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Postgraduate Medical Journal Feb 2006Parenteral nutrition is an expensive therapeutic modality that is used to treat patients with intestinal failure. The benefit it offers in terms of life prolongation... (Review)
Review
Parenteral nutrition is an expensive therapeutic modality that is used to treat patients with intestinal failure. The benefit it offers in terms of life prolongation needs to be weighed against its risks and burdens. Through the use of descriptive clinical vignettes, this article illustrates the ethical and legal principles that underpin decisions to administer and, more importantly, to withhold or withdraw parenteral nutrition.
Topics: Bioethical Issues; Health Resources; Humans; Legislation, Medical; Life Support Care; Medical Futility; Parenteral Nutrition; Risk Factors; Third-Party Consent; Treatment Refusal
PubMed: 16461468
DOI: 10.1136/pgmj.2005.037127 -
Nutricion Hospitalaria Jun 2024Introduction: the stability of total parenteral nutrition admixtures for neonates (TPNAn) has been questioned in relation to the interaction between calcium and fish oil...
Introduction: the stability of total parenteral nutrition admixtures for neonates (TPNAn) has been questioned in relation to the interaction between calcium and fish oil emulsions. Aim: the aim of this study was to check the stability (particle size < 1 µm) of different individualized TPNAn prepared with fish-oil emulsion and containing calcium at concentrations ranging from 10 to 20 mmol/L. Methods: admixtures analyzed: twelve different formulations with SMOFlipid® 20 % (conserved for 24 h and for 96 h), three formulations with Lipoplus® 20 % (conserved for 96 h) and three formulations with SMOFlipid® 20 % with Multi-12K1® Pediatric (conserved for 96 h). Two bags were compounded for each formulation and conservation period. Measurements on each admixture bag: particle standardized diameter by laser diffraction technique and pH by a calibrated pH-meter. Data analysis with mixed linear regression models. Results: maximum particle size was < 0.8 µm for all investigated admixtures. Lipid concentration of 5 g/L and sodium and potassium concentration of 100 mmol/L slightly increased the proportion of particles > 0.6 µm. Ninety six hours storage also increased the percentage of particles > 0.6 µm (+0.143 ± 0.07; p = 0.038) but did not influence other parameters. No association with calcium composition was observed. Amino acid content was inversely correlated with pH (-0.83; p < 0.0001). Conclusions: the studied individualized parenteral nutrition admixtures for newborns that contain fish oil emulsions and meet cation requirements are stable for at least 96 hours.
Topics: Humans; Fish Oils; Infant, Newborn; Calcium; Fat Emulsions, Intravenous; Drug Stability; Parenteral Nutrition, Total; Parenteral Nutrition; Particle Size; Emulsions; Parenteral Nutrition Solutions; Olive Oil; Soybean Oil; Triglycerides
PubMed: 38328971
DOI: 10.20960/nh.04931 -
German Medical Science : GMS E-journal Nov 2009PN (parenteral nutrition) should be standardised to ensure quality and to reduce complications, and it should be carried out in consultation with a specialised nutrition... (Review)
Review
Organisation, regulations, preparation and logistics of parenteral nutrition in hospitals and homes; the role of the nutrition support team - Guidelines on Parenteral Nutrition, Chapter 8.
PN (parenteral nutrition) should be standardised to ensure quality and to reduce complications, and it should be carried out in consultation with a specialised nutrition support team whenever possible. Interdisciplinary nutrition support teams should be established in all hospitals because effectiveness and efficiency in the implementation of PN are increased. The tasks of the team include improvements of quality of care as well as enhancing the benefit to cost ratio. Therapeutic decisions must be taken by attending physicians, who should collaborate with the nutrition support team. "All-in-One" bags are generally preferred for PN in hospitals and may be industrially manufactured, industrially manufactured with the necessity to add micronutrients, or be prepared "on-demand" within or outside the hospital according to a standardised or individual composition and under consideration of sterile and aseptic conditions. A standardised procedure should be established for introduction and advancement of enteral or oral nutrition. Home PN may be indicated if the expected duration of when PN exceeds 4 weeks. Home PN is a well established method for providing long-term PN, which should be indicated by the attending physician and be reviewed by the nutrition support team. The care of home PN patients should be standardised whenever possible. The indication for home PN should be regularly reviewed during the course of PN.
Topics: Germany; Government Regulation; Home Care Services; Hospitalization; Humans; Nutrition Disorders; Parenteral Nutrition; Patient Care Team; Practice Guidelines as Topic
PubMed: 20049081
DOI: 10.3205/000079 -
Nutrients Aug 2023Gender-based medicine is attracting increasing interest every day, but studies on pediatric populations are still limited. In this setting, sex differences among...
Gender-based medicine is attracting increasing interest every day, but studies on pediatric populations are still limited. In this setting, sex differences among patients undergoing total parenteral nutrition (TPN) have not been previously reported. This study investigated the presence of sex differences in parenteral nutrition composition and outcomes among a cohort of pediatric patients admitted at the Oncohematology and Bone Marrow Transplant Unit of the Institute for Maternal and Child Health "Burlo Garofolo" of Trieste, Italy. For all 145 recruited patients (87 males, 58 females), the following data were collected: age, sex, volume and duration of TPN, macro- and micronutrient composition of TPN bags, electrolytic or blood gases imbalance, glycolipid alterations, liver damage during TPN, and the incidence of sepsis and thrombosis. The analysis showed that females required higher daily phosphate intake ( = 0.054) and essential amino acid supplementation ( = 0.07), while males had a higher incidence of hypertriglyceridemia ( < 0.05) and cholestasis. A higher incidence of sepsis was found in the non-transplanted male population ( < 0.05). No significant differences were appreciable in other analyzed variables. This study aims to create a basis for future gender-based nutritional recommendations in the pediatric field.
Topics: Humans; Female; Male; Child; Sex Characteristics; Parenteral Nutrition; Men; Parenteral Nutrition, Total; Academies and Institutes
PubMed: 37686854
DOI: 10.3390/nu15173822 -
Cellular and Molecular Gastroenterology... 2022Parenteral nutrition (PN) is a lifesaving therapy for patients with intestinal failure. Hepatic steatosis is a potentially fatal complication of long-term PN, but the...
BACKGROUND & AIMS
Parenteral nutrition (PN) is a lifesaving therapy for patients with intestinal failure. Hepatic steatosis is a potentially fatal complication of long-term PN, but the involved pathological mechanisms are incompletely unclarified. Herein, we identify the role of protein phosphatase 2A (PP2A) in the pathogenesis of parenteral nutrition-associated hepatic steatosis (PNAHS).
METHODS
Proteomic/phosphoproteomic analyses of liver samples from patients with PNAHS were applied to identify the mechanism of PNAHS. Total parenteral nutrition (TPN) mice model, in vivo, and in vitro experiments were used to assess the effect of PP2A-Cα on liver fatty acid metabolism.
RESULTS
Reduced expression of PP2A-Cα (catalytic subunit) enhanced activation of serine/threonine kinase Akt2 and decreased activation of adenosine monophosphate-activated protein kinase (AMPK) were associated with hepatic steatosis in patients with PNAHS. Mice given PN for 14 days developed hepatic steatosis, down-regulation of PP2A-Cα, activation of Akt2, and inhibition of AMPK. Hepatocyte-specific deletion of PP2A-Cα in mice given PN exacerbated Akt2 activation, AMPK inhibition, and hepatic steatosis through an effect on fatty acid degradation, whereas hepatocyte-specific PP2A-Cα overexpression significantly ameliorated hepatic steatosis accompanied with Akt2 suppression and AMPK activation. Additionally, pharmacological activation of Akt2 in mice overexpressing PP2A-Cα led to the aggravation of hepatic steatosis.
CONCLUSIONS
Our findings demonstrate that hepatic PP2A-Cα serves as a protective factor of PNAHS due to ameliorating hepatic steatosis and improving liver function. Our study provides a strong rationale that PP2A-Cα may be involved in the pathogenesis of PNAHS.
Topics: AMP-Activated Protein Kinases; Animals; Fatty Acids; Fatty Liver; Humans; Mice; Parenteral Nutrition; Parenteral Nutrition, Total; Protein Phosphatase 2; Proteomics
PubMed: 35643235
DOI: 10.1016/j.jcmgh.2022.05.008 -
Nutrients Feb 2021Total parenteral nutrition (TPN) is a life-saving intervention for infants that are unable to feed by mouth. Infants that remain on TPN for extended periods of time are... (Review)
Review
Total parenteral nutrition (TPN) is a life-saving intervention for infants that are unable to feed by mouth. Infants that remain on TPN for extended periods of time are at risk for the development of liver injury in the form of parenteral nutrition associated cholestasis (PNAC). Current research suggests the lipid component of TPN is a factor in the development of PNAC. Most notably, the fatty acid composition, vitamin E concentration, and presence of phytosterols are believed key mediators of lipid emulsion driven PNAC development. New emulsions comprised of fish oil and medium chain triglycerides show promise for reducing the incidence of PNAC in infants. In this review we will cover the current clinical studies on the benefit of fish oil and medium chain triglyceride containing lipid emulsions on the development of PNAC, the current constituents of lipid emulsions that may modulate the prevalence of PNAC, and potential new supplements to TPN to further reduce the incidence of PNAC.
Topics: Cholestasis; Fat Emulsions, Intravenous; Humans; Infant, Newborn; Liver Diseases; Parenteral Nutrition
PubMed: 33557154
DOI: 10.3390/nu13020508 -
Critical Care (London, England) 2008Acute kidney injury (AKI) develops mostly in the context of critical illness and multiple organ failure, characterized by alterations in substrate use, insulin... (Review)
Review
Acute kidney injury (AKI) develops mostly in the context of critical illness and multiple organ failure, characterized by alterations in substrate use, insulin resistance, and hypercatabolism. Optimal nutritional support of intensive care unit patients remains a matter of debate, mainly because of a lack of adequately designed clinical trials. Most guidelines are based on expert opinion rather than on solid evidence and are not fundamentally different for critically ill patients with or without AKI. In patients with a functional gastrointestinal tract, enteral nutrition is preferred over parenteral nutrition. The optimal timing of parenteral nutrition in those patients who cannot be fed enterally remains controversial. All nutritional regimens should include tight glycemic control. The recommended energy intake is 20 to 30 kcal/kg per day with a protein intake of 1.2 to 1.5 g/kg per day. Higher protein intakes have been suggested in patients with AKI on continuous renal replacement therapy (CRRT). However, the inadequate design of the trials does not allow firm conclusions. Nutritional support during CRRT should take into account the extracorporeal losses of glucose, amino acids, and micronutrients. Immunonutrients are the subject of intensive investigation but have not been evaluated specifically in patients with AKI. We suggest a protocolized nutritional strategy delivering enteral nutrition whenever possible and providing at least the daily requirements of trace elements and vitamins.
Topics: Acute Kidney Injury; Energy Metabolism; Enteral Nutrition; Humans; Multiple Organ Failure; Nutritional Requirements; Nutritional Status; Parenteral Nutrition; Point-of-Care Systems; Research Design
PubMed: 18768091
DOI: 10.1186/cc6945 -
JPEN. Journal of Parenteral and Enteral... Aug 2022Parenteral nutrition (PN) remains a critical therapeutic option in patients who cannot tolerate enteral feeding. However, although lifesaving, PN is associated with...
BACKGROUND
Parenteral nutrition (PN) remains a critical therapeutic option in patients who cannot tolerate enteral feeding. However, although lifesaving, PN is associated with significant side effects, including liver injury, the etiology of which is multifactorial. Carbamazepine (CBZ), an antiepileptic medication, is known to modulate hepatic fibrosis and hepatocellular injury in a variety of liver diseases. We hypothesized that CBZ could prevent PN-associated liver disease (PNALD), which we tested by using our novel ambulatory PN piglet model.
METHODS
Piglets were fitted with jugular catheters and infusion pumps for PN and randomized to enteral nutrition (n = 7), PN (n = 6), or PN with parenteral CBZ (n = 6) for 2 weeks. Serum and liver tissue were analyzed via light microscopy, quantification of serum liver injury markers, Ki67 and cytokeratin-7 indexing, and real-time quantitative polymerase chain reaction.
RESULTS
PN-fed piglets in our model developed manifestations of PNALD-particularly, increased serum bilirubin, gamma-glutamyltransferase, liver cholestasis, and Ki67 expression compared with that of EN-fed animals (P < 0.03). CBZ therapy in PN-fed animals led to a significant reduction in these markers of injury (P < 0.05). Investigation into the mechanism of these therapeutic effects revealed increased expression of sterol regulatory element-binding protein 1 (SREBP-1), peroxisome proliferator-activated receptor alpha (PPAR-α), and fatty acid binding protein (FABP) in PN-fed animals receiving CBZ (P < 0.03). Further investigation revealed increased LC3 expression and decreased lysosomal-associated membrane protein (LAMP1) expression with CBZ (P < 0.03).
CONCLUSION
CBZ administration mitigates PNALD severity, suggesting a novel therapeutic strategy targeting PN-associated side effects, and may present a paradigm change to current treatment options.
Topics: Animals; Carbamazepine; Ki-67 Antigen; Liver Diseases; Parenteral Nutrition; Swine
PubMed: 35072265
DOI: 10.1002/jpen.2330 -
The Turkish Journal of Gastroenterology... Aug 2023This descriptive study aims to examine the complications that might develop in patients who receive enteral or parenteral nutrition treatment in intensive care unit in...
BACKGROUND
This descriptive study aims to examine the complications that might develop in patients who receive enteral or parenteral nutrition treatment in intensive care unit in this process and to examine the nutritional status, oral mucositis, and gastrointestinal system symptoms among patients who receive enteral or parenteral nutrition treatment in intensive care unit.
MATERIALS AND METHODS
A sample of this study consists of 104 patients who received enteral or parenteral nutrition treatment in intensive care units between January and June 2019. The data were collected face to face by using Sociodemographic Form, constipation severity scale, Mini Nutritional Assessment Scale, Mucositis Assessment Scale, visual analog scale, and gastrointestinal system Symptoms Scale. The results were calculated as numbers, percentage, SD, and mean values.
RESULTS
Among the participating patients, 67.4% were older than 65 years, 55.8% were female, 42.3% were receiving treatment in internal medicine intensive care units, and 43.4% had severe mucositis. It was determined that 31.7% of the patients receiving treatment in intensive care units required nutrition treatment. It was determined that patients receiving parenteral nutrition had more symptoms such as gastrointestinal system symptoms, mucositis, constipation, and colonic inertia.
CONCLUSIONS
It was determined that when compared to the patients receiving enteral nutrition, the patients receiving parenteral nutrition had higher scores in mucositis, visual analog scale pain, Mini Nutritional Assessment Test, constipation, obstructive defecation, colonic inertia, and gastrointestinal symptom total scores.
Topics: Humans; Female; Male; Nutritional Status; Mucositis; Parenteral Nutrition; Intensive Care Units; Stomatitis; Constipation
PubMed: 37404117
DOI: 10.5152/tjg.2023.22125 -
Nutricion Hospitalaria Jun 2017
Review
Topics: Adult; Child; Critical Care; Evidence-Based Medicine; Humans; Parenteral Nutrition; Parenteral Nutrition, Total
PubMed: 29154660
DOI: 10.20960/nh.1374