Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral
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Case Reports
[Severe hypophosphataemia after starting parenteral nutrition in a patient with an intestinal fistula].
Hypophosphataemia is a complication that may appear in undernourished patients who are given nutrition by either enteral or parenteral means. It is associated with several clinical manifestations, including cardiological, neurological and haematological conditions of note, and may potentially be even life-threatening. It is therefore mandatory to ensure prevention and follow-up in those patients at risk of suffering this condition, taking into account the considerable morbidity and mortality associated with it.
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Over the last few years, obesity has been constantly increasing, thus turning it into a serious public health problem, with the subsequent impact on health-related expenditure, particularly in developed countries. The main peculiarity of obesity is its association with numerous pathologies (respiratory disease, cardiovascular problems, endocrinological or metabolic disorders, etc.) that leads it to be related with high levels of mortality and morbidity, affecting both the quality and duration of the life of sufferers. The attempts to prevent obesity and, when these fail, the treatments that can be resorted to cover many aspects: behavioural, dietary and medical. ⋯ This is a part of the therapeutic armoury that is enjoying a constant boom, with very favourable results that mean the physiopathology of this condition should be known in greater detail by all of the multidisciplinary team dealing with the problem: GPs, endocrinologists, psychiatrists, general surgeons and anaesthesiologists, with the latter being involved in all of the peri-surgical activity (pre-, intra- and post-operative stages, in the reanimation units). From the standpoint of anaesthesia (the focus of this paper as it is the least well-known of those mentioned), obese individuals are at a disadvantage with respect to other non-obese patients as the process is complicated and the risk increases. With this review of the subject, it is intended to recall the physiopathological changes produced by obesity as well as the anaesthetic implications within the framework of bariatric surgery, so as to achieve the most favourable possible results from the surgery.
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To assess the degree of hypernutrition of critically-ill patients under treatment with parenteral nutrition (PN) in a multi-purpose intensive care unit (ICU). ⋯ The glucose of dextrose solution and the propofol lipid are not routinely discounted from the PN regime. A trend towards hypernutrition of the critically-ill patient is shown, especially on days with simultaneous treatment with PN and EN.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Randomized study of two different fat emulsions in total parenteral nutrition of malnourished surgical patients;effect of infectious morbidity and mortality].
Lipid infusions of a physical mixture of medium-chain triglycerides and long-chain triglycerides (MCT/LCT) used in peri-operative total parenteral nutrition (TPN) have a lower immunosuppressive effect in laboratory studies than emulsions containing only long-chain triglycerides (LCT). The purpose of the present study was to compare the incidence of nosocomial infections and the in-hospital mortality of severely undernourished surgical patients treated with TPN using an MCT/LCT lipid emulsion or with an LCT mixture, administered under a randomized, double blind protocol. ⋯ Lipid infusions of MCT/LCT used in peri-operative TPN protect severely undernourished surgical patients against the onset of intra-abdominal abscesses when compared with LCT infusions. Patients without cancer may obtain more benefit from the use of these mixtures.