Scott; Allard, Johane P

    2007-01-01

    BACKGROUND: Long-term administration of home total parenteral nutrition (HTPN) has permitted patients with chronic intestinal failure to survive for prolonged periods of time. However, HTPN is associated with numerous complications, all of which increase morbidity and mortality. In Canada, a comprehensive review of the HTPN population has never been performed. OBJECTIVES: To report on the demographics, current HTPN practice and related complications in the Canadian HTPN population. METHODS: This was a cross-sectional study. Five HTPN programs in Canada participated. Patients’ data were entered by the programs’ TPN team into a Web site-based registry. A unique confidential record was created for each patient. Data were then downloaded into a Microsoft Excel (Microsoft Corp, USA) spreadsheet and imported into SPSS (SPSS Inc, USA) for statistical analysis. RESULTS: One hundred fifty patients were entered into the registry (37.9% men and 62.1% women). The mean (± SD) age was 53.0±14 years and the duration requiring HTPN was 70.1±78.1 months. The mean body mass index before the onset of HTPN was 19.8±5.0 kg/m2. The primary indication for HTPN was short bowel syndrome (60%) secondary to Crohn’s disease (51.1%), followed by mesenteric ischemia (23.9%). Complications: over one year, 62.7% of patients were hospitalized at least once, with 44% of hospitalizations related to TPN. In addition, 28.6% of patients had at least one catheter sepsis (double-lumen more than single-lumen; P=0.025) and 50% had at least one catheter change. Abnormal liver enzymes were documented in 27.4% of patients and metabolic bone disease in 60% of patients, and the mean Karnofsky score was 63. CONCLUSIONS: In the present population sample, the data suggest that HTPN is associated with significant complications and health care utilization. These results support the use of a Canadian HTPN registry to better define the HTPN population, and to monitor complications for quality assurance and

  9. Functioning and health in patients with cancer on home-parenteral nutrition: a qualitative study

    PubMed Central

    2010-01-01

    Background Malnutrition is a common problem in patients with cancer. One possible strategy to prevent malnutrition and further deterioration is to administer home-parenteral nutrition (HPN). While the effect on survival is still not clear, HPN presumably improves functioning and quality of life. Thus, patients' experiences concerning functioning and quality of life need to be considered when deciding on the provision of HPN. Currently used quality of life measures hardly reflect patients' perspectives and experiences. The objective of our study was to investigate the perspectives of patients with cancer on their experience of functioning and health in relation to HPN in order to get an item pool to develop a comprehensive measure to assess the impact of HPN in this population. Methods We conducted a series of qualitative semi-structured interviews. The interviews were analysed to identify categories of the International Classification of Functioning, Disability and Health (ICF) addressed by patients' statements. Patients were consecutively included in the study until an additional patient did not yield any new information. Results We extracted 94 different ICF-categories from 16 interviews representing patient-relevant aspects of functioning and health (32 categories from the ICF component 'Body Functions', 10 from 'Body Structures', 32 from 'Activities & Participation', 18 from 'Environmental Factors'). About 8% of the concepts derived from the interviews could not be linked to specific ICF categories because they were either too general, disease-specific or pertained to 'Personal Factors'. Patients referred to 22 different aspects of functioning improving due to HPN; mainly activities of daily living, mobility, sleep and emotional functions. Conclusions The ICF proved to be a satisfactory framework to standardize the response of patients with cancer on HPN. For most aspects reported by the patients, a matching concept and ICF category could be found. The

  10. In vitro evaluation of BAL9141, a novel parenteral cephalosporin active against oxacillin-resistant staphylococci.

    PubMed

    Jones, Ronald N; Deshpande, Lalitagauri M; Mutnick, Alan H; Biedenbach, Douglas J

    2002-12-01

    Community-acquired and nosocomial infections caused by multidrug-resistant Gram-positive pathogens continue to increase in prevalence and have become a serious problem in many parts of the world. BAL9141 is a member of the class of parenteral pyrrolidinone-3-ylidenemethyl cephalosporins, and has a broad spectrum of activity. In the current study, BAL9141 was tested against a large number (n = 2263) of recent isolates from various international surveillance programmes including 1097 Gram-positive strains. Susceptibility to (S) and activity of (mg/L) to BAL9141, based on proposed breakpoints (MIC50/MIC90/% S) were as follows: methicillin-susceptible Staphylococcus aureus (0.5/0.5/100%), methicillin-resistant S. aureus (MRSA) (1/2/100%), methicillin-susceptible coagulase-negative staphylococci (CoNS) (0.12/0.25/100%), methicillin-resistant CoNS (MR-CoNS) (1/2/100%), Streptococcus pneumoniae (< or = 0.015/0.25/100%), viridans group streptococci (0.03/0.5/99%), beta-haemolytic streptococci (< or = 0.015/< or = 0.015/100%), Enterococcus faecalis (0.5/16/90%), Enterococcus faecium (>32/>32/22%), Haemophilus influenzae (0.06/0.06/100%), Moraxella catarrhalis (0.06/0.5/100%), Neisseria gonorrhoeae (0.03/0.06/100%) and Neisseria meningitidis (< or = 0.002/0.004/100%). BAL9141 susceptibility at < pr = 4 mg/L (100% S) surpassed that of ceftriaxone (CRO; 1% S) and quinupristin/dalfopristin (Q-D; 92% S) against MRSA and MR-CoNS (CRO 0.9% S; Q-D 94% S). All S. pneumoniae were inhibited by BAL9141 at < or = 1 mg/L compared with CRO (90% S) and levofloxacin (LVX; 98% S). Susceptibility rates for viridans group streptococci to BAL9141 (>98%) were also higher than to CRO (86%) and LVX (96%). BAL9141 demonstrated excellent activity against most species of wild-type enteric bacilli, with > or = 95% of isolates being susceptible; however, only modest activity was observed for BAL9141 against non-fermentative Gram-negative species and ESBL-producing Escherichia coli or Klebsiella

  11. Randomised placebo-controlled trial of teduglutide in reducing parenteral nutrition and/or intravenous fluid requirements in patients with short bowel syndrome

    PubMed Central

    Gilroy, R; Pertkiewicz, M; Allard, J P; Messing, B; O'Keefe, S J

    2011-01-01

    Background and aims Teduglutide, a GLP-2 analogue, may restore intestinal structural and functional integrity by promoting repair and growth of the mucosa and reducing gastric emptying and secretion, thereby increasing fluid and nutrient absorption in patients with short bowel syndrome (SBS). This 24-week placebo-controlled study evaluated the ability of teduglutide to reduce parenteral support in patients with SBS with intestinal failure. Methods In 83 patients randomised to receive subcutaneous teduglutide 0.10 mg/kg/day (n=32), 0.05 mg/kg/day (n=35) or placebo (n=16) once daily, parenteral fluids were reduced at 4-week intervals if intestinal fluid absorption (48 h urine volumes) increased ≥10%. Responders were subjects who demonstrated reductions of ≥20% in parenteral volumes from baseline at weeks 20 and 24. The primary efficacy end point, a graded response score (GRS), took into account higher levels and earlier onset of response, leading to longer duration of response. The intensity of the response was defined as a reduction from baseline in parenteral volume (from 20% to 100%), and the duration of the response was considered the response at weeks 16, 20 and 24. The results were tested according to a step-down procedure starting with the 0.10 mg/kg/day dose. Results Using the GRS criteria, teduglutide in a dose of 0.10 mg/kg/day did not have a statistically significant effect compared with placebo (8/32 vs 1/16, p=0.16), while teduglutide in a dose of 0.05 mg/kg/day had a significant effect (16/35, p=0.007). Since parenteral volume reductions were equal (353±475 and 354±334 ml/day), the trend towards higher baseline parenteral volume (1816±1008 vs 1374±639 ml/day, p=0.11) in the 0.10 mg/kg/day group compared with the 0.05 mg/kg/day group may have accounted for this discrepancy. Three teduglutide-treated patients were completely weaned off parenteral support. Serious adverse events were distributed similarly between active

  12. Bodybuilding supplementation and tooth decay.

    PubMed

    Ali, M S; Batley, H; Ahmed, F

    2015-07-10

    Supplementation is a key component in bodybuilding and is increasingly being used by amateur weight lifters and enthusiasts to build their ideal bodies. Bodybuilding supplements are advertised to provide nutrients needed to help optimise muscle building but they can contain high amounts of sugar. Supplement users are consuming these products, while not being aware of their high sugar content, putting them at a higher risk of developing dental caries. It is important for dental professionals to recognise the increased risk for supplement users and to raise awareness, provide appropriate preventative advice and be knowledgeable of alternative products to help bodybuilders reach their goals, without increasing the risk of dental caries. PMID:26159983

  13. Nutritional Supplementation and Meal Timing

    NASA Astrophysics Data System (ADS)

    Farris, Jim

    For the competitive athlete and the serious recreational athlete, nutritional supplementation can have a positive effect on training and on performance. There are many fad supplements on the market, and many that have come and gone. However, two nutrients have withstood the test of time and many tests in research laboratories around the world, and they continue to have positive training- and performance-enhancing effects. Carbohydrates are commonly supplemented to improve energy availability and to replace valuable muscle and liver glycogen stores. Protein supplementation usually is associated with building muscle tissue.

  14. Supplemental fuel vapor system

    SciTech Connect

    Foster, P.M.

    1991-01-08

    This patent describes a supplemental fuel system utilizing fuel vapor. It comprises: an internal combustion engine including a carburetor and an intake manifold; a fuel tank provided with air vents; a fuel conduit having a first end connected to the fuel tank and in communication with liquid fuel in the tank and a second end connected to the carburetor; the fuel conduit delivering the liquid fuel to the carburetor from the fuel tank; a fuel vapor conduit having a first end connected to the fuel tank at a location displaced from contact with the liquid fuel and a second end connected to a carbon canister; a PCV conduit having a first end connected to a pollution control valve and a second end connected to the intake manifold; and, an intermediate fuel vapor conduit having a first end connected to the fuel vapor conduit and a second end connected to the PCV conduit; wherein the air vents continuously provide air to the tank to mix with the liquid fuel and form fuel vapor. The fuel vapor drawn from the fuel tank by vacuum developed in the intake manifold and flows through the fuel vapor conduit. The intermediate fuel vapor conduit and the intake manifold to combustion chambers of the internal combustion engine so as to supplement fuel delivered to the engine by the fuel conduit. The liquid fuel and the fuel vapor constantly delivered to the engine during normal operation.

  15. A nutrition support team led by general surgeons decreases inappropriate use of total parenteral nutrition on a surgical service.

    PubMed

    Saalwachter, A R; Evans, H L; Willcutts, K F; O'Donnell, K B; Radigan, A E; McElearney, S T; Smith, R L; Chong, T W; Schirmer, B D; Pruett, T L; Sawyer, R G

    2004-12-01

    The purpose of this study was to decrease the number of inappropriate orders for total parenteral nutrition (TPN) in surgical patients. From February 1999 through November 2000 and between July 2001 and June 2002, the surgeon-guided adult nutrition support team (NST) at a university hospital monitored new TPN orders for appropriateness and specific indication. In April 1999, the NST was given authority to discontinue inappropriate TPN orders. Indications, based on the American Society for Parenteral and Enteral Nutrition (ASPEN) standards, included short gut, severe pancreatitis, severe malnutrition/catabolism with inability to enterally feed > or =5 days, inability to enterally feed >50 per cent of nutritional needs > or =9 days, enterocutaneous fistula, intra-abdominal leak, bowel obstruction, chylothorax, ischemic bowel, hemodynamic instability, massive gastrointestinal bleed, and lack of abdominal wall integrity. The number of inappropriate TPN orders declined from 62/194 (32.0%) in the first 11 months of the study to 22/168 (13.1%) in the second 11 months (P < 0.0001). This number further declined to 17/215 (7.9%) in the final 12 months of data collection, but compared to the second 11 months, this decrease was not statistically significant (P = 0.1347). The involvement of a surgical NST was associated with a reduction in inappropriate TPN orders without a change in overall use. PMID:15663055

  16. [Research on early warning signals of adverse drug reactions to parenterally administered xiyanping based on spontaneous reporting system (SRS) data].

    PubMed

    Wang, Zhi-Fei; Xiang, Yong-Yang; Xie, Yan-Ming

    2013-09-01

    This article focused on early warning signals regarding the safety of parenterally administered Xiyanping. The study data was obtained from reports made between 2005-2012 from the national spontaneous reporting system (SRS). Proportion reporting ratio (PRR) and Bayesian confidence propagation neural network (BCPNN) algorithms were used to analyse: erythra, pruritus, anaphylactoid reactions and shiver with cold, these 4 adverse drug reactions had a total count of more than 500 events. The article found that Xiyanping's incidence rate of erythra was higher than for background-drugs in every year and in every season. Pruritus was an early warning signal in the second season of 2009, and anaphylactoid reaction was an early warning signal in the fourth season of 2011 and in the second season of 2012. There was however no early warning signal indicated by shiver with cold. This data indicates that erythra maybe an adverse drug reactions to parenterally administered Xiyanping, and if the incidence rate of pruritus and anaphylactoid reaction rises attention should be paid to its safety. PMID:24471321

  17. Characterization and in vivo evaluation of novel lipid–chlorambucil nanospheres prepared using a mixture of emulsifiers for parenteral administration

    PubMed Central

    Song, Honglin; Nie, Shufang; Yang, Xinggang; Li, Ning; Xu, Hongtao; Zheng, Liangyuan; Pan, Weisan

    2010-01-01

    Purpose The purpose of the study was to develop and evaluate different lipid-based formulations for parenteral administration, as potential novel carrier systems for lipophilic drugs, and to turn an unstable drug such as chlorambucil into a useful one. Methods A two-stage, high-pressure homogenizer was used to yield a very fine monodispersed lipid nanosphere. The strategy of combining egg yolk phospholipid and nonionic emulsifier (Lutrol F 68 and Tween 80) as an emulsifier mixture was adopted to increase safety and tolerance. The final lipid nanospheres, in a lipophilic mixture consisting of three components, monostearin, medium-chain triglycerides and soya oil, were evaluated for physicochemical properties, such as particle size, surface morphology, drug-entrapment efficiency, drug-loading capacity, lyophilization and in vivo drug-release behavior. Results A monodispersed lipid nanosphere with a mean particle size ranging from 90 to 150 nm was achieved. The optimized injectable cryoprotectants for lipid nanosphere were sucrose (7.5%) and mannitol (7.5%), which can stabilize the particle size (LD50) at approximately 129 nm after reconstitution. The results show that the formulation can effectively administer anticancer drugs and thus improve patient quality of life. Conclusions The novel lipid nanosphere complex developed is a useful anticancer drug delivery vehicle for parenteral administration. The formulation strategy has the potential for the development of further methods of drug delivery for a wide variety of anticancer drugs. PMID:21187945

  18. Inhibition of priming for bovine respiratory syncytial virus-specific protective immune responses following parenteral vaccination of passively immune calves

    PubMed Central

    Ellis, John; Gow, Sheryl; Bolton, Michael; Burdett, William; Nordstrom, Scott

    2014-01-01

    The effect of maternal antibodies (MatAb) on immunological priming by neonatal parenteral vaccination for bovine respiratory syncytial virus (BRSV) was addressed for the first time in experimental infection in 34 Holstein calves. Both vaccinated and control calves developed moderate to severe respiratory disease characteristic of acute BRSV infection. There were no differences in clinical signs, BRSV shed, arterial oxygen concentrations, or mortality between vaccinated and control calves after BRSV challenge approximately 11 wk after vaccination. There were no anamnestic antibody or cytokine responses in the vaccinates after challenge. Lung lesions were extensive in both groups, and although there was a statistically significant (P = 0.05) difference between groups, this difference was considered not biologically significant. These data indicate that stimulation of protective immune responses was inhibited by maternal antibodies when a combination modified-live BRSV vaccine was administered parenterally to young passively immune calves. Alternate routes of administration or different vaccine formulations should be used to successfully immunize young calves with good passive antibody transfer. PMID:25477547

  19. Dietary Supplements for Weight Loss

    MedlinePlus

    ... supplements, they won’t be listed on the product label and they could harm you. Weight-loss supplements can be sold without being tested or approved by the U.S. Food and Drug ... can recall that product. Visit this website to view the FDA’s public ...

  20. Should You Take Dietary Supplements?

    MedlinePlus

    ... study. These include glucosamine (for joint pain) and herbal supplements such as echinacea (immune health) and flaxseed oil ( ... be fine,” Coates says. “According to the FDA, supplement products most likely ... ingredients are herbal remedies promoted for weight loss and for sexual ...

  1. Dietary Supplements: What Is Safe?

    MedlinePlus

    ... escape to close saved articles window. My Saved Articles » My ACS » Dietary Supplements: What Is Safe? Download Printable Version [PDF] » Dietary supplements include things like vitamins, minerals, herbs, or products made from plants, animal parts, algae, seafood, or yeasts. The information here can ...

  2. Nutritional Supplements for Endurance Athletes

    NASA Astrophysics Data System (ADS)

    Rasmussen, Christopher J.

    Athletes engaged in heavy endurance training often seek additional nutritional strategies to help maximize performance. Specific nutritional supplements exist to combat certain factors that limit performance beginning with a sound everyday diet. Research has further demonstrated that safe, effective, legal supplements are in fact available for today's endurance athletes. Several of these supplements are marketed not only to aid performance but also to combat the immunosuppressive effects of intense endurance training. It is imperative for each athlete to research the legality of certain supplements for their specific sport or event. Once the legality has been established, it is often up to each individual athlete to decipher the ethics involved with ingesting nutritional supplements with the sole intent of improving performance.

  3. Efficacy of Oral and Parenteral Bacille Calmette-Guerin (BCG Danish Strain 1331) in Protecting White-tailed Deer (Odecoileus Virginianus) against Bovine Tuberculosis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Wildlife Disease Association Annual Conference, August 6-10, 2006 Terry Amundson Student Presentation Award Oral Presentation EFFICACY OF ORAL AND PARENTERAL BACILLE CALMETTE-GUERIN (BCG DANISH STRAIN 1331) IN PROTECTING WHITE-TAILED DEER (ODECOILEUS VIRGINIANUS) AGAINST BOVINE TUBERCULOSIS Paulin...

  4. Mucosal but Not Parenteral Immunization with Purified Human Papillomavirus Type 16 Virus-Like Particles Induces Neutralizing Titers of Antibodies throughout the Estrous Cycle of Mice

    PubMed Central

    Nardelli-Haefliger, Denise; Roden, Richard; Balmelli, Carole; Potts, Alexandra; Schiller, John; De Grandi, Pierre

    1999-01-01

    We have recently shown that nasal immunization of anesthetized mice with human papillomavirus type 16 (HPV16) virus-like particles (VLPs) is highly effective at inducing both neutralizing immunoglobulin A (IgA) and IgG in genital secretions, while parenteral immunization induced only neutralizing IgG. Our data also demonstrated that both isotypes are similarly neutralizing according to an in vitro pseudotyped neutralization assay. However, it is known that various amounts of IgA and IgG are produced in genital secretions along the estrous cycle. Therefore, we have investigated how this variation influences the amount of HPV16 neutralizing antibodies induced after immunization with VLPs. We have compared parenteral and nasal protocols of vaccination with daily samplings of genital secretions of mice. Enzyme-linked immunosorbent assay analysis showed that total IgA and IgG inversely varied along the estrous cycle, with the largest amounts of IgA in proestrus-estrus and the largest amount of IgG in diestrus. This resulted in HPV16 neutralizing titers of IgG only being achieved during diestrus upon parenteral immunization. In contrast, nasal vaccination induced neutralizing titers of IgA plus IgG throughout the estrous cycle, as confirmed by in vitro pseudotyped neutralization assays. Our data suggest that mucosal immunization might be more efficient than parenteral immunization at inducing continuous protection of the female genital tract. PMID:10516071

  5. Consensus statement of the academy of nutrition and dietetics/american society for parenteral and enteral nutrition: Characteristics recommended for the identification and documentation of adult malnutrition (undernutrition)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommend that a standardized set of diagnostic characteristics be used to identify and document adult malnutrition in routine clinical practice. An etiologically based diagno...

  6. The Effect of Fish Oil-Based Lipid Emulsion and Soybean Oil-Based Lipid Emulsion on Cholestasis Associated with Long-Term Parenteral Nutrition in Premature Infants

    PubMed Central

    Wang, Leilei; Zhang, Jing; Gao, Jiejin; Qian, Yan; Ling, Ya

    2016-01-01

    Purpose. To retrospectively study the effect of fish oil-based lipid emulsion and soybean oil-based lipid emulsion on cholestasis associated with long-term parenteral nutrition in premature infants. Methods. Soybean oil-based lipid emulsion and fish oil-based lipid emulsion had been applied in our neonatology department clinically between 2010 and 2014. There were 61 qualified premature infants included in this study and divided into two groups. Soybean oil group was made up of 32 premature infants, while fish oil group was made up of 29 premature infants. Analysis was made on the gender, feeding intolerance, infection history, birth weight, gestational age, duration of parenteral nutrition, total dosage of amino acid, age at which feeding began, usage of lipid emulsions, and incidence of cholestasis between the two groups. Results. There were no statistical differences in terms of gender, feeding intolerance, infection history, birth weight, gestational age, duration of parenteral nutrition, total dosage of amino acid, and age at which feeding began. Besides, total incidence of cholestasis was 21.3%, and the days of life of occurrence of cholestasis were 53 ± 5.0 days. Incidence of cholestasis had no statistical difference in the two groups. Conclusion. This study did not find the different role of fish oil-based lipid emulsions and soybean oil-based lipid emulsions in cholestasis associated with long-term parenteral nutrition in premature infants. PMID:27110237

  7. Efficacy of Oral and Parenteral Routes of Mycobacterium bovis bacille Calmette-Guerin Vaccination Against Experimental Bovine Tuberculosis in White-tailed deer (Odocoileus virginianus): A Feasibility Study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We investigated the efficacy of oral and parenteral Mycobacterium bovis bacille Calmette-Guerin Danish strain 1331 (BCG) in its ability to protect white-tailed deer (Odocoileus virginianus) against disease caused by M. bovis infection. Thirty white-tailed deer were divided into four groups. One gr...

  8. An exclusive human milk-based diet in extremely premature infants reduces the probability of remaining on total parenteral nutrition: A reanalysis of the data

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We have previously shown that an exclusively human-milk-based diet is beneficial for extremely premature infants who are at risk for necrotizing enterocolitis (NEC). However, no significant difference in the other primary study endpoint, the length of time on total parenteral nutrition (TPN), was fo...

  9. Parenteral lipid fatty acid composition directly determines the fatty acid composition of red blood cell and brain lipids in preterm pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Studies in enterally-fed infants have shown a positive effect of n-3 long-chain polyunsaturated fatty acid (LCPUFA) supplementatin on neurodevelopment. The effect of n-3 LCPUFA in fish oil-based parenteral (PN) lipid emulsions on neuronal tissues of PN-fed preterm infants is unknown. The objective ...

  10. Drugs, Herbs and Supplements: MedlinePlus

    MedlinePlus

    ... www.nlm.nih.gov/medlineplus/druginformation.html Drugs, Herbs and Supplements To use the sharing features on ... approved labels included in drug packages, see DailyMed . Herbs and Supplements Browse dietary supplements and herbal remedies ...

  11. Effects of phosphate buffer in parenteral drugs on particle formation from glass vials.

    PubMed

    Ogawa, Toru; Miyajima, Makoto; Wakiyama, Naoki; Terada, Katsuhide

    2013-01-01

    The characteristics of inorganic particles generated in glass vials filled with phosphate buffer solutions were investigated. During storage, particles were visually detected in the phosphate buffer solution in particular glass vials which pass compendial tests of containers for injectable drugs. These particles were considered to be different from ordinal glass delamination, which has been reported in a number of papers because the particles were mainly composed of Al, P and O, but not Si. The formation of the particles accelerated at higher storage temperatures. Among the surface treatments tested for the glass vials, sulfur treatment showed a protective effect on the particle formation in the vials, whereas the SiO(2) coating did not have any protective effects. It was found that the elution ratio of Al and Si in the solution stored in the glass vials after the heating was similar to the ratio of Al and Si in borosilicate glass. However, the Al concentration decreased during storage (5°C, 6 months), and consequently, particle formation was observed in the solution. Adding citrate, which is a chelating agent for Al, effectively suppressed the particle formation in the heated solution. When 50 ppb and higher concentrations of Al ion were added to the phosphate buffer solution, the formation of white particles containing Al, P and O was detected. It is suggested that a phosphate buffer solution in a borosilicate glass vial has the ability to form particles due to interactions with the Al that is eluted from the glass during storage. PMID:23420583

  12. Dietary supplements containing prohibited substances.

    PubMed

    van der Bijl, P; Tutelyan, V A

    2013-01-01

    Dietary supplement use among athletes to enhance performance is proliferating as more individuals strive for obtaining that chemical competitive edge. As a result the concomitant use of dietary supplements containing performance-enhancing substances of those falling in the categories outlined in the current review, can also be expected to rise. This despite ever-increasing sophisticated analytical methodology techniques being used to assay dietary supplement and urine samples in doping laboratories. The reasons for this include that a variety of these chemical entities, many of them on the prohibited drug list of the WADA, are being produced on commercial scales in factories around the world (ephedrine and pseudoephedrine, sibutramine, methylhexaneamine, prohormones, 'classic' anabolic steroids, clenbuterol, peptide hormones etc.), aggressive marketing strategies are being employed by companies and these supplements can be easily ordered via e.g. the internet. It can also be anticipated that there will be an increase in the number of supplements containing 'designer' steroids and other 'newer' molecules. Chromatographic techniques combined with mass spectrometry leading to identification of molecular fragments and productions will assist in determining these substances. To prevent accidental doping, information regarding dietary supplements must be provided to athletes, coaches and sports doctors at all levels of competition. The risks of accidental doping via dietary supplement ingestion can be minimized by using 'safe' products listed on databases, e.g. such as those available in The Netherlands and Germany. PMID:24741950

  13. Dietary Supplements are Not all Safe and Not all Food: How the Low Cost of Dietary Supplements Preys on the Consumer.

    PubMed

    Sax, Joanna K

    2015-01-01

    Dietary supplements are regulated as food, even though the safety and efficacy of some supplements are unknown. These products are often promoted as 'natural.' This leads many consumers to fail to question the supplements' safety, and some consumers even equate 'natural' with safe. But, 'natural' does not mean safe. For example, many wild berries and mushrooms are dangerous although they are natural. Another example is tobacco--a key ingredient in cigarettes: it is natural, but overwhelming studies have established the harm of cigarette smoke. The Food and Drug Administration (FDA) requires safety and efficacy testing prior to market entry for drugs. In contrast, the FDA only has limited ability to regulate the entry of new dietary supplements into the marketplace because supplements are treated as food. Two main arguments support the current regulatory structure of dietary supplements: (1) cost and (2) access. But lower cost and increased access to dietary supplements do not necessary have any relationship to safety and efficacy. Manufacturers' marketing techniques tout the health benefits of their supplements. Meanwhile, consumers are ingesting supplements without scientific studies indicating whether or not they are harmful. The FDA Food Safety and Modernization Act, signed into law on January 4, 2011, did not address the safety concerns regarding dietary supplements. This article discusses the regulatory deficiencies concerning dietary supplements and proposes novel solutions to address this specific sector of the food supply. This article advocates for the use of scientific data to support a multi-tiered classification system to ensure that dietary supplements on the market are safe. PMID:26591824

  14. [Efficiency of a pharmaceutical care program for long-acting parenteral antipsychotics in the health area of Santiago de Compostela].

    PubMed

    Vázquez-Mourelle, Raquel; Parrondo, Carmen Durán; López-Pardo Pardo, Estrella; Carracedo-Martínez, Eduardo

    2016-01-01

    In the healthcare area of Santiago de Compostela (Spain), the therapeutic subgroup "other antipsychotics" represented the fifth largest outpatient expenditure in 2013. More than half of this expenditure corresponded to long-acting parenteral forms of paliperidone and risperidone. Over a 12-month period, the implementation of a pharmaceutical care program based on process management and coordination of actions between health professionals in both levels of care represented savings of € 636,391.01 for the organization and a direct saving of € 16,767.36 and 9,008 trips to the pharmacy for patients. This study shows the efficiency of the program, which was facilitated by its situation in an area of integrated management and the use the unified medical records and electronic prescription, elements that will enable the future implementation of similar programmes. The new registries and healthcare interventions will allow reliable evaluation of their effectiveness in terms of treatment adherence, relapses and hospitalisations. PMID:26627381

  15. Bone metabolism in very preterm infants receiving total parenteral nutrition: do intravenous fat emulsions have an impact?

    PubMed

    Bridges, Kayla M; Pereira-da-Silva, Luis; Tou, Janet C; Ziegler, Jane; Brunetti, Luigi

    2015-12-01

    Very preterm infants (<32 weeks' gestation) are at high risk for impaired skeletal development because of factors that limit the provision of extrauterine nutrients. Cumulative net deficiencies of calcium, phosphorus, docosahexaenoic acid (DHA), and arachidonic acid (ARA) are evident in these infants after prolonged administration of total parenteral nutrition (TPN). This is significant because minerals as well as metabolites of DHA and ARA are important modulators of bone cell differentiation, lengthening of bone, and bone matrix deposition. Furthermore, diets containing only precursors of DHA and ARA result in suboptimal skeletal growth. With the emergence of new intravenous lipid emulsions, it is important to understand the impact of fatty acids on bone metabolism in the third trimester in order to optimize the provision of TPN in very preterm infants. The purpose of this review is to evaluate current evidence regarding intravenous lipid emulsions and bone metabolism in very preterm infants receiving prolonged TPN and to identify areas of research needed. PMID:26518033

  16. Comparison of routes for achieving parenteral access with a focus on the management of patients with Ebola virus disease

    PubMed Central

    Ker, Katharine; Tansley, Gavin; Beecher, Deirdre; Perner, Anders; Shakur, Haleema; Harris, Tim; Roberts, Ian

    2015-01-01

    Background Dehydration is an important cause of death in patients with Ebola virus disease (EVD). Parenteral fluids are often required in patients with fluid requirements in excess of their oral intake. The peripheral intravenous route is the most commonly used method of parenteral access, but inserting and maintaining an intravenous line can be challenging in the context of EVD. Therefore it is important to consider the advantages and disadvantages of different routes for achieving parenteral access (e.g. intravenous, intraosseous, subcutaneous and intraperitoneal). Objectives To compare the reliability, ease of use and speed of insertion of different parenteral access methods. Search methods We ran the search on 17 November 2014. We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, Ovid MEDLINE(R) and Ovid OLDMEDLINE(R), Embase Classic + Embase (OvidSP), CINAHL (EBSCOhost), clinicaltrials.gov and screened reference lists. Selection criteria Randomised controlled trials comparing different parenteral routes for the infusion of fluids or medication. Data collection and analysis Two review authors examined the titles and abstracts of records obtained by searching the electronic databases to determine eligibility. Two review authors extracted data from the included trials and assessed the risk of bias. Outcome measures of interest were success of insertion; time required for insertion; number of insertion attempts; number of dislodgements; time period with functional access; local site reactions; clinicians' perception of ease of administration; needlestick injury to healthcare workers; patients' discomfort; and mortality. For trials involving the administration of fluids we also collected data on the volume of fluid infused, changes in serum electrolytes and markers of renal function. We rated the

  17. Diets and enteral supplements for improving outcomes in chronic kidney disease

    PubMed Central

    Kalantar-Zadeh, Kamyar; Cano, Noël J.; Budde, Klemens; Chazot, Charles; Kovesdy, Csaba P.; Mak, Robert H.; Mehrotra, Rajnish; Raj, Dominic S.; Sehgal, Ashwini R.; Stenvinkel, Peter; Ikizler, T. Alp

    2013-01-01

    Protein-energy wasting (PEW), which is manifested by low serum levels of albumin or prealbumin, sarcopenia and weight loss, is one of the strongest predictors of mortality in patients with chronic kidney disease (CKD). Although PEW might be engendered by non-nutritional conditions, such as inflammation or other comorbidities, the question of causality does not refute the effectiveness of dietary interventions and nutritional support in improving outcomes in patients with CKD. The literature indicates that PEW can be mitigated or corrected with an appropriate diet and enteral nutritional support that targets dietary protein intake. In-center meals or oral supplements provided during dialysis therapy are feasible and inexpensive interventions that might improve survival and quality of life in patients with CKD. Dietary requirements and enteral nutritional support must also be considered in patients with CKD and diabetes mellitus, in patients undergoing peritoneal dialysis, renal transplant recipients, and in children with CKD. Adjunctive pharmacological therapies, such as appetite stimulants, anabolic hormones, and antioxidative or anti-inflammatory agents, might augment dietary interventions. Intraperitoneal or intradialytic parenteral nutrition should be considered for patients with PEW whenever enteral interventions are not possible or are ineffective. Controlled trials are needed to better assess the effectiveness of in-center meals and oral supplements. PMID:21629229

  18. Nutritional Supplements in Canine Dermatoses

    PubMed Central

    Ackerman, Lowell

    1987-01-01

    Nutritionally-related dermatoses of dogs have received considerable attention in the veterinary community in the past few years and most of this attention has centered on the role of vitamin E, vitamin A, zinc, and the essential fatty acids. Nutritional supplements for dogs abound in the marketplace yet few actually meet the requirements of a pet with a skin problem. Many more are not formulated strictly for dermatological cases but rather as general supplements to augment the nutritional needs of pets. The potential actions of these different nutrients are discussed and comparisons made of the different commercial supplements. PMID:17422880

  19. Preoperative overnight parenteral nutrition (TPN) improves skeletal muscle protein metabolism indicated by microarray algorithm analyses in a randomized trial.

    PubMed

    Iresjö, Britt-Marie; Engström, Cecilia; Lundholm, Kent

    2016-06-01

    Loss of muscle mass is associated with increased risk of morbidity and mortality in hospitalized patients. Uncertainties of treatment efficiency by short-term artificial nutrition remain, specifically improvement of protein balance in skeletal muscles. In this study, algorithmic microarray analysis was applied to map cellular changes related to muscle protein metabolism in human skeletal muscle tissue during provision of overnight preoperative total parenteral nutrition (TPN). Twenty-two patients (11/group) scheduled for upper GI surgery due to malignant or benign disease received a continuous peripheral all-in-one TPN infusion (30 kcal/kg/day, 0.16 gN/kg/day) or saline infusion for 12 h prior operation. Biopsies from the rectus abdominis muscle were taken at the start of operation for isolation of muscle RNA RNA expression microarray analyses were performed with Agilent Sureprint G3, 8 × 60K arrays using one-color labeling. 447 mRNAs were differently expressed between study and control patients (P < 0.1). mRNAs related to ribosomal biogenesis, mRNA processing, and translation were upregulated during overnight nutrition; particularly anabolic signaling S6K1 (P < 0.01-0.1). Transcripts of genes associated with lysosomal degradation showed consistently lower expression during TPN while mRNAs for ubiquitin-mediated degradation of proteins as well as transcripts related to intracellular signaling pathways, PI3 kinase/MAPkinase, were either increased or decreased. In conclusion, muscle mRNA alterations during overnight standard TPN infusions at constant rate altered mRNAs associated with mTOR signaling; increased initiation of protein translation; and suppressed autophagy/lysosomal degradation of proteins. This indicates that overnight preoperative parenteral nutrition is effective to promote muscle protein metabolism. PMID:27273879

  20. Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy: a meta-analysis.

    PubMed

    Peng, J; Cai, J; Niu, Z-X; Chen, L-Q

    2016-05-01

    Early postoperative enteral nutrition (EN) after esophagectomy in esophageal cancer patient has been reported to be correlated with a better rehabilitation than parenteral nutrition (PN). However, a robust conclusion has not been achieved. Therefore, we performed a meta-analysis to compare the postoperative EN and PN in patients with esophageal cancer undergoing esophagectomy. Three electronic databases were searched for eligible studies to be included in the meta-analysis. The summary relative risk/weighted mean difference (RR/WMD) estimates and corresponding 95% confidence interval (CI) were calculated using fixed- and random-effects models. Ten studies met the inclusion criteria. The analysis demonstrated that the early postoperative EN could significantly decrease the pulmonary complications (RR = 0.37, 95% CI = 0.22-0.62, P = 0.00, test for heterogeneity: I(2) = 0.0%, P = 0.89) and anastomotic leakage (RR = 0.46, 95% CI = 0.22-0.96, P = 0.04, test for heterogeneity: I(2) = 0.0%, P = 0.66) compared with PN. On the eighth postoperative day, the EN group had a higher levels of albumin (WMD = 1.84, 95% CI = 0.47-3.21, P = 0.01, test for heterogeneity: I(2) = 84.5%, P = 0.00) and prealbumin (WMD = 12.96, 95% CI = 3.63-22.29, P = 0.01, test for heterogeneity: I(2) = 0.0%, P = 0.63) compared with the PN group. However, there was no difference in digestive complications between these two approaches (RR = 1.30, 95% CI = 0.79-2.13, P = 0.30, test for heterogeneity: I(2) = 0.0%, P = 0.97). For patients with esophageal cancer following esophagectomy, the early postoperative EN support could decrease the morbidity of severe complications, such as pulmonary complications and anastomotic leakage, and maintain patients at a better nutritional status than parenteral nutrion support. PMID:25721689

  1. Anti-Inflammatory and Anti-Fibrotic Profile of Fish Oil Emulsions Used in Parenteral Nutrition-Associated Liver Disease

    PubMed Central

    Pastor-Clerigues, Alfonso; Marti-Bonmati, Ezequiel; Milara, Javier; Almudever, Patricia; Cortijo, Julio

    2014-01-01

    Home parenteral nutrition (PN) is associated with many complications including severe hepatobiliary dysfunction. Commercial ω-6 fatty acid-soybean based-lipid emulsions in PN may mediate long term PN associate liver disease (PNALD) whereas ω-3-fish oil parenteral emulsions have shown to reverse PNALD in children. However, its clinical effectiveness in adults has been scarcely reported. In this work, we study the role of soybean and fish oil lipid commercial emulsions on inflammatory and profibrotic liver markers in adults with long term PNALD and in in vitro cellular models. Inflammatory and profibrotic markers were measured in serum of ten adults with long term PNALD and in culture supernatants of monocytes. Liver epithelial to mesenchymal transition (EMT) was induced by transforming growth factor beta 1 (TGFβ1) to evaluate in vitro liver fibrosis. Omegaven®, a 100% fish oil commercial emulsion, was infused during four months in two patients with severe long term PNALD reversing, at the first month, the inflammatory, profibrotic and clinical parameters of PNALD. The effect was maintained during the treatment course but impaired when conventional lipid emulsions were reintroduced. The other patients under chronic soybean oil-based PN showed elevated inflammatory and profibrotic parameters. In vitro human monocytes stimulated with lipopolysaccharide induced a strong inflammatory response that was suppressed by Omegaven®, but increased by soybean emulsions. In other experiments, TGFβ1 induced EMT that was suppressed by Omegaven® and enhanced by soybean oil lipid emulsions. Omegaven® improves clinical, anti-inflammatory and anti-fibrotic parameters in adults with long-term home PNALD. PMID:25502575

  2. Low iron diet and parenteral cadmium exposure in pregnant rats: the effects on trace elements and fetal viability.

    PubMed

    Piasek, Martina; Blanusa, Maja; Kostial, Krista; Laskey, John W

    2004-02-01

    The effects of latent iron deficiency combined with parenteral subchronic or acute cadmium exposure during pregnancy on maternal and fetal tissue distribution of cadmium, iron and zinc, and on fetal viability were evaluated. Timed-pregnant Sprague-Dawley rats were fed on semisynthetic test diets with either high iron (240 mg kg) or low iron (10 mg kg), and concomitantly exposed to 0, 3 or 5 mg cadmium (as anhydrous CdCl2) per kilogram body weight. Animals were exposed to cadmium from gestation day 1 through 19 by subcutaneously implanted mini pumps (Subchronic exposure) or on gestation day 15 by a single subcutaneous injection (Acute exposure). All rats were killed on gestation day 19. Blood samples, selected organs and fetuses were removed and prepared for element analyses by atomic absorption spectrometry. Low iron diet caused decreases in maternal body weight, maternal and fetal liver weights, placental weights and tissue iron concentrations. By cadmium exposure, both subchronic and acute, tissue cadmium concentrations were increased and the increase was dose-related, maternal liver and kidney zinc concentrations were increased, and fetal zinc concentration was decreased. Cadmium concentration in maternal liver was additionally increased by low iron diet. Acute cadmium exposure caused lower maternal body and organ weights, high fetal mortality, and decreased fetal weights of survivors. In conclusion, parenteral cadmium exposure during pregnancy causes perturbations in essential elements in maternal and fetal compartments. Acute cadmium exposure in the last trimester of gestation poses a risk for fetal viability especially when combined with low iron in maternal diet. PMID:14977357

  3. To supplement or not to supplement: a metabolic network framework for human nutritional supplements.

    PubMed

    Nogiec, Christopher D; Kasif, Simon

    2013-01-01

    Flux balance analysis and constraint based modeling have been successfully used in the past to elucidate the metabolism of single cellular organisms. However, limited work has been done with multicellular organisms and even less with humans. The focus of this paper is to present a novel use of this technique by investigating human nutrition, a challenging field of study. Specifically, we present a steady state constraint based model of skeletal muscle tissue to investigate amino acid supplementation's effect on protein synthesis. We implement several in silico supplementation strategies to study whether amino acid supplementation might be beneficial for increasing muscle contractile protein synthesis. Concurrent with published data on amino acid supplementation's effect on protein synthesis in a post resistance exercise state, our results suggest that increasing bioavailability of methionine, arginine, and the branched-chain amino acids can increase the flux of contractile protein synthesis. The study also suggests that a common commercial supplement, glutamine, is not an effective supplement in the context of increasing protein synthesis and thus, muscle mass. Similar to any study in a model organism, the computational modeling of this research has some limitations. Thus, this paper introduces the prospect of using systems biology as a framework to formally investigate how supplementation and nutrition can affect human metabolism and physiology. PMID:23967053

  4. Photoinduced particulate matter in a parenteral formulation for bisnafide, an experimental antitumor agent.

    PubMed

    Rubino, J T; Chan, L L; Walker, J T; Segretario, J; Everlof, J G; Hussain, M A

    1999-08-01

    This paper assesses the cause of particulate formation in vials of the experimental antitumor agent bisnafide and investigates pharmaceutical techniques to reduce the number of particulates in the product. Solution preparation and particulate isolation were performed under Class 100 laminar air flow. Reversed-phase HPLC and infrared microscopy were used to characterize drug and isolated particulate matter, whereas a Hiac particle counter was used to quantify the particulate matter. Particulate matter was observed following agitation of the drug solutions and was found to be associated with specific lots of drug substance. HPLC of the isolated particulate matter indicated that the particulates consisted largely of bisnafide and impurities that were identified as the products of photodegradation, confirmed to be the result of the photolytic cleavage of bisnafide to form a poorly soluble aldehyde. The aldehyde may, in turn, interact with bisnafide molecules to form the particulate matter as suggested by the observed pH-dependent reversibility of the particulate phenomenon. The particulate matter could be reduced by protecting solutions of bisnafide from light during chemical synthesis and production of the dosage form and, alternatively, by reducing the solution pH to 3.0 or less, addition of surfactants below their critical micelle concentration, and removal of impurities by froth flotation of the bisnafide solutions. PMID:10434290

  5. Breastfeeding FAQs: Solids and Supplementing

    MedlinePlus

    ... Is it OK to give my baby breast milk and formula? Although breast milk is the best nutritional choice for infants, in ... with a supplemental nursing system in which pumped milk or formula goes through a small tube that ...

  6. Botanical Dietary Supplements: Background Information

    MedlinePlus

    ... plant, but many compounds may be responsible for valerian' ;s relaxing effect. Are botanical dietary supplements safe? Many ... before their full effects are achieved. For example, valerian may be effective as a sleep aid after ...

  7. Nutritional supplements for macular degeneration.

    PubMed

    2006-02-01

    Age-related macular degeneration is the commonest cause of blindness in developed countries and the third most common worldwide. Each year in the UK, around 17,000 people become blind or partially sighted as a result of this condition, and its prevalence is likely to increase with an ageing population. Laser therapy and rarely surgery, can slow disease progression in a minority of patients but is unlikely to restore lost vision. A wide range of nutritional supplements are now on sale with promotional claims that they improve eye health. While some specialists recommend their use to patients with advanced disease, these supplements are also increasingly promoted to people with early or no signs of disease. Consequently, GPs come under pressure from patients to recommend, or even prescribe, a nutritional supplement. Here we examine the evidence for nutritional supplements in the management of age-related macular degeneration and consider which, if any, can be recommended. PMID:16550811

  8. Dietary Supplement Label Database (DSLD)

    MedlinePlus

    ... Print Report Error T he Dietary Supplement Label Database (DSLD) is a joint project of the National ... participants in the latest survey in the DSLD database (NHANES): The search options: Quick Search, Browse Dietary ...

  9. Flavonoids, the emerging dietary supplement against cisplatin-induced nephrotoxicity.

    PubMed

    Athira, K V; Madhana, Rajaram Mohanrao; Lahkar, Mangala

    2016-03-25

    The letter illustrates the emerging potential of flavonoids as dietary supplement to ameliorate cisplatin-induced nephrotoxicity and refers to the recent article on ''Anti-apoptotic and anti-inflammatory effects of naringin on cisplatin-induced renal injury in the rat'' by Chtourou et al. They demonstrated that supplementation of naringin, a flavanone glycoside, found in grape and citrus fruit species, can attenuate cisplatin-induced renal dysfunction via restoration of redox balance and suppression of inflammation, NF-κB activation and apoptosis. The chemotherapeutic efficacy of cisplatin has always compelled the researchers to find solution to ameliorate its side effects. In recent years, numerous candidates have been evaluated for their protective potential against cisplatin-induced nephrotoxicity and flavonoids have come up with promising results. The future prospects might be promising with a proper refinement and collective integration of the preclinical and clinical research in the field of flavonoid supplementation to cisplatin therapy. PMID:26876905

  10. Vitamin D supplementation in neonates.

    PubMed

    Wu, Zhe

    2014-01-01

    Vitamin D deficiency may lead to the development of rickets. In our paediatrics department in a major London hospital, we audited the number of babies with low vitamin D levels attending our prolonged jaundice clinic. Prior to our newly designed intervention, those babies with low vitamin D levels would be given a letter to encourage collection of supplementation from their GP. The GP would receive a letter which included a 14-page guideline on vitamin D supplementation. For this project, we included all breastfed babies that attended our prolonged jaundice clinic between August 2012 and December 2012. Those babies that were either vitamin D deficient or insufficient were identified. We then followed up these patients and asked them whether they were being prescribed the correct supplementation after being identified as vitamin deficient. For our intervention, we designed a leaflet to simplify guidelines that was then distributed to mothers and their GPs. Following this intervention, we re-audited the new cohort of patients who received the leaflet between August and November 2013. The study found 71% of babies to be vitamin D deficient. Moreover, almost two in five mothers had less than the recommended six months of vitamin supplementation during pregnancy. After identifying a deficiency, one would expect that uptake of vitamin supplementation would increase dramatically. However, only four in 10 babies went on to receive the correct dose and preparation of supplements. A marked increase in uptake was seen during the re-audit post intervention, with 71% of babies receiving correct supplementation. While an increase in government advertising would have contributed to the rise in uptake of vitamin D supplementation, a leaflet proved to be a simple yet effective intervention in improving vitamin uptake in babies. As a result, this was then implemented as part of trust guidelines. PMID:26733062

  11. Vitamin D supplementation in neonates

    PubMed Central

    Wu, Zhe

    2014-01-01

    Vitamin D deficiency may lead to the development of rickets. In our paediatrics department in a major London hospital, we audited the number of babies with low vitamin D levels attending our prolonged jaundice clinic. Prior to our newly designed intervention, those babies with low vitamin D levels would be given a letter to encourage collection of supplementation from their GP. The GP would receive a letter which included a 14-page guideline on vitamin D supplementation. For this project, we included all breastfed babies that attended our prolonged jaundice clinic between August 2012 and December 2012. Those babies that were either vitamin D deficient or insufficient were identified. We then followed up these patients and asked them whether they were being prescribed the correct supplementation after being identified as vitamin deficient. For our intervention, we designed a leaflet to simplify guidelines that was then distributed to mothers and their GPs. Following this intervention, we re-audited the new cohort of patients who received the leaflet between August and November 2013. The study found 71% of babies to be vitamin D deficient. Moreover, almost two in five mothers had less than the recommended six months of vitamin supplementation during pregnancy. After identifying a deficiency, one would expect that uptake of vitamin supplementation would increase dramatically. However, only four in 10 babies went on to receive the correct dose and preparation of supplements. A marked increase in uptake was seen during the re-audit post intervention, with 71% of babies receiving correct supplementation. While an increase in government advertising would have contributed to the rise in uptake of vitamin D supplementation, a leaflet proved to be a simple yet effective intervention in improving vitamin uptake in babies. As a result, this was then implemented as part of trust guidelines. PMID:26733062

  12. [Nutrient supplements - possibilities and limitations].

    PubMed

    Ströhle, Alexander; Hahn, Andreas

    2013-05-01

    The consumption of micronutrient-supplements by the general public has become widespread; between 25 and more than 40% of individuals questioned in western developed nations confirm to regularly consume such products. In principle, there are two product categories for micronutrient-supplements - medicinal products (drugs) and foodstuffs. The latter are marketed as food supplements (FS) and dietary foodstuffs for particular nutritional uses including foods for special medical purposes (FSMP). FS serve the general supplementation of any consumer whilst foodstuffs for particular nutritional uses are directed at consumers with special dietary requirements; FSMP are intended for the dietary management of patients. There are clearly defined legal frameworks for those product categories. Independently of their legal product status, six areas of application can be characterised for micronutrient-supplements: general and special supplementation, primary prevention, compensation of disease-related deficits, therapeutic function and containment of diseases or avoidance of subsequent damages (secondary and tertiary function). Gauged with the mean-intake, micro nutrient supply in Germany is sufficient (exception: folic acid and vitamin D; partially also iodine). However, the intake of vitamins E, C, B1 and B2 as well as the minerals calcium, magnesium, zinc and iodine could be improved in 20-50% of the general public. Micro nutrient preparations in physiological dose could contribute to closing this gap in supply. PMID:23758028

  13. 7 CFR 1924.49 - State supplements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 12 2010-01-01 2010-01-01 false State supplements. 1924.49 Section 1924.49 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS... supplements. State Supplements or policies will not be issued or adopted to either supplement or...

  14. 31 CFR 8.58 - Supplemental charges.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Supplemental charges. 8.58 Section 8... ALCOHOL, TOBACCO AND FIREARMS Disciplinary Proceedings § 8.58 Supplemental charges. If it appears that the... supplemental charges against the respondent. These supplemental charges may be tried with other charges in...

  15. 31 CFR 8.58 - Supplemental charges.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Supplemental charges. 8.58 Section 8... ALCOHOL, TOBACCO AND FIREARMS Disciplinary Proceedings § 8.58 Supplemental charges. If it appears that the... supplemental charges against the respondent. These supplemental charges may be tried with other charges in...

  16. Food Supplement Usage by Adolescent Males.

    ERIC Educational Resources Information Center

    Fleischer, Barbara; Read, Marsha

    1982-01-01

    Adolescent males (N=568) responded to a questionnaire examining their food supplement usage, types of food supplements consumed, reasons for use and non-use, relationship of use to concern for health, and demographic and external factors influencing supplement use. Presents factors related to food supplement usage. (RC)

  17. Stability of apomorphine hydrochloride in aqueous sodium bisulphite solutions.

    PubMed

    Ng Ying Kin, N M; Lal, S; Thavundayil, J X

    2001-10-01

    Apomorphine (Apo), a dopamine receptor agonist used extensively in clinical research, is known to be chemically unstable. The authors have used a high performance liquid chromatography (HPLC) method to study the long-term stability of pharmaceutical preparations of R(-) Apomorphine hydrochloride (ApoHCI) for parenteral use. In a concentration of 1 mg/ml, ApoHCI in aqueous solutions of sodium metabisulphite (0.125%), kept at 4 degrees and shielded from light, was found to be stable for up to six months. On the other hand, solutions of 0.1 mg/ml were found to decompose after only three weeks, showing extraneous peaks in the HPLC. However, the blue-green discoloration, characteristic of Apo degradation, was only apparent after six weeks storage. The rapidity of the HPLC method used, its reproducibility and sensitivity make it suitable for quality control studies of pharmaceutical preparations of ApoHCI intended for clinical research. PMID:11513359

  18. Aerobic growth of campylobacter in media supplemented with a-ketoglutaric, lactic, and/or fumaric acids

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A study was conducted to examine the ability of Campylobacter spp. to grow aerobically in media supplemented with selected organic acids. Basal broth media composed of tryptose, yeast extract, and a mineral-vitamin solution was supplemented with a-ketoglutaric, lactic, and/or fumaric acids. The fina...

  19. Environmental Report 1999 Data Supplement

    SciTech Connect

    Larson, J M; Biermann, A H; Harrach, R J; Althouse, P E; Bertoldo, N A; Blake, R G; Brandstetter, E R; Brigdon, S L; Brown, R A; Christofferson, E; Folks, K J; Gallegos, G M; Garcia, L M; Giesing, T A; Grayson, A R; Hall, L C; MacQueen, D H; Mathews, S; Peterson, S R; Taffet, M J; Tate, P J; Vellinger, R J; Ward, R J; Williams, R A

    2000-09-01

    This Data Supplement to the Lawrence Livermore National Laboratory's (LLNL's) annual ''Environmental Report 1999'' was prepared for the U.S. Department of Energy. The main volume is intended to provide all information on LLNL's environmental impact and compliance activities that is of interest to most readers. The Data Supplement supports main volume summary data and is essentially a detailed data report that provides individual data points, where applicable. Some summary data are also included in the Data Supplement, and more detailed accounts are given of sample collection and analytical methods. The two volumes are organized in a parallel fashion to aid the reader in cross-referencing between them. This supplement includes more detailed information to support the nine chapters in the main volume that cover monitoring of air, air effluent, sewerable water, surface water, ground water, soil and sediment, vegetation and foodstuff, environmental radiation, and quality assurance. The other five chapters in the main volume have no supporting information in the Data Supplement. As in our previous annual reports, data are presented in Systeme International (SI) units. In particular, the primary units used for radiological results are becquerels and sieverts for activity and dose, with curies and rem used secondarily (1 Bq = 2.7 x 10{sup -11} Ci; 1 Sv = 100 rem).

  20. Environmental Report 2000 Data Supplement

    SciTech Connect

    Biermann, A H; Althouse, P E; Bertoldo, N A; Blake, R G; Brigdon, S L; Brown, R A; Campbell, C G; Christofferson, E; Clark, L M; Folks, K J; Gallegos, G M; Grayson, A R; Harrach, R J; Larson, J M; MacQueen, D H; Mathews, S; Nisbet, B; Ring Peterson, S; Taffet, M J; Tate, P J; Vellinger, R J; Williams, R A

    2001-09-01

    This Data Supplement to the Lawrence Livermore National Laboratory's (LLNL's) annual ''Environmental Report 2000'' was prepared for the U.S. Department of Energy. The main volume is intended to provide all information on LLNL's environmental impact and compliance activities that is of interest to most readers. The Data Supplement supports main volume summary data and is essentially a detailed data report that provides individual data points, where applicable. Some summary data are also included in the Data Supplement, and more detailed accounts are given of sample collection and analytical methods. The two volumes are organized in a parallel fashion to aid the reader in cross-referencing between them. This supplement includes more detailed information to support the nine chapters in the main volume that cover monitoring of air surveillance, air effluent, sewerable water, surface water, groundwater, soil and sediment, vegetation and foodstuff, environmental radiation, and quality assurance. The other five chapters in the main volume have no supporting information in the Data Supplement. As in our previous annual reports, data are presented in Systeme International (SI) units. In particular, the primary units used for radiological results are becquerels and sieverts for activity and dose, with curies and rem used secondarily (1 Bq = 2.7 x 10{sup -11} Ci; 1 Sv = 100 rem).