Body composition changes in the critically ill patient: emphasis on water balance

Early parenteral nutrition in patients unconscious because of acute drug poisoning

The author studied the clinical and laboratory effects of early parenteral nutrition (EPN) in patients who were comatose as a result of acute drug poisoning. All patients were unconscious at the time of admission and entry into the study and received our usual conservative therapy for the first 24 hours. Alternate patients received an EPN solution containing amino acids and glucose. Volume, composition, and caloric content of the EPN solution were calculated separately for each patient according to weight and height nomograms. It was found that the group receiving EPN (n = 46) normalized their nitrogen balance sooner and demonstrated a consistent decrease in their creatine phosphokinase level. Serum amino acid values in patients treated with EPN did not change significantly during the treatment trial. The control group (n = 40) demonstrated a significantly lower serum amino acid concentration on the third day of treatment (p < .001), had significantly more pneumonias (p < .05), and their hospitalization time was significantly longer (.01 < p < .05) than the EPN group. There were significantly fewer instances of disseminated intravascular coagulation in the group receiving EPN (p < .05).