Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison between two fat emulsions: Intralipid 30 cent vs intralipid 10 cent in critically ill patients.
Fat emulsions, Intralipid 30% and Intralipid 10% were compared in terms of the resulting plasma levels of different lipid components and clinical tolerance in critically-ill patients with multi-injuries. Sixteen critically-ill patients with severe systemic inflammatory response were randomly assigned to two groups, each one comprised of eight patients. Each group was administered the same quantity of fat/Kg/day either Intralipid 30% or Intralipid 10%. ⋯ On the contrary, there was an increase in LpX in the Intralipid 10% group. From the above findings, we draw the conclusion that Intralipid 30% revealed better profiles of different lipid components than Intralipid 10% in critically-ill patients. The new emulsion of higher concentration in triglyceride was proved clinically safe and its use is suggested for critically-ill patients who require total parenteral nutrition.
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It was previously demonstrated that single frequency bio-electrical impedance (BIA) measurement at 50 kHz is a useful method to assess total body water (TBW) in patients with chronic obstructive pulmonary disease (COPD). In the present study it was examined whether bio-electrical impedance spectroscopy (BIS) could predict extracellular water (ECW) and improve the prediction of TBW in these patients. TBW and ECW (corrected bromide space) were measured by deuterium and bromide dilution. ⋯ Predicted ECW using BIS-measurements was not significantly different from measured ECW (male symbol r = 0.75, SEE: 1.4 L, female symbol r = 0.73, SEE: 1.2 L), but the error in the prediction was relatively large and the correlation between predicted and actual ECW relatively low compared to most studies in healthy subjects. Predicted TBW using BIS was comparable to actual TBW, but presented no improvement of the prediction of TBW using BIA at 50 kHz and a patient specific regression equation. The error of the prediction of ECW by BIS limits the ability to predict fluid shifts in individual patients with clinically stable COPD.
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In the infant on parenteral nutrition, cysteine supplementation has been suggested due to low levels of hepatic cystathionase activity limiting synthesis from methionine. We have examined the plasma concentrations of sulfur amino acids in four groups of post-surgical infants requiring parenteral nutrition receiving (A) a low methionine + cysteine + taurine formula, (B) a high methionine formula (non-steady state), (C) a high methionine formula (steady state), and (D) a high methionine + cysteine formula. Plasma methionine concentrations were above the normal reference range (2.2-4.9 micromol/dL) of normal breast-fed infants in Groups B (15.9 +/- 10.7 micromol/dL) and D (5.7 +/- 1.9 micromol/dL) and at the upper limit for Group C (4.9 +/- 1.7 micromol/dL). ⋯ Parenteral cysteine administration resulted in a greater proportion of plasma free cysteine concentration, but not cystine. The proportion of free to bound cysteine/cystine, as well as the proportion of free cystine to cysteine, was not normal during parenteral nutrition with or without cysteine HCI supplementation. Little benefit in plasma concentrations was derived from cysteine HCI supplementation to a high methionine formulation.
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This study was undertaken to determine the effects on the fatty acid (FA) composition of various dog tissues of 4 different lipid emulsions (a 100% long-chain triacylglycerol (LCT) derived from soya bean oil emulsion, a mixed 50% medium-chain triacylglycerol (MCT)/50% LCT emulsion as well as both these emulsions supplemented with 10% fish oil (FO) triacylglycerols), when daily infused over 15 days as a substantial component of total parenteral nutrition. Lipids represented 55% of the non-protein energy. Blood samples as well as biopsies from liver, muscle and adipose tissue were taken 15 days before, and again immediately after TPN. ⋯ Infusion of soya bean oil emulsion was associated with an increased content of linoleate in liver PL (from 13.6 +/- 0.4% to 17.7 +/- 0.4%), but not in other tissues. MCT/LCT did not markedly affect PL/FA pattern in any tissue. Supplementation with fish oil was associated with an efficient incorporation of n-3FA into tissue PL, particularly in the liver (from 0.4 +/- 0.1% to 2.5 +/- 0.3% for EPA and from 3.9 +/- 0.8% to 9.1 +/- 0.4% for DHA, with the LCT + FO emulsion).