Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
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Percutaneous endoscopic gastrostomy (PEG) or PEG tube with transgastric jejunostomy tube (PEG-J) feeding has not been shown to decrease aspiration pneumonia. The aim of this study was to determine if direct percutaneous endoscopic jejunostomy (DPEJ) tube placement results in a decreased incidence of aspiration pneumonia in high-risk patients. The design was a retrospective review of all patients receiving DPEJ tube for aspiration pneumonia from 1999 to 2005. ⋯ The total number of documented aspiration pneumonia episodes for all patients decreased from 29 (mean, 3.64; range, 1-6) before DPEJ placement to 3 (mean, 0.27; range, 0-2) after DPEJ placement (P < .001). The mean number of aspiration pneumonia events per month prior to the DPEJ placement was 3.39 and postplacement was 0.42 (P < .001). DPEJ placement appears to decrease recurrent aspiration pneumonia in patients with history of aspiration pneumonia.
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The ability to diagnose and treat acid-base disorders is an important component in the practice of the nutrition support clinician. A complete understanding of the basic principles of metabolic and respiratory disorders allows the practitioner to formulate educated decisions regarding fluids, parenteral nutrition salts, and the management of electrolytes. This review will discuss the diagnosis and treatment of common metabolic and respiratory disorders encountered in nutrition support practice.
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Alterations in sodium and water balance are commonplace and often occur concurrently. Dysnatremias (hyponatremia and hypernatremia) merely reflect a relative excess or deficit of plasma water in relation to plasma sodium. ⋯ Enteral and parenteral nutrition regimens can be modified to help restore normal plasma sodium concentrations. Response to treatment requires close monitoring to avoid potential complications associated with rapid correction of hyponatremia and hypernatremia.
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Selenium functions as a part of proteins known as selenoproteins. Through these selenoproteins, selenium functions as a defensive mechanism for oxidative stress, for the regulation of thyroid hormone activity, and for the redox status of vitamin C and other molecules. In several of its roles, selenium functions as a dietary antioxidant and thus has been studied for its possible role in chronic diseases. ⋯ A few studies regarding aging and mortality are also included. What can be ascertained from this current review is that the maintenance of adequate selenium nutriture and, at minimum, the prevention of a deficiency in selenium would be advisable for all individuals. In addition, the indiscriminant use of selenium supplements should be approached with caution until further randomized, controlled trials monitor the effects of such supplementation, especially on a long-term basis.
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Obesity is an emerging problem worldwide. Hospitalized obese patients often have a worse outcome than patients of normal weight, particularly in the setting of trauma and critical care. Obesity creates a low-grade systemic inflammatory response syndrome (SIRS) that is similar (but on a much smaller scale) to gram-negative sepsis. ⋯ However, this approach does not address the putative pathophysiologic mechanisms of inflammation and altered metabolism associated with obesity. A number of dietary agents such as arginine, fish oil, and carnitine may correct these problems at the molecular level. Pharmaconutrition formulas may provide exciting innovations for the nutrition therapy of the obese patient.