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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A review of the literature on the effectiveness of essential amino acid and hypertonic dextrose in the nutritional management of patients with acute renal failure is evaluated critically. Earlier case reports and studies published indicated that the administration of these solutions could lead to lower blood urea nitrogen concentrations, positive nitrogen balance, and various other clinical and metabolic improvements. Recent studies, however, show that various combinations of essential and nonessential amino acids can provide similar results. Some investigators have suggested increasing the concentration of branched-chain amino acids in these solutions to decrease protein catabolism in muscle. Unfortunately, patients with complications such as sepsis, burns, and shock may not benefit from any of these therapies. Further research is needed to elucidate fully the optimal composition of these solutions in severely stressed hypercatabolic patients with this disorder.
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PMID:Use of essential amino acid/dextrose solutions in the nutritional management of patients with acute renal failure. 391 44

Previous data from our laboratory have demonstrated that glucan administration significantly alters the course of a variety of experimentally induced infectious diseases. In view of the increasing incidence of gram-negative infections, studies were initiated to evaluate the effect of intraperitoneal glucan therapy on Escherichia coli-induced peritonitis and sepsis. Male ICR/Tex mice were injected intraperitoneally with glucan or dextrose on days 5 and 3 prior to intraperitoneal challenge with 1.0 x 10(8) E. coli. Glucan administration resulted in a significant enhancement of survival. Evaluation of the mechanism of protective action of glucan revealed that both the glucan and dextrose control groups showed an equivalent level of blood-borne E. coli at early periods. At 6 hours after challenge the glucan group showed a significant decrease in blood-borne E. coli. In contrast, the dextrose control group demonstrated progressive bacteremia. A significant depression of phagocytic activity occurred in E. coli-infected mice as compared with control mice that were not exposed to the bacterial challenge. The enhancement in phagocytic function observed in glucan-treated control mice was unaltered in E. coli challenged, glucan-treated mice. The possible importance of hyperfunctional macrophages in reduction of mortality from E. coli sepsis was denoted by methyl palmitate-induced reversal of the glucan hyperfunctional state. Methyl palmitate-treated glucan injected mice were not protected against E. coli infection. These data denote that the intraperitoneal administration of glucan significantly modifies the course of E. coli-induced peritonitis and bacteremia due, in part, to glucan-induced enhancement of macrophage function.
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PMID:Immunotherapeutic modification of Escherichia coli--induced experimental peritonitis and bacteremia by glucan. 633 16

Antibodies against the major capsular polysaccharide of Cryptococcus neoformans, glucuronoxylomannan (GXM), and a minor secreted polysaccharide, galactoxylomannan (GalXM), were surveyed by indirect enzyme immunoassay (EIA) in patients with cryptococcosis, with other mycoses, and in normal controls. Measurement of IgG levels against GalXM revealed cross reactions in candidiasis patients that were reduced by adsorption with Candida albicans cell walls. Measurement of IgM levels were subject to fewer cross reactions. The combination of adsorption with C albicans cell walls and measurement of IgM detected antibodies in 12 of 55 cryptococcosis patients. An end point equal to or greater than a titer of 1/16 excluded reactions in normals and limited cross reactivity in candidiasis patients to below 7%. This test has potential diagnostic significance in cryptococcosis patients who show no evidence of cryptococcal antigen circulating in the cerebrospinal fluid or serum. Reactions in this IgM assay were not spuriously due to rheumatoid factor. The major capsular GXM was much less serologically active and was subject to cross reactions with agents of bacterial sepsis. The specificity of the GalXM is directed mainly by the mannose and to a lesser extent by galactosyl residues.
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PMID:Enzyme immunoassay detection of IgM to galactoxylomannan of Cryptococcus neoformans. 638 77

A randomized prospective study was performed to determine the effects of substrate composition on immunity in septic malnourished patients. A balanced substrate formula was administered to 11 patients with sepsis and 11 nonseptic patients. This provided 40 kcal/kg/day and 1 to 1.5 g of protein per kilogram each day with a carbohydrate-nitrogen ratio of 50:1. A 25% dextrose and 4.25% protein solution that provided 50 kcal/kg/day and 1 to 1.5 g of protein per kilogram each day with a carbohydrate-nitrogen ratio of 150:1 was provided to ten patients with sepsis and 11 without. Skin test conversion rates were not affected by substrate composition; however, the absolute lymphocyte count was significantly improved in septic patients who achieved positive nitrogen balance, regardless of the nutritional support regimen used. These findings suggest that substrate composition per se has no effect on immunologic responsiveness.
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PMID:Substrate composition and sepsis. Effects on immunity. 640 22

Free fatty acid (FFA) metabolism was studied in 18 traumatized and/or septic patients. Each patient was studied while receiving 5% dextrose (D5W) and after 4 to 7 days of total parenteral nutrition (TPN). Nonprotein energy during TPN was given either entirely as glucose (Glucose System) or as equal portions of intravenous fat and glucose (Lipid System). Plasma FFA concentrations were in the normal range on D5W and decreased markedly with TPN. FFA turnover was higher than normal on D5W and did not decrease significantly with TPN. The poor correlation between these two variables emphasizes the need to perform kinetic studies to characterize FFA metabolism in trauma and sepsis. Plasma FFA oxidation and net whole body fat oxidation measured by indirect calorimetry were in the normal range on D5W, 35 and 82%, respectively, of resting energy expenditure (REE). With a glucose intake averaging 108% of REE, plasma FFA oxidation and net fat oxidation decreased to 17 and 13%, respectively, of REE. Nonprotein RQ increased only to 0.94 despite administration of glucose in excess of REE, indicating an abnormal persistence of fat oxidation. During D5W administration, plasma FFA accounted for less than one half of total fat oxidation, indicating that unlabeled fat, such as tissue or plasma triglycerides not in rapid equilibrium with plasma FFA, accounted for the bulk of fat oxidation. Glucagon concentrations which were high on D5W did not decrease significantly with TPN. Insulin concentrations were normal on D5W and increased in response to TPN. The abnormal hormonal milieu may account for much of the abnormal fat metabolism. Administration of large amounts of glucose decreased FFA oxidation much more than FFA mobilization. Thus, the infused glucose acts to increase the rate of "futile cycling" of FFA in these acutely ill patients.
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PMID:Free fatty acid mobilization and oxidation during total parenteral nutrition in trauma and infection. 641 94

Current concepts in the nutritional support of patients with renal disease are reviewed. In chronic renal failure, alterations in fat, carbohydrate, and glycogen metabolism usually occur and may be worsened by acute illness. Total parenteral nutrient (TPN) therapy is rarely required unless complications occur. In contrast, acute renal failure is generally associated with hypovolemia, sepsis, soft tissue injury, and coagulation defects, all of which influence metabolism and extracellular fluid volume; the gluconeogenesis that often occurs in these patients masks the metabolic effects of uremia. Nutritional support of patients with renal disease aims at providing adequate nutrients while limiting accumulation of nitrogenous waste. Current concepts concerning essential amino acids (EAAs), nonessential amino acids (NEAAs), and urea recycling are reviewed. The caloric needs of patients with renal failure are assumed to be similar to those of other hospitalized patients. There is no clinically important advantage of using an EAA formulation rather than mixed (EAA and NEAA) amino acids. Since fluid restriction is recommended and protein use is improved with diets with a high calorie-to-nitrogen ratio, the use of TPN solutions with dextrose 350 g is recommended. If glucose intolerance is severe, fat should be considered as a calorie source. Recommendations for monitoring the metabolic status of patients with renal failure receiving nutritional support are reviewed. Monitoring the metabolic status of patients with renal disease is crucial to providing safe and effective nutritional therapy. There appears to be no clinically important advantage to amino acid products specially formulated for use in renal disease.
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PMID:Nutritional support of patients with renal disease. 642 98

To investigate possible causes for the significantly increased incidence of sepsis observed in galactosemic neonates, the in vitro effect of galactose on neutrophil function in healthy newborns was studied. Neutrophils from 25 normal newborns and 23 normal adult volunteers were incubated with 100 mg of glucose per dl, 300 mg of galactose per dl and 300 mg of galactose plus 100 mg of glucose per dl, respectively. Tests for neutrophil function included chemiluminescence (CL), chemotaxis (CTX) and adherence. Neutrophil CL (measure of bactericidal activity) was significantly depressed by galactose in both adults (30.2%) and newborns (59.5%); however, neonatal neutrophil function (CL) was depressed to a much greater extent than in adults. CTX was also significantly depressed by galactose in newborns but not in adults. Supplementing the galactose-containing medium with glucose restored both CL and CTX function to normal in adults. However, only CTX was restored in newborns, while CL remained markedly depressed. Neutrophil adhesion, a function which is not energy-dependent, was not affected by galactose in both adults and newborns. These findings indicate that depressed neutrophil function by galactose or its metabolites may contribute to the high incidence of sepsis in galactosemic neonates.
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PMID:Galactose inhibition of neonatal neutrophil function. 665 98

Utilization of the totally implantable infusion system provides a convenient, cost-effective, and safe administration technique for oncology patients who require cyclic or continuous intravenous medication. In addition, it provides an excellent conduit for blood withdrawal access. The efficacy of this technique abrogates the necessity for periodic replacement of subclavian lines and their associated complications and possibly represents an advantage over percutaneous Broviac and Hickman catheters and the attendant catheter-related sepsis associated with their use. The initial low incidence of complications and absence of catheter thrombosis with this implantable system suggests its superiority over percutaneous silicone catheter devices for bolus drug injection and the continuous infusion of chemotherapeutic agents. Cyclic or continuous infusion of hypertonic dextrose and amino acid solutions (total parenteral nutrition) with this system is being evaluated but cannot yet be recommended as being more advantageous than infusion with an implanted Hickman or Broviac catheter.
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PMID:Totally implantable venous access system for cyclic administration of cytotoxic chemotherapy. 673 99

Lipopolysaccharides (LPS) were extracted from 13 of the 16 Heddleston serotypes of Pasteurella multocida by phenol-chloroform-petroleum ether (PCP). Serotypes 3, 9, and 13 were extracted only by phenol-water (PW). After extraction of LPS of serotype 9 by PW, an additional LPS was isolated by PCP. All LPS contained glucose, 2-keto-3-deoxyoctonate, and heptose. Two isomers of heptose, D-glycero-D-mannoheptose and L-glycero-D-mannoheptose, were found in serotypes 2 and 5. Antisera made against purified LPS of serotypes 2 and 5 reacted with both heat-stable antigens and LPS from serotypes 2 and 5 in the gel-diffusion precipitin test. Antisera against serotype 2 LPS protected turkeys against challenge with capsulated serotype 5, indicating that a structural relationship exists between LPS of strains that cause hemorrhagic septicemia and fowl cholera. Rhamnose was a component of serotype 9 LPS, and galactose was found in all LPS, except for serotype 11. The LPS of serotype 13 contained an isomer of heptose that has not been identified. The LPS had buoyant densities in CsCl of 1.40 +/- 0.0148 g/ml, and all hemagglutinated chicken and turkey, but not sheep or horse, RBC.
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PMID:Lipopolysaccharides of the Heddleston serotypes of Pasteurella multocida. 673 91

Total exchangeable potassium (Ke) measurements were done on 13 patients who received total parenteral nutrition (TPN) at 25% dextrose and 2.5% amino acids (AA) (a hypertonic dextrose solution) by central vein, and 12 patients who received TPN as 10% dextrose, 10% fat emulsion (Intralipid), and 2.5% AA with lipid supplying about 60% of the nonprotein calories. There were 13 patients with benign diseases, three with carcinoma resected for cure, four with sepsis, three with severe burns, and two receiving chemotherapy for cancer. All but four of the septic and three of the burned patients had lost more than 10% of their normal body weight. A tracer dose of 150 to 300 microCi of K42 was injected intravenously during the first few days of the TPN therapy and a 48-hour urine collection and 24-, 36-, and 48-hour urine spot samples were obtained. Measurement of Ke was repeated after 7, 14, or 21 days of TPN therapy. Calories per kilogram per day, delta K per day, and percent delta K per day were determined for each patient and the data entered into a Textronics graphics computer for selection of curves of best fit. Similar curves of calories per kilogram per day versus delta K per day were obtained for the central and peripheral TPN groups. Intercepts where the body cell mass was maintained were at 32 calories/kg/day for the central TPN group and 34 calories/kd/day for the peripheral TPN group. Patients in both groups received a minimum of 0.6 gm protein/kg/day and the majority received from 0.8 to 1.2 gm protein/kg/day. Protein intake correlated with delta K per kilogram per day in the central but not the peripheral TPN group. We conclude that in nonseptic malnourished patients, an Intralipid calorie is as efficient as a dextrose calorie and that delta K is related to caloric rather than protein intake. None of the septic or burned patients maintained his body cell mass. However, they all received less than 30 calories/kg/day for a number of reasons.
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PMID:Total exchangeable potassium in patients receiving total parenteral nutrition. 677 83


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