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Query: UMLS:C0020505 (hyperphagia)
 6,116 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effect of intravenous hyperalimentation with essential amino acids and hypertonic dextrose on nitrogen metabolism, total body urea and creatinine was studied in 16 patients with end-stage renal disease prior to and after bilateral nephrectomy, splenectomy and appendectomy. Parenteral essential amino acids and hypertonic dextrose are effective in lowering blood urea nitrogen in anephric patients who are incapable of improving renal function. The inclusion of essential amino acids in hypertonic dextrose increases nutritional value far beyond that which can be attributed to the caloric concentration of the amino acids themselves.
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PMID:Parenteral nutrition with essential amino acids in pretransplantation anephrics. 12 7

Solutions of crystalline amino acids infused without dextrose produce a marked improvement in nitrogen balance. Increasing the infusion level of amino acid from 1.0 to 1.7 grams per kilogram further improves nitrogen balance. The addition of dextrose to the amino acid solutions did not affect nitrogen balance and proved that the role of insulin during protein sparing has been overemphasized. Nitrogen balance is slightly, but not significantly, superior when nonprotein dextrose calories are administered. However, amino acid solutions are isotonic and can be infused peripherally, whereas adding dextrose doubles the concentration and renders peripheral infusion more difficult. Protein sparing may be useful for short term nutritional support when the potential risks of total parenteral hyperalimentation are not justified. Endogenous body fat is mobilized. Hence, protein sparing also prevents the development of fatty acid deficiency and may be useful in treating fatty infiltration of the liver. Protein sparing provides suboptimal caloric replacement and should only be used for temporary nutritional support until oral alimentation is resumed or until there is an absolute indication for intravenous hyperalimentation. Expense and the fact that most patients do well after elective abdominal operations militate against the proposition that amino acids should become a routine substitute for 5 per cent dextrose therapy post-operatively.
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PMID:The current status of protein sparing. 40 22

Safe and consistently reliable parenteral hyperalimentation in the care of the critically ill or injured remains an unrealized expectation. Our experience with critically ill patients managed with standard 25% dextrose/4.25% protein hyperalimentation solution (S.H.A.) delivered through a centrally placed catheter demonstrated that S.H.A. was associated with a high catheter infection rate, fluctuations in hyperosmolar tolerance, unstable insulin requirements, and a high discontinuation rate. In retrospect this unsatisfactory experience resulted from the inappropriate assumption that a single type of nutritional support and delivery system could meet the varying metabolic requirements of the critically ill or injured. In an effort to reduce these complications, we have recently utilized a system of selective hyperalimentation in managing 25 consecutive patients. We now identify specific risk factors for groups of patients and use these factors to select the appropriate rout and solution. Selective hyperalimentation has resulted in a lowering of infusion complications and an improvement in completion rate, with satisfactory weight gain and protein response. These results suggest that our approach is sucessful in meeting the nutritional requirements of differing groups of critically ill patients without exposing upsuitable candidates to the potential risks of standard hyperalimentation.
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PMID:Selective hyperalimentation: a new look at an old problem. 40 8

Zinc, copper, iron, magnesium, and chromium were analyzed in commercially prepared total parenteral nutrition solutions of amino acid/protein hydrolysate, dextrose, lipid, and water from several manufacturers. Concentrations of each varied with both the manufacturer and the solution lot number, with the greatest differences observed for zinc (0.026 to 4.04 mg/liter) and iron (0.025 to 1.370 mg/liter). Since the consequences of prolonged total parenteral nutrition with trace-metal-deficient solutions are dependent upon the physical state of the patients, the duration of hyperalimentation and problems associated with trauma, it is recommended that the endogenous concentrations described be supplemented as needed for each patient. This need is difficult to determine, however, because little is known about the clinical effect of any trace-metal-deficiency state developing in patients receiving long-term total parenteral nutrition.
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PMID:Trace metal profile of parenteral nutrition solutions. 41 17

Liver biopsy specimens were studied in 26 patients in whom liver function abnormalities developed during intravenous hyperalimentation (IVH). The clinical manifestations and duration of IVH were evaluated in relation to the morphological changes seen in the liver. Early hepatic changes consisted of fatty metamorphosis, and progressive intrahepatic cholestasis developed as IVH was continued. Essential fatty acid deficiency, amino acid imbalance, caloric excess, and toxic manifestations of certain amino acids are postulated as causative factors. The hepatic steatosis secondary to IVH may be treated by lowering the dextrose concentration of the infusion or by administering dextrose-free amino acid solutions. The clinical importance of this common complication of IVH is the difficulty in distinguishing it from other causes of cholestasis in seriously ill patients.
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PMID:Hepatic dysfunction during hyperalimentation. 41 12

The glucose analogue 2-deoxy-D-glucose (2DG) inhibits glucose metabolism and causes a rapid increase in food consumption in most species. This increase is most apparent during the first 6 postinjection hours, although it may persist as long as 10 hr. There are no published descriptions of alterations in food consumption subsequent to the hyperphagia. In the present study male and female rats were injected with 2DG (750 mg/kg IP), insulin (regular, 20 U/kg SC) or distilled water, and food intake was compared to baseline levels during the next 1, 6 and 24 hr. Results showed that food intake: (1) was not affected by injections of water: (2) was higher than normal during all 3 time periods following insulin injections: and (3) was higher than normal at 1 and 6 hr following 2DG, but significantly lower than normal by the end of 24 hr. The reasons underlying the development of hypophagia subsequent to the initial hyperphagia produced by 2DG are presently unknown.
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PMID:Hypophagia follows the initial hyperphagia produced by 2-deoxy-D-glucose in rats. 51 10

Phosphate depletion occurring during total parenteral nutrition has been frequently reported during the part 4 years. Hypophosphatemia may be associated with confusion, hyperventilation, and neuromuscular irritability, suggesting a total body phosphate deficiency. If inorganic phosphate levels fall below 1.0 mg %, diminished red cell glycolysis occurs with low erythrocyte levels of 2,3 diphosphoglycerate and adenosine triphosphate. Lowered red cell organic phosphates are associated with increased hemoglobin oxygen affinity. If severe hypophosphatemia occurs, hemolytic anemia, which is correctible by phosphate infusion, may result. In addition, leucocyte function is impaired by low levels of serum inorganic phosphate. While recognized as a needed additive, recommended phosphate supplements vary. Different infusion regimens have been suggested over the past 4 years, based primarily on assumed daily requirements. In the 19 trauma patients described who received hyperalimentation as part of their treatment, phosphate administration was calculated retrospectively and prospectively as a function of non-protein calories infused. Four different groups were studied. Group A received no phosphate additive and quickly became severely hypophosphatemic. Group B received from one to 15 meg of potassium acid phosphate per 1,000 K cal and developed a more gradual lowering of serum inorganic phosphate levels. Group C received 15 to 25 meg of potassium acid phosphate per 1,000 K cal and maintained normal phosphate levels throughout the course of treatment. Group D received greater than 25 meq of potassium acid phosphate per 1,000 K cal and gradually increased their serum inorganic phosphate levels. A significant positive correlation was found between serum inorganic phosphate levels, 2,3 diphosphoglycerate levels, adenosine triphosphate levels, and P50 of the oxy-hemoglobin dissociation curve. No patients developed hemolytic or neuromuscular syndromes which were attributable to hypophosphatemia. This study describes a simple method for the maintenance of adequate phosphate levels in patients whose dextrose-protein solutions may vary from day to day, by relating it to non-protein calories. Provision of 20 to 25 meq of potassium dihydrogen phosphate per 1,000 K cal will maintain normal serum levels of inorganic phosphate during total parenteral nutrition.
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PMID:Phosphate depletion and repletion: relation to parenteral nutrition and oxygen transport. 81 Nov 82

Nitrogen balance has been studied under conditions of simple fasting and in the postoperative period on a total of 102 patients. It is much more difficult to restore a positive nitrogen balance in the post-traumatic period, and this can be obtained only with calorie and, above all, amino acid quotas much higher than those capable of equilibrating the balance of fasting patients. The absence of a constant relationship between nitrogen sparing and the caloric value of the solutions infused and the advantages of hyperamino-acid therapy for the purpose of the balance agree with the hypothesis that the postoperative protein catabolism has the purpose of supplying the injured area with intermediate carbohydrate metabolites and constitutes the theoretic basis for the use of parenteral hyperalimentation during the postoperative period. This can be planned with doses of 35 to 40 calories per kilogram per day in the form of dextrose solution plus at least 2 grams of amino acids per kilogram per day.
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PMID:Parenteral nutrition in surgical patients. 81 94

Two groups of patients suffering from advanced neoplastic disease were fed parenterally for a period ranging from 1 to 16 weeks. The parameters considered were: weight change, serum albumin level, lymphocyte transformation test and serum immunoglobulin level. There were 23 patients in one group and 21 patients in the other. Regimens included for group I: saline solution (1000-1500 ml), glucose (100-150 g) and amino acids (15-30 g) per day; for group 2: 40-50 Cal/kg per day (dextrose about 15 g/kg per day), about 2 g of amino acids/kg/day and about 40-50 ml water/kg/day. In addition, 13 patients underwent both treatments sequentially. All the Group I patients lost weight (1.3 kg/week); while out of 23 patients in Group 2, 15 gained weight, 2 remained unchanged and 6 continued to lose weight, but to a lesser rate than before hyperalimentation (the average weight gain was 1.1 kg/week). Serum albumin levels decreased in 19 out of 25 patients in Group I and increased in 14 out of 26 patients of Group 2. Initial values of the lymphocyte blast transformation test were very low in both groups of patients, and an increase was observed only in patients treated by hyperalimentation. The increase was more evident in patients who were not under antiblastic treatment. Changes in serum immunoglobulin levels were not significant. The authors conclude that malnutrition plays a very important role in neoplastic cachexia and can be improved by parenteral hyperalimentation. Although it is possible that in the near future hyperalimentation and conventional neoplastic therapies will play complementary roles in treatment of advanced neoplastic disease, malnutrition is still the specific indication for intravenous hyperalimentation.
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PMID:[Parenteral hyperalimentation in patients with advanced neoplastic disease (author's transl)]. 82 82

Bacterial and fungal growth in 10% soybean oil emulsion (Intralipid) and 5% fibrin hydrolysate in 5% dextrose was studied at 4, 25 and 37 degrees C. Staphylococcus aureus, Streptococcus pyogenes, Str. fecalis, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli and Candida albicans were grown in broth at 37 degrees C, diluted in saline and inoculated into each of the two preparations as well as a mixture of the two. Growth was measured at 24, 48 and 72 hours. In 10% soybean emulsion, all bacteria except S. pyogenes multiplied, but in fibrin hydrolysate-dextrose solution the only organism of those studied to grow was S. aureus. In the hydrolysate-dextrose-lipid mixture, all organisms multiplied except S. pyogenes and P. aeruginosa. C. albicans grew in all solutions tested. While at 4 degrees C, organisms did not multiply. The fibrin hydrolysate-dextrose solutions given by infusion into a central vein for hyperalimentation have been shown to support predominantly fungal growth, and contamination of the solution and ultimately of the indwelling catheter is a constant hazard. Because both bacteria and C. albicans grew equally well in 10% soybean oil emulsion, its use as a caloric source when infused into a central vein may increase the occurrence of sepsis. When this emulsion is used to provide essential fatty acids or calories, it should be given via a peripheral vein, so that a central catheter will not be contaminated.
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PMID:Growth of common bacteria and Candida albicans in 10% soybean oil emulsion. 83 63


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