Elevated urinary C-peptide excretion in multiple trauma patients

Liver and biliary tract changes and injury associated with total parenteral nutrition: pathogenesis and prevention

Total parenteral nutrition (TPN), now widely used, is successful in preventing and reversing malnutrition in individuals with various diseases and conditions. However, hepatic and biliary complications of TPN are encountered in both adult and pediatric patients. Certain complications, such as sepsis and TPN-associated cholestasis, occur more frequently in very young infants. Continuing problems commonly seen in adults are steatosis and steatonecrosis. Reasons for the development of these complications are multifactorial. Etiologies of hepatic complications, especially the role of deficiency/excess of nutrients in the pathogenesis of hepatobiliary disorders, are summarized. Complications caused by the duration of TPN are discussed with emphasis on prevention and management. Evidence now suggests that prompt enteral feeding, even in minimal amounts, may prevent many of the metabolic complications associated with TPN. TPN should be used only in amounts meeting needs and for a duration essential to survival.

Acute IGF-1 deficiency in multiple trauma victims

The circulating levels of IGF-1 in the catabolic flow phase of injury were measured in multiple trauma victims once before nutritional support and again after 4 days of intravenous feeding. The hypermetabolic and highly catabolic state of injury is characterized by a diminished level of IGF-1 along with increased levels of stress hormones. Inverse relationships of adiposity and aging on IGF-1 levels are seen both in injured and uninjured subjects. Feeding could restore the IGF-1 levels in non-obese, young patients but it is delayed in obese or elderly subjects. This diminished responsiveness to feeding of IGF-1 hormone deficiency in obese and elderly subjects should be taken into consideration in their post-trauma treatment and may warrant adjuvant administration in these types of patients.