Advances in Parenteral Nutrition: Proceedings of an International Symposium held in Bermuda, 16–19th May, 1977

560 Pages·1978·51.64 MB·English

by  I. D. A. Johnston (auth.), Ivan D. A. Johnston (eds.)

Advances in Parenteral Nutrition
Advances in
Parenteral Nutrition
Proceedings of an International Symposium
held in Bermud.a, 16-19th May, 1977
Edited by
Ivan D. A. Johnston
Department of Surgery, University of Newcastle-Upon-Tyne
University Park Press
Baltimore
Published in the USA and Canada by
University Park Press
233 East Redwood Street
Baltimore, Maryland 21202
Published in the UK by
MTP Press Ltd
St Leonard's House
St Leonardgate
Lancaster
England
Copyright © 1978 MTP Press Ltd
Softcover reprint of the hardcover 1st edition 1978
No part of this book may be reproduced
in any form without permission from the
publishers except for the quotation of
brief passages for the purposes of review
Library of Congress Cataloging in Publication Data
Main entry under title:
Advances in parenteral nutrition.
Includes bibliographical references and index.
1. Parenteral feeding-Congresses. I. Johnstone,
Ivan David Alexander.
RM224.A38 615'.5 77-20198
ISBN-13: 978-94-011-7190-8 e-ISBN-13: 978-94-011-7188-5
DOl: 10.1007/978-94-011-7188-5
Contents
Page
Preface Xl
List of Contributors XIII
SECTION I FOUNDATIONS OF PARENTERAL NUTRITION
I. Metabolic foundations of intravenous nutrition 3
I. D. A. Johnston
SECTION II CARBOHYDRATES IN PARENTERAL NUTRITION
2. Some general considerations concerning the use of carbohydrates 23
in parenteral nutrition
H. A. Krebs
3. Metabolic pathways for carbohydrates in parenteral nutrition 29
D. Newton, H. Connor and H. F. Woods
4. Short-term parenteral nutrition with and without fructose 45
P. Vi nay, D. Bourbeau, G. Lemieux, A. Duranceau and
A. Gougoux
5. Evaluation of non-glucose carbohydrates in parenteral nutrition 61
N. Zollner
Panel Discussion 75
SECTION 1lI AMINO ACIDS IN PARENTERAL NUTRITION
6. Intracellular amino acids and energy metabolism In catabolic 85
patients with regard to muscle tissue
P. FUrst, J. Bergstrom, E. Vinnars, B. Schildt and B. Holstrom
Discussion 105
7. Biological limiting factors to parenteral amino acid feeding in man 107
H.N.Munro
v
ADVANCES IN PARENTERAL NUTRITION
8. Isotonic crystalline amino acids for protein sparing 119
G. L. Blackburn and H. Y. Reinhoff, Jr.
Discussion 134
9. The protein-sparing effect of isotonic amino acids: metabolic 141
considerations
K. J. Foster, K. G. M. M. Alberti and S. J. Karran
Discussion 160
SECTION IV FAT EMULSIONS IN PARENTERAL NUTRITION
10. Use of fat emulsions in parenteral nutrition 165
D. E. F. Tweedle
Discussion 178
11. Lipid metabolism in stress 179
R. L. Holliday, T. Viidik and B. Jennings
Discussion 192
12. Role of lipid as a source of nonprotein calories 195
D. W. Wilmore
Discussion 208
13. Effect of long-term administration of fat emulsion on lipid 211
deposition in the reticuloendothelial system in man
U. Freund, A. L. Durst, Y. Krausz, I. S. Levij and M. Eliakim
Discussion 217
14. Toxicity of lipids 219
T. D. Darby and R. F. Wallin
Discussion 228
SECTION V TRACE ELEMENTS IN PARENTERAL NUTRITION
15. Trace element formulations in intravenous feeding 233
N. J. Kartinos
16. Zinc and other trace elements 241
G. S. Fell and R. R. Burns
Panel Discussion 262
SECTION VI PARENTERAL NUTRITION IN PAEDIATRICS
17. Aspects of intravenous feeding in childhood 267
J. T. Harries
vi
CONTENTS
18. Study of the use of total parenteral nutrition in neonates suffering 281
from necrotizing enterocolitis
A. B. Jones
19. Use of Travasol in paediatric patients 293
M. T. Ste-Marie
20. Abnormalities of amino acid metabolism in the newborn 301
H. N. Tucker
Discussion 312
SECTION VII CONTROL OF INFECTION IN PARENTERAL NUTRITION
21. Microbial hazards in the assembly of intravenous infusions 319
R. B. Kundsin
22. Bacterial contamination of intravenous infusions due to faulty 325
technique
C. W. Walter
23. The incidence of nosocomial infection in patients receiving total 339
parenteral nutrition
J. R. Allen
24. Tracing sources of infection associated with parenteral infusions 379
l. Phillips and S. Eykyn
Discussion 385
SECTION VIII BIOCHEMICAL ASPECTS OF PARENTERAL NUTRITION
25. Acid-base balance during parenteral nutrition with Travasol 391
D. Bourbeau, P. Vinay, G. Lemieux, A. Gougoux and
A. Duranceau
Discussion 40 I
26. Metabolic complications of parenteral nutrition 403
R. K. Ausman and G. Hardy
Discussion 41 I
27. The compatibility of extemporaneously added drug additives with 415
Travasol (amino acid) injection
R. L. Nedich
Discussion 425
vii
ADVANCES IN PARENTERAL NUTRITION
SECTION IX CLINICAL ASPECTS OF PARENTERAL NUTRITION
28. Clinical experience of total parenteral nutrition 429
D. B. Allardyce
Discussion 444
29. Protein sparing therapy during prolonged ileus 447
K. J. Foster, K. G. M. M. Alberti, N. Allen, J. Jenkins,
R. M. Kammeriing, S. J. Karran and C. Smart
Discussion 458
30. Cholestatic jaundice during parenteral alimentation in adults 461
A. Sitges-Creus, E. Canadas and L. Vilar
Discussion 470
31. The importance of parenteral nutrition as an adjunct to cancer 473
treatment
E. M. Copeland III and S. J. Dudrick
Discussion 496
32. Artificial nutrition and the gastrointestinal tract: some clinical 501
and experimental data
Y. A. Carpentier and Ph. Janne
Discussion 507
SECTION X PARENTERAL NUTRITION AND BODY COMPOSITION: ASSESSMENT
OF THERAPY
33. The tissue composition of surgical weight loss 511
J. M. Kinney
Discussion 519
34. Research in malnutrition and its application to parenteral 521
feeding
w. P. T. James
Discussion 532
35. The use of body composition measurements to assess the efficacy 535
of parenteral nutrition
H. M. Shizgal
Discussion 552
viii
CONTENTS
36. Use of 4°K counting and its relationship to other estimates of 557
lean body mass
A. w. Goode and T. Hawkins
Discussion 571
Appendix - Sf units 573
Index 577
IX
Preface
Parenteral nutrition has been one of the most significant therapeutic advances
of the past twenty years. Many patients have survived very serious illness
only because of intravenous nutrition for either short or very long periods
of time.
The indications for parenteral nutrition are simple and can be summarised
as the inability to ingest necessary nutrients for a significant time during
increased metabolic demands.
Many problems in the preparation of energy sources and amino acid
solutions have been solved so that the time is opportune to review what has
been achieved and discuss recent advances and current thinking in the light
of future requirements.
The next phase in parenteral nutrition will undoubtedly be the provision
of regimens designed for specific situations. The needs of the neonate for
example are known to differ from adult requirements.
The choice of carbohydrate for intravenous use has been a matter of much
discussion. The supremacy of glucose both in biochemical and clinical terms
now seems well established. The value of intravenous fat is well documented,
but the interchange of fat and carbohydrate as calorie sources and the
effects of prolonged infusions of fat merit further investigation.
The evidence that isotonic amino acids are utilized effectively when given
alone due to the availability of endogenous energy sources has led to a
greater understanding of the metabolic changes and demands associated with
injury and sepsis.
The value of parenteral nutrition in clinical terms will always be assessed
in relation to associated complications. Many of the biochemical problems
such as hypophosphataemia and hyperosmolar situations can now be
anticipated and avoided. The amount and extent of trace element supple-
mentation required during prolonged parenteral nutrition is an interesting
and challenging field of study. The most serious drawback to intravenous
nutrition has always been the problems associated with access to the cir-
culation. Meticulous attention to details of aseptic technique in all aspects
Xl
ADVANCES IN PARENTERAL NUTRITION
of the preparation and delivery of intravenous nutrients will reduce the
hazards of infection to a minimum.
Many chapters in this book and the associated discussions point the way
forward to further advances in the understanding of metabolism during
illness and the provision of nutritional support.
IVAN D. A. JOHNSTON
xii