The all-in-one nutrient solution in parenteral nutrition

Normal gestation after 5 years on home parenteral nutrition

A case of normal gestation after 5 years on HPN is reported. The patient had her entire jejunum and ileum and right colon resected because of gangrene and has subsisted normally on HPN ever since. From the second trimester on, her HPN formula was supplemented to meet the requirement for growth and development of the foetus. Anaemia, hypoalbuminaemia, low plasma zinc levels and jaundice became manifest in the final trimester. These responded readily to readjustment of her HPN formula. A normal baby weighing 2020 g was delivered by Caesarean section at 36 weeks. Long-term HPN, final trimester abnormalities and HPN formula adjustments are discussed.

The effect of surface charge and partition coefficient on the chemical stability of solutes in O/W emulsions

Methylparaben (MP) was the model solute used to study the effect of surface charge on the rate of degradation in oil-in-water emulsions. The surface charge was varied by adding small amounts of phosphatidylglycerol (anionic) or stearylamine (cationic) to a standard intravenous lipid emulsion stabilized by egg phospholipid. The rates of hydrolysis at pH 8.0 in the water phase, oil phase, interface, and aqueous micellar phase were determined by application of a four-phase kinetic model. The rate of hydrolysis in the aqueous phase was dependent on the zeta potential. This was attributed to the effect of surface charge on the pH of the microenvironment of the oil drops through the phenomena known as surface acidity. MP in the aqueous phase hydrolyzed at a rate associated with the pH of the microenvironment, not the pH of the bulk. The effect of the partition coefficient of the solute was studied by substituting ethylparaben (EP), propylparaben (PP), and butylparaben (BP) for MP in the emulsions used to study the effect of surface charge. The rate of hydrolysis was inversely related to the partition coefficient. The effect of surface charge on the rate of hydrolysis was evident in the emulsions containing MP and EP. Partitioning had the greatest effect on the emulsions containing PP and BP. In general, the effect of surface charge predominated when the partition coefficient was small. The partition coefficient had a greater effect than surface charge when the partition coefficient was large.

A 10-year survey of nutritional support in a surgical ICU: 1986-1995

Total parenteral nutrition (TPN) has long been considered the optimal nutrition technique in critically ill patients, but recently the use of enteral nutrition (EN) has increased. This study describes the evolution of the different nutritional support techniques in a surgical intensive care unit (ICU) in a university hospital, through (1) a global survey over 10 y assessing the evolution of the use of EN and TPN, and (2) a prospective study performed over 6 mo. Severity of illness and diagnostic categories were stable (n = 11,539 patients). From 1986 to 1990, the proportion of TPN administered increased from 10-25% of ICU days, decreasing to 10% thereafter. EN was used in about 5% of ICU days in 1986, and had increased to 30% of total ICU treatment days in 1995. The proportion of nutrients actually delivered to the patients was 75% with EN and 88% with TPN. Major changes in nutritional support have been observed since 1986. The frequency of nutritional support provided in general has increased to 40% of ICU treatment days. TPN has been largely overtaken by EN, with the risk of insufficient energy delivery, related to the difficulties of EN in the critically ill. These results reinforce the importance of continuous quality control by daily assessment of nutrient supply.