PubMed Journal Database | JPEN. Journal of parenteral and enteral nutrition 
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Showing PubMed Articles 1–25 of 38 from JPEN. Journal of parenteral and enteral nutrition
Fluid and electrolyte management: putting a plan in motion.
Fluid and electrolyte management is challenging for clinicians, as electrolytes shift in a variety of settings and disease states and are dependent on osmotic changes and fluid balance. The development of a plan for managing fluid and electrolyte abnormalities should start with correcting the underlying condition. In most cases, this is followed by an assessment of fluid balance with the goal of achieving euvolemia. After fluid status is understood and/or corrected, electrolyte imbalances are simplified. Ma...
Retinol binding protein: marker for insulin resistance and inflammation postburn?
Introduction: Burn injury leads to vast changes in both metabolic and inflammatory responses and is associated with increased morbidity and mortality. Insulin resistance (IR) and hyperglycemia are major components of the hypermetabolic response found in burn-injured patients and subsequently contribute to adverse outcomes. Studies have shown that increased systemic retinol binding protein (RBP) levels are associated with IR and hyperinflammation in diabetic and obese patients. The aim of this study was to d...
A 22-year-old man suffered an acute small bowel infarct leading to extensive bowel resection, resulting in only 20 cm of jejunum to a jejunostomy, although he also had 50 cm of residual colon with a mucous fistula. The patient was out on long-term home parenteral nutrition (PN) but endured high stomal losses of 5-6 L per day and, despite all conventional measures, required 6.1 L of fluid (including PN) and 555 mmol sodium per day. Although body mass index was maintained, he suffered debilitating malaise and...
Background: The function of secretory phospholipase A2 (sPLA2) is site dependent. In tissue, sPLA2 regulates eicosanoid production; in circulation, sPLA2 primes neutrophils; and in the intestinal lumen, sPLA2 provides innate bactericidal immunity as a defensin-related protein. Since parenteral nutrition (PN) primes leukocytes while suppressing intraluminal mucosal immunity, the authors hypothesized that (1) PN would diminish luminal sPLA2 activity but increase activity in intestinal tissue and serum and (2)...
Nutrition and traumatic brain injury: a perspective from the institute of medicine report.
Background: Complications related to venous access devices (VADs) remain the major drawback of home parenteral nutrition (HPN) support. In addition to technical issues, patients also experience psychosocial problems. The aim of this study is to present an overview of VAD-related complications in patients on long-term HPN and to assess whether these adversities are related to experienced psychosocial problems and quality of life (QOL). Methods: Information on VAD-related complications was collected from the...
As care of the critically ill patient grows more complex, so does the breadth of knowledge required of the intensivist to deliver quality service. Nutrition is one area of many where the complexity of care has grown and the opportunity for improving patient outcomes has become evident. The use of mnemonics has proven successful in compartmentalizing information that must be considered in complex decision-making processes. The authors propose one such mnemonic, "CAN WE FEED?" to assist in the development and...
Vitamin d--new recommendations worthy of our consideration.
Providing or withholding nutrition in severely disabled elderly persons is a challenging dilemma for families, health professionals, and institutions. Despite limited evidence that nutrition support improves functional status in vulnerable older persons, especially those suffering from dementia, the issue of nutrition support in this population is strongly debated. Nutrition might be considered a basic need that not only sustains life but provides comfort as well by patients and their families. Consequently...
Background: Vitamin D deficiency is common in inflammatory bowel disease (IBD). The aim of the study was to determine the prevalence and predictors of vitamin D deficiency in an IBD cohort. It was hypothesized that vitamin D deficiency is associated with increased disease activity and lower health-related quality of life (HRQOL). Methods: This was a retrospective cohort study. Harvey-Bradshaw index and ulcerative colitis disease activity index were used to assess disease activity. Short Inflammatory Bowel D...
Background: The aim of this study was to assess the effect of preoperative and postoperative synbiotic treatment in hepatectomy patients with or without liver cirrhosis. Methods: Sixty-one patients with hepatic cancer were assigned randomly to receive either oral synbiotics that consisted of Bifidobacterium, Lactobacillus, and galactooligosaccharides or no synbiotics (control) preoperatively for 14 days and postoperatively for 11 days. Infectious complications, intestinal mucosal integrity as measured by se...
Background: Similar to metabolic syndrome, parenteral nutrition (PN) administration has also been associated with biologic abnormalities of glucose and lipids. Such complications include hyperglycemia, hypertriglyceridemia, liver dysfunction, and hepatobiliary complications. Because metabolic syndrome has been associated with altered expression of adipocytokines, and peroxisome proliferator-activated receptors (PPARs), the present study hypothesized that PN would also lead to alterations in adipocytokines a...
Relationship between feeding tube site and respiratory outcomes.
It is unclear if placing feeding tubes postpylorically to prevent respiratory complications is worth the extra effort. This study sought to determine the extent to which aspiration and pneumonia are associated with feeding site (controlling for the effects of severity of illness, degree of head-of-bed elevation, level of sedation, and use of gastric suction).
Background: In many binge-eating/vomiting patients, abstinence could not be obtained from classical treatments. Since the authors showed that tube feeding (TF) reduced such episodes in anorexia nervosa (AN)-hospitalized patients, they carried out a randomized trial on the efficacy of TF plus cognitive behavioral therapy (CBT) vs CBT alone in AN and bulimia nervosa adult outpatients. Methods: The authors randomly assigned 103 ambulatory patients to receive 16 sessions of CBT alone (n = 51) or CBT plus 2 mont...
Background: Patients with head and neck cancers (HNCs) are at increased risk of experiencing malnutrition, which is associated with poor outcomes. Advances in the treatment of HNCs have resulted in improved outcomes that are associated with severe toxic oral side effects, placing patients at an even greater risk of malnutrition. Prophylactic placement of percutaneous endoscopic gastrostomy (PEG) tubes before treatment may be beneficial in patients with HNC, especially those undergoing more intense treatment...
Pureed by gastrostomy tube diet improves gagging and retching in children with fundoplication.
Background: Children with feeding disorders requiring Nissen fundoplication may develop gagging and retching following gastrostomy feedings. We developed a "pureed by gastrostomy tube" (PBGT) diet in an attempt to treat these symptoms and provide adequate nutrition and hydration. Methods: Children post- fundoplication surgery with symptoms of gagging and retching with gastrostomy feedings were selected from our interdisciplinary feeding team. An individualized PBGT diet was designed to meet the child's nutr...
The benefits of home enteral tube feeding (HETF) provided by nutrition support teams (NSTs) have been questioned recently, given the growing costs to the healthcare system. This study examined the effect of a specialized home enteral nutrition program on clinical outcome variables in HETF patients.
The intrahepatic cholestasis attributed to parenteral nutrition (PN) in the adult patient is relatively rare and usually occurs in patients receiving long-term PN. This article reports the first case of an adult patient with cholestatic PN-associated liver disease without sepsis who received almost all her nutrition requirements through PN. Administration of an ω-3-enriched lipid emulsion added to the PN regimen reversed cholestasis and demonstrated histologic improvement on serial liver biopsy. The patien...
Sterility of pediatric lipid emulsions repackaged by an automated compounding device.
Background: The daily requirement of intravenous (IV) lipid in pediatric patients is often less than the volumes and sizes available in prepackaged, commercially available preparations. In clinical practice, IV lipid emulsions (IVLEs) have been repackaged into syringes to prevent infusions from exceeding 12 hours, to reduce waste, and to improve patient safety. Recent data suggest an increasing risk of contamination when these preparations are repackaged manually. This study investigates the sterility of sm...
Background: Plasticizers such as di(2-ethylhexyl) phthalate (DEHP) are added to polyvinyl chloride (PVC) to confer flexibility. However, DEHP is associated with reproductive disorders in humans. Because of its noncovalent bond to the PVC matrix, this plasticizer tends to leach easily. Infants and children undergoing cyclic, long-term parenteral nutrition (PN) could be particularly at risk of potential toxicity from DEHP due to regular exposure. Malondialdehyde (MDA) is one of the most commonly used markers...
Background: Insulin regulates albumin synthesis in vitro and in various experimental models. The current study was undertaken to determine the effects of a physiologic hyperinsulinemia on albumin synthesis in postoperative patients in whom plasma albumin concentrations are decreased. Methods: Studies were performed in postabsorptive patients after major abdominal operations. Mass spectrometry techniques were used to directly determine the incorporation rate of 1-[(13)C]-leucine into albumin. Consecutive blo...
Prediction of parenteral nutrition osmolarity by digital refractometry.
Background: Infusion of high-osmolarity parenteral nutrition (PN) formulations into a peripheral vein will damage the vessel. In this study, the authors developed a refractometric method to predict PN formulation osmolarity for patients receiving PN. Methods: Nutrients in PN formulations were prepared for Brix value and osmolality measurement. Brix value and osmolality measurement of the dextrose, amino acids, and electrolytes were used to evaluate the limiting factor of PN osmolarity prediction. A best-fit...
A.s.p.e.N. Clinical guidelines: nutrition support in adult acute and chronic renal failure.
Immunonutrition in high-risk surgical patients: a systematic review and analysis of the literature.
BACKGROUND: Immunomodulating diets (IMDs) have been demonstrated to improve immune function and modulate inflammation. However, the clinical benefit of these diets in patients undergoing elective surgery is controversial. The goal of this meta-analysis was to determine the impact of IMDs on the clinical outcomes of high-risk patients undergoing elective surgery. METHODS: The review included prospective, controlled, clinical trials that compared the clinical outcome of elective surgical patients who were ran...
