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Query: UMLS:C0038187 (starvation)
 24,951 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Total parenteral nutrition has evolved as a distinct therapeutic reality within the past decade. Starvation or malnutrition need no longer be accepted as a necessary component of prolonged illness. Though current TPN techniques can be both safe and effective, the prevention of potential complications must always have a high priority. Changes in technique are to be anticipated as further knowledge and improved materials allow the pursuit of more basic clinical problems. The recent experience with the use of high caloric TPN solutions for prolonged gastrointestinal failure in 73 patients at the Loyola University Medical Center has been summarized. The need for the involvement of an experienced TPN team in the care of these patients cannot be overemphasized if the numerous and diverse potential complications of the TPN system are to be minimized.
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PMID:Total parenteral nutrition. 41 2

Branched chain amino acids (BCAA) may serve as a major oxidative fuel for skeletal muscle during periods of starvation. This study compared the ability of protein-undernourished rats to heal musculo-aponeurotic wounds of the abdominal wall when they were infused with solutions containing 45% BCAA or 8% BCAA (conventional TPN). Although the provision of 45% BCAA tended to result in better nourished animals and significantly increased plasma glutamine concentrations, this was not associated with improved healing.
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PMID:Influence of branched chain amino acid infusions on wound healing. 211 86

Total parenteral nutrition has been widely available for almost 20 years. This therapy can demonstrably support growth in neonates and children and will maintain life in adults with an inadequate intestine. It may be beneficial in highly selected preoperative patients, and patients with head trauma. Otherwise, its role in specific disease states or pathologic conditions remains unclear. Whether its benefits outweigh its hazards is largely unknown. Crucial to the decision-making process for initiation of TPN is a knowledge of when starvation becomes detrimental to an individual and whether TPN can prevent or reverse any of starvation's detrimental effects; this information is unknown. Many potential complications exist, the frequency of which generally is dependent on the expertise of the user. Nutritional support teams appear to reduce septic, mechanical, and metabolic complications and may improve the clinical efficacy and decrease the cost of TPN care.
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PMID:Efficacy and safety of total parenteral nutrition. 213 48

PCM can be usefully considered in terms of edematous (kwashiorkor-like) and nonedematous (marasmic) forms, as long as the limitations of the traditional terms are kept in mind. The body composition of subjects with undernutrition, or total starvation, both appear to maintain an extracellular fluid volume at a normal level, which increases as a percentage of the shrinking body weight. This is in contrast to patients with hospital malnutrition, in whom there is often an absolute increase in the extracellular volume while the body cell mass is shrinking. Data from the starvation literature suggest that the adult subject must gain approximately 10% of his or her body weight as extracellular expansion before edema is clinically evident. Preliminary evidence indicates that the hospitalized patient with the edematous form of malnutrition is at greater risk for complications and death when undergoing an operation, or requiring intensive care. The depleted patient who shows a rise in a depressed serum albumin after 7 to 10 days of TPN will have an improved prognosis when undergoing the stress of an elective operation. This improvement appears to be more the result of decreasing the expanded extracellular fluid volume than achieving a major increase in protein stores. The severely catabolic patient, particularly during episodes of major infection, can be expected to benefit by a nutritional intake that is carefully designed to provide calorie and nitrogen equilibrium. Nutritional intake high enough to guarantee positive balances of calories and nitrogen should be delayed until the acute catabolic stimulus has subsided, at which time the nutritional objective is to rebuild lost tissue.
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PMID:Forms of malnutrition in stressed and unstressed patients. 308 75

The influence of nutritional status on the resumption of adequate food intake in 101 patients recovering from colorectal cancer operation was examined. Two thirds of these patients were well-nourished; the others were malnourished. Malnutrition criteria were serum albumin of less than 3.5 gm per dl plus any two of the following four factors: recent weight loss greater than 10 per cent or weight for height, mid-arm circumference, and triceps skinfold thickness lower than the tenth percentile. Over half of the well-nourished patients were eating 60 per cent or greater of their caloric requirements by the tenth postoperative day, whereas only one quarter of the malnourished patients had attained this intake. the morbidity and mortality in 33 malnourished patients was 52 and 12 per cent, respectively, compared with 31 and 6 per cent (p less than 0.01) in 68 nourished patients. The duration of postoperative functional starvation in malnourished patients without complications increased to an average of 22 days following a complication and was further prolonged after a complication. Age or operative procedure (curative or palliative) did not influence complication rate. Our data suggest that postoperative nutritional support as either TPN or enteral feeding using an elemental diet is indicated in malnourished patients and in well-nourished patients immediately following a complication requiring therapeutic intervention.
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PMID:Influence of nutritional status on the resumption of adequate food intake in patients recovering from colorectal cancer operations. 309 45

Tumor-bearing animals provided with intravenous glucose and amino acids (TPN) exhibit enhanced response to S-phase-specific chemotherapeutic agents (H. M. Reynolds, J. M. Daly, B. Rowlands, S. J. Dudrick, and E. M. Copeland. Cancer 45: 3069, 1980; M. H. Torosian, J. L. Mullen, E. E. Miller, et al. J. Parenter. Enteral Nutr. 7: 337, 1983). To determine the mechanism of this response, DNA synthesis rate during starvation or a 48-hr infusion of glucose/amino acids (Glu/AA) was evaluated in tumor, liver, and terminal ileal cells of 68 rats. Tumor cells exhibited a rapid increase in DNA synthesis following the initiation of an infusion of Glu/AA. This increase was most marked after 2 hr of infusion and returned to control levels within 24 hr. Liver DNA synthesis rate increased in both starved and Glu/AA animals over 48 hr with a larger increase in animals receiving Glu/AA. Ileal DNA synthesis decreased equally in both groups. Short pulse Glu/AA produced transient increases in tumor DNA synthesis. Changes in host tissues occurred but followed a different temporal sequence. This may indicate the existence of a period of time following initiation of metabolic manipulation when tumor susceptibility to phase-specific chemotherapeutic agents will be enhanced while host tissues will be spared from increased toxicity.
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PMID:The effects of glucose and amino acids on tumor and host DNA synthesis. 393 82

Adequate parenteral nutritional support improves nutritional status in cancer patients, but its effect on tumor growth remains controversial. Using a transplantable mammary adenocarcinoma in a rat-TPN model, the relative effect of different exogenous intravenous nutrients on tumor growth and host maintenance was studied. Relative to chow controls, starvation increased host depletion without reducing tumor growth. Adequate carbohydrate calories alone neither improved host maintenance nor stimulated tumor growth, yet adequate amino acids alone did improve host maintenance but also stimulated tumor growth. Adequate amino acids and carbohydrates given simultaneously maximized both host maintenance and tumor growth. In contrast, an isocaloric, isonitrogenous, intravenous diet providing non-nitrogenous calories as fat promoted host maintenance equivalent to carbohydrate-based TPN with no tumor stimulation. This apparent differential utilization of fat calories by normal and malignant cells may permit manipulation of the relative benefit of parenteral nutrition to host or to tumor, permitting host repletion without tumor stimulation or alternatively tumor stimulation at appropriate times to increase sensitivity to phase-specific antineoplastic therapy.
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PMID:Host-tumor interaction and nutrient supply. 738 37

Malnutrition develops rapidly with total starvation, especially when a catabolic stress is superimposed. The measurement of body composition provides an accurate and quantitative measurement of both the nutritional state and the response to nutritional therapy. With malnutrition there is a loss of body fat and BCM with a concomitant expansion of the ECM. With the appropriate administration of calories and amino acid as TPN, a malnourished body composition is restored to normal. However the nutritional state is restored relatively slowly, particularly when compared to the rapid rate at which malnutrition may develop, especially in the septic and starving patient. The administration of nandrolone decanoate, a potent anabolic steroid, significantly improves the efficacy of TPN, resulting in a more rapid correction of the malnourished state. However, to demonstrate this effect an accurate and precise measurement of the nutritional state is required. Furthermore it is essential to account for a number of important independent variable which influence this response; specifically the caloric intake, the nutritional state and the age.
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PMID:Anabolic steroids and total parenteral nutrition. 825 50

We analyzed clinical, biochemical, and histo- logic parameters of ten infants with parenteral nutrition-induced hepatobiliary dysfunction. The data were compared with the results of a rabbit model. All infants were born prematurely with low birth weight. Their clinical diagnoses were necrotizing enterocolitis (6), gastroschisis (1), intrauterine volvulus (1), and lung hypoplasia (2). All required total (TPN) or partial parenteral nutrition for at least 8 weeks. All had repeated episodes of infections or sepsis. A rise in bilirubin and aminotransferase levels occurred after a minimum of 5 weeks; peak bilirubin levels ranged from 4 to 14 mg% and aminotransferases from 40 to 140 IU/l. One child later developed gallstones. Liver biopsies after 1 to 24 months showed fibrosis, bile-duct proliferation, cholestasis, and hydropic degeneration. All of the above-mentioned clinical factors have been accused of causing the observed biochemical and histologic changes. In our rabbit model we were able to produce almost identical symptoms by TPN alone: gallbladder distension, sludge, and stones developed after 1-4 weeks of TPN as well as uncharacteristic changes in aminotransferases and bilirubin after 4 weeks. Liver histology revealed severe hydropic degeneration of zone 3 as early as 1 week after beginning TPN. A rise of fibrosis and bile-duct proliferation after 1 to 4 weeks of infusion was statistically significant. Cholestasis, as was observed in the infants, could not be detected. In our model, all alterations observed could be attributed exclusively to TPN. We therefore assume that TPN was the true cause of the dysfunction. In a second experimental series infusions were reduced to 80% PN and free access to lab chow. These animals produced normal feces, indicating physiologic enteral stimulation. They developed the same degenerative and proliferative histologic changes, whereas gallbladder distension, sludge, and stones were not noted. We conclude that: (1) The TPN solution itself is responsible for the histologic changes in the liver, which is supported by the fact that hydropic degeneration of zone 3 is typical of a direct toxic effect; and (2) Complete enteral starvation with an absence of enteral stimulation causes disease of the lower biliary tract.
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PMID:Parenteral nutrition-induced hepatobiliary dysfunction in infants and prepubertal rabbits. 1052 3

Hepatobiliary dysfunctions (TPN-HBD) occur during parenteral nutrition. In older children these are usually reversible whereas in newborns and infants these hepatobiliary abnormalities play a significant role in the morbidity. Cholestasis is a commonly occurring TPN-HBD. It correlates directly with the decreasing gestational age, low birth weight and increasing duration of TPN therapy. The pathogenesis of cholestasis of TPN is multifactorial and predisposed by necrotising enterocolitis, sepsis, cardiac failure, shock, and hypotension. Diagnosis is made with exclusion of other causes of direct hyperbilirubinemia. Most TPN-HBD appear within 4 weeks of starting of TPN but severe complications manifest usually after the 16th week. Histologically there is intralobular cholestasis. In few cases there may be severe portal fibrosis followed by development of micronodular biliary cirrhosis. Enteral starvation, defective bile acid carriers, hypercaloric TPN are the major factors responsible for TPN-HBD, including cholestasis. Biliary complications of TPN-HBD are acalculous, cholecystitis, and cholelithiasis. Bile stasis is a major pathological factor for these. If the calories are provided only by glucose or glucose-containing electrolyte solutions it may lead to cholestasis and other TPN-HBD. Even small oral alimentation (continuous or bolus) during TPN, prevent TPN-HBD. Choleretic agents have been useful in the prevention and management of cholestasis and other parenteral nutrition induced hepatobiliary abnormalities.
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PMID:Hepatobiliary abnormalities and parenteral nutrition. 1102 27


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