Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0020505 (hyperphagia)
 6,116 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper presents the clinical and metabolic findings in two young boys with long-standing Kearns-Sayre syndrome. Following short exposure to oral prednisone, both boys developed lethargy, increasing somnolence, polydipsia, polyphagia, and polyuria. Both presented in the emergency room with profound coma, hypotension, severe hyperglycemia, and acidosis. Nonketotic lactic acidosis was present in one and ketosis without a known serum lactate level was present in the other. Respiratory failure rapidly ensued and both patients expired in spite of efforts at resuscitation. We believe these two cases represent a newly described and catastrophic metabolic-endocrine failure in the Kearns-Sayre syndrome.
 ...
PMID:Hyperglycemic acidotic coma and death in Kearns-Sayre syndrome. 370 9

The objectives of this study were to determine the ability of enteral hyperalimentation to meet the caloric and protein requirements in acute severe head injury, and to study the effect of increasing protein intake on nitrogen balance. This consecutive series of 20 patients suffered acute severe head injury and remained comatose for at least 24 hours. They were all without other major injuries, and were treated with steroids. These patients were randomly placed in two comparable treatment groups: one group was fed with an enteral formula containing 14% of its calories as protein and the other group received a formula containing 22% protein calories. Feedings were advanced to replace 140% of caloric expenditure measured by indirect calorimetry, averaging 3500 kcal/24 hr. Balance periods of the targeted intake were 7 days in duration, and were begun during the 1st week after injury for 65% of patients and in the 2nd week after injury for 35% of patients. The lower protein group received an average of 26.8 gm/24 hr of nitrogen, equivalent to 188 gm of protein, and the higher protein group 34.3 gm/24 hr, equivalent to 231 gm of protein. Nitrogen balance was -9.2 +/- 6.7 gm/24 hr in the lower protein group and -5.3 +/- 5.0 gm/24 hr in the higher protein group, but the difference did not reach statistical significance because of sample size and variability in extent of catabolism among patients. Despite the hyperalimentation, there was a mean negative cumulative nitrogen balance of 200 gm by the 2nd week after injury, and only three patients achieved net nitrogen equilibrium for the 7-day balance period. Despite enteral hyperalimentation, the patients' weight fell by 15% in the 2nd week, serum albumin was often decreased, and creatinine-height index decreased over time but remained in a normal range. Monitoring urinary urea nitrogen, which has been advocated as a generally available technique for measuring urinary nitrogen concentration, was found to be a poor measure of urinary nitrogen excretion. This work has demonstrated: 1) that high caloric and protein feedings may be delivered for prolonged periods enterally for most patients in the acute phase of head injury with few metabolic complications, and 2) that increasing the nitrogen content of feedings from 14% to 22% may somewhat improve nitrogen retention, although nitrogen equilibrium is seldom achieved.
 ...
PMID:Enteral hyperalimentation in head injury. 391 45

Ricardo T., aged 20 years, was a passenger in a Varig air-craft which suffered an accident on July 11th 1973. A fire developed on board whilst the plane was in the air, at about 3 p.m. After emergency landing, rescue workers (firemen and emergency ambulance teams) discovered only two survivors amongst the 122 passengers. One was in his forties and died a few moments later. The other (Ricardo) was rapidly transported to the surgical and traumatological intensive care unit of the Henri Mondor Hospital. At the time of arrival, he was in stage 1 coma with skin burns (3rd degree), burns of the airway and a high carbon monoxide blood level. Treatment consisted of assisted ventilation for 24 hours, with intermittent bronchial lavage used to eliminate ashes and calcinated debris, then for 10 days, spontaneous ventilation without intubation, with a tele-expiratory counter-pressure of 4 milibar in a mini-chamber (globe) enriched in oxygen. Intravenous hyperalimentation was started during the first few hours, continued on the 24th day by enteral alimentation. Initial chest XRays showed heavy flaky appearances, predominantly in the hilar region, and more marked on the right. At about the 15th day, XRay showed fibrous with predominance of signs of the apex. These sequellae were confirmed by respiratory function tests which gave objective evidence of a diffusion disturbance with decrease in membrane permeability coefficient. Repetition of RFT indicated a decrease in mechanical problems. On August 31st (on the 51st day) Ricardo was able to return to Rio in a good general condition, dorso-lumbar burns having healed. There was a dysphonia of mixed origin: scarred infiltrate of the vocal cords, but with normal mobility, and a decrease in vital capacity of --30%. Seen again in September 1978, Ricardo was found to be well with normal activity and slight effort dyspnea. Chest XRays showed signs of residual fibrosis.
 ...
PMID:[Case history of a gassed patient]. 611 Dec 80

Caloric expenditure and nitrogen balance were measured in 14 steroid-treated comatose head-injured patients acutely and up to 28 days after injury. During this period patients were fed with a continuous enteral infusion of a formula containing 2 Kcal/cc and 10 gm nitrogen/liter. Indirect calorimetry was carried out for 102 patient-days. The mean resting metabolic expenditure (RME) for nonsedated nonparalyzed patients was 138% +/- 37% of that expected for an uninjured resting person of equivalent age, sex, and body surface area. Nitrogen excretion was measured for 135 patient-days. The mean excretion was 20.2 +/- 6.4 gm/day. The mean protein caloric contribution was 23.9% +/- 6.7% and was greater than 25% for six patients, compared to normal values of 10% to 15%. Despite hyperalimentation, positive nitrogen balance for any 3-day period was achieved in only seven patients, and required replacement of 161% to 240% of RME with enterally administered formula. Head-injured patients had a metabolic response similar to that reported for patients with burns of 20% to 40% of the body surface.
 ...
PMID:The metabolic response to severe head injury. 642 80

The purpose of this investigation was to evaluate the effectiveness of hyperalimentary therapy on the outcome in patients after severe head injuries. The observations were carried out in patients admitted within 24 hours after injury and divided into various alimentary groups (hyperalimentation, parenteral nutrition and enteral nutrition). The follow-up examination of patients' reactivity according to the Glasgow Coma Scale (GCS) performed 8-10 days after admission revealed improvement 1.2 +/- 0.9 pts in hyperalimentary subjects, while in the groups fed enterally or parenterally only 0.6 +/- 0.6 pts and 0.7 +/- 0.9 pts, respectively. In patients with severe head trauma and GCS score level lower than 5 the prognosis is unfavourable, irrespective of the treatment method.
 ...
PMID:Does hyperalimentation improve outcome in patients with severe head injury? 749 78

Hyperamylasemia of pancreatic origin has been noted in patients with severe head injury without abdominal trauma or evidence of pancreatitis. Thirty-eight patients with intracranial bleeding of various types were evaluated for elevated pancreatic amylase and lipase enzymes without associated pancreatitis. Twenty-five patients had elevated serum lipase; 17 of 25 also had elevated amylase without pancreatitis. Most lipase elevations occurred earlier than those of amylase. Six clinical variables--mannitol, ceftriaxone, nimodipine, steroids, Glasgow Coma Score, and total parenteral and enteral hyperalimentation--were evaluated to determine relationship to the enzyme elevations. A significant relationship exists between patients not treated with steroids and elevated lipase and amylase enzyme activities. Multivariate analysis revealed a significant interaction between lipase elevation and decreasing Glasgow Coma Score, indicative of increasing severity of intracranial bleeding. Proposed causes of enzyme elevations in intracranial bleeding include vagal stimulation, altered modulation of the central control of pancreatic enzyme release, and release of cholecystokinin from the brain. Physician awareness of the association of intracranial bleeding with the elevation of amylase and lipase without pancreatitis can save the patient needless cost and manipulation.
 ...
PMID:Significance of elevated pancreatic enzymes in intracranial bleeding. 752 51

A 61-year-old woman was hospitalized because of ulcerative colitis which had caused fever, vomiting and diarrhea since June 16, 1992. Then she developed toxic megacolon, and was transferred to our hospital on the 1st of July and underwent subtotal colectomy the same day. After surgery, she received intravenous hyperalimentation (IVH) which contained 1,000 Kcal/day without vitamin supplementation. From the 8th to the 13th post-operative days, she took 3/4 or more of the liquid diet which contained 1,050 Kcal, protein 35 g, carbohydrate 166 g and vitamin B1 0.59 mg per day. From the 14th to the 23rd post-operative days, she ate 4/5 or more of the oral diet which contained 1,700 Kcal/day, protein 68 g, carbohydrate 236 g and vitamin B1 0.93 mg per day. During the 7th to the 23rd day, the IVH was reduced to 800 Kcal and then 500 Kcal per day. She talked less on the 19th post-operative day, and in a few days, her level of consciousness began to decline progressively. On the 27th post-operative day, neurological examinations revealed the following: semi-coma, almost fixed pupils which were 3 mm in diameter, absent doll's eye movement to all directions, flaccid extremities with abolished deep tendon reflexes. Pertinent abnormalities on laboratory data at that time consisted of hemoglobin 7.8 g/dl and serum total protein 5.4 g/dl. Lumbar puncture revealed normal cerebrospinal fluid under normal opening pressure. Cranial magnetic resonance imaging (MRI) taken on the 27th post-operative day demonstrated, on T2-weighted images, symmetrical high intensity lesions in the periventricular areas of the third and fourth ventricles, and periaqueductal area of the midbrain.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Development of Wernicke's encephalopathy during the period of oral food intake after a subtotal colectomy for ulcerative colitis]. 778 Dec 34

With the multi-faceted approach to head and neck cancer today, maintaining caloric intake by long-term enteral hyperalimentation is commonplace. Along with the tremendous advantages of this form of nutrition, the disadvantage of hyperosmolar nonketotic diabetic acidotic coma is present. Mortality rates are quoted from 40% to 70% according to the literature reviewed. Therefore, prevention is the best form of treatment. The cause, diagnosis, and treatment will be discussed.
 ...
PMID:Hyperosmolar nonketotic coma: prevention, diagnosis, and treatment. 1099 16


<< Previous 1 2