Parenteral hyperalimentation and its practical applications

Postoperative Parenteral Hyperalimentation and Wound Healing in Oncological Surgery

Two groups of patients (4 each) were treated by parenteral infusions during the first five postoperative days after abdominoperineal resection of rectum according to the following schedules: Group I: 12.4 Cal/kg/day + 0.044 gm. N/kg/day; Group II: 52.7 Cal/kg/day + 0.235 gm. N/kg/day. The nitrogen balance was studied and collagenogenesis evaluated by chromatographic determination of OH-lysine in the biopsies of the healing tissue carried out on the 2°, 3°, 4°, 5°, 6°, 9°, 12°, and 15° postoperative day. It was noted that in Group II of patients, the nitrogen balance was better and that there was more collagen in the biopsies of the healing tissue than in Group I. Parenteral postoperative hyperalimentation not only spares endogenous nitrogen but may help healing.

Total parenteral nutrition, An important therapeutic advance

Total parenteral nutrition (TPN) is a potent form of therapy. It is particularly useful in patients who must undergo surgery or those with conditions that preclude normal feeding. The procedure is not without risk, but better understanding of the basic principles involved, refinements in technique, and experience with its use in different situations have combined to improve the results of therapy over those first obtained. TPN represents an important therapeutic advance and emphasizes the need for an undertanding of nutritional principles by physicians and for a team approach to the management of complicated conditions.

Elemental balances during intravenous hyperalimentation of underweight adult subjects

Intravenous hyperalimentation was done in 11 underweight adults whose body weight (body wt) was less than 85 percent of ideal. For the first 6 days, "complete formula" was infused furnishing per kilogram ideal body wt per day: 15 g glucose, 0.40 g N, 0.018 g P, 2.4 meq K, 3.0 meq Na, 2.3 meq C1, 0.5 meq Mg, 0.45 meq Ca, and 50 ml H20. Patients gained weight at an average rate of 9.0 g/kg ideal body wt/day and showed average balances/kilogram ideal body wt/day as follows: plus 0.14 g N; plus 0.012 g P; plus 0.43 meq K; plus 0.49 meq Na; plus 0.37 meq Cl; and plus 0.085 meq Ca. Application of standard equations to the elemental balances indicated weight gain consisted of 35-50 percent protoplasm, 35-50 percent extracellular fluid, 5-25 percent adipose tissus, and less than 1 percent bone. Withdrawas of N, P, Na, or K impaired or abolished retention of other elements. Removal of N halted retention P, K, Na and C1; withdrawal of K stopped retention of N and P; and removal of Na or P interrupted retention of all other elements. Weight gain continued at a rate of 1.4-3.1 g/kg ideal body wt/day despite zero or negative elemental balances of N, K, P, and sometimes Na and C1. Calculations showed that weight gain during infusion of fluids lacking N, P, K, or Na consisted largely of adipose tissue, with little or no contribution by protoplasm or extracellular fluid. Data show that repletion of protoplasm and extracellular fluid of wasted adults by intravenous hyperalimentation is retarded or abolished if N, P, Na, or K is lacking. Repletion of bone mineral does not occur in absence of Na or P but proceeds in absence of N, P, K, or Na. Thus, quality of weight gained by underfed adult patients during hyperalimentation depends on elemental composition of the infusate.