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An Abbreviated History of Nutritional Support
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
The patient did quite well and it wasn’t long before we were finding other cases for our new system. After a few months, I was certain that we could streamline the process and make it easier for patients to do TPN at home. I went to Dr Kinney and told him we could start a service based on it, either as part of the metabolic service or as an independent entity. He wasn’t enthusiastic about the idea and felt there might be potential conflicts for him. But he encouraged me to do it on my own and that was how I came to start Clinical Homecare Corporation (CHC).
Meeting personal needs: hydration and nutrition
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
In some instances, it may not be possible to provide nutrition enterally. Parenteral feeding (often referred to as total parenteral nutrition – TPN) may be used when a person is unable to use the gastrointestinal tract for nutrition, either temporarily or in the long term. An example would be a person who has had major surgery to the gastrointestinal tract. In parenteral nutrition, nutrients and micronutrients are administered directly into the circulation intravenously via a device in the vein and therefore only qualified healthcare workers can administer TPN.
Critical Care and Anaesthesia
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rajkumar Rajendram, Alex Joseph, John Davidson, Avinash Gobindram, Prit Anand Singh, Animesh JK Patel
What are the typical requirements for components of TPN?Fluid: 30 mL/kg/dayCalories: 25–30 kcal/kg/dayProtein: 1–2 g/kg/daySodium: 1–2 mmol/kg/dayPotassium: 1 mmol/kg/dayCalcium: 0.1–0.3 mmol/kg/dayMagnesium: 0.1–0.3 mmol/kg/dayEnergy should be approximately 30% lipid and 70% carbohydrate.Whilst standard preparations of TPN are available, the content of TPN should ideally be adjusted daily according to laboratory blood results.
Effect of standardized fluid management on cardiac function after CRS + HIPEC in patients with PMP: a single-center case-control study
Published in International Journal of Hyperthermia, 2023
Rui Yang, Yan-Dong Su, Gang Liu, Yang Yu, Xin-Bao Li, Xin Zhao, Zhong-He Ji, Ru Ma, Zhi-Ran Yang, Yu-Lin Lin, He-Liang Wu, Yan Li
TPN configuration tool (Figure 1): The daily total postoperative fluid was divided into therapeutic and nutritional fluids, with a total volume of 35–45 ml/(kg × d), which was adjusted according to the amount of input and output. Therapeutic fluids include conventional antibiotics, anti-stress drugs, and essential organ protection drugs, which can be formulated individually according to the condition. Nutritional fluid intake was individually calculated according to the patient’s sex, age, weight, and nutritional status. Based on EXCEL and functional language, a TPN nutritional treatment plan configuration table was created to visually display the dosage and energy ratio of each component of glucose, amino acids, fat emulsion, electrolytes, vitamins, and trace elements. While meeting the total energy of 25–35 kcal/kg, the ratio of glycolipid energy supply should be approximately 6:4, the ratio of energy to nitrogen should be 100–220:1 kcal/g, and the insulin scheme was configured based on glucose to insulin ratio of 4–6:1 g/U to maintain blood glucose balance.
Five New Cases of Megacystis-Microcolon-Intestinal Hypoperistalsis Syndrome (MMIHS), with One Case Showing a Novel Mutation
Published in Fetal and Pediatric Pathology, 2021
Alyssa Kalsbeek, Renee Dhar-Dass, Abdul Hanan, Eman Al-Haddad, Iman William, Adina Alazraki, Janet Poulik, Kasey McCollum, Aya Almashad, Bahig M. Shehata
Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) was first described in 1976 by Walter Berdon et al. The disorder is characterized by markedly dilated non-obstructed bladder, also known as megacystis, decreased or absent intestinal peristalsis, and microcolon [1]. This intestinal dysfunction often leads to difficulty in achieving proper nutrition and requires TPN (total parenteral nutrition) or a multiorgan transplant for longer survival. Despite progressions in treatment MMHIS still has significant morbidity and mortality [2]. Familial studies support an autosomal recessive inheritance pattern and a strong preponderance of females, due to increased severity and lethality in males [3,4]. Familial inheritance also shows a female predisposition to MMIHS in consanguineous parents which has implications for genetic counseling and treatment options [5]. Genes affecting smooth muscle function and contraction that have been associated with MMIHS include MYH11, MYLK, ACTG2, LMOD1, MYL9, PDCL3 [5, 6]. Of the five cases presented here, four had gene mutations involving chromosome 15q24 which has been previously but infrequently identified in the literature. The other identified case presented with a new missense mutation which to our knowledge has not been described in the literature in a patient with MMIHS. This report evaluates the implications of the preceding gene mutations on the prognosis and survival of patients with MMIHS, while also proposing an approach of using early genotype identification to aid in planning treatment options and predicting survival outcomes.
Myocardial ischemia in an adolescent secondary to nutritional thiamine deficiency
Published in Baylor University Medical Center Proceedings, 2018
Cassandra Lefevre, Lea H. Mallett, Lori Wick
An 18-year-old woman with a history of nasopharyngeal carcinoma, as well as chemotherapy and radiation that had been completed 2 months previously, was transferred to the pediatric intensive care unit from the floor due to depressed left ventricular function seen on echocardiogram. She presented with vomiting, dyspnea, tachycardia, numbness, and tingling down her left arm and bilateral legs. The patient also complained of occasional abdominal discomfort and dizziness. She had recently lost 26 pounds due to decreased appetite and oral aversion following her cancer treatments. The patient had been receiving TPN 8 hours each evening in replacement of oral nutrition. She had an allergic reaction 3 months prior to the preservatives within the TPN related to vitamin supplementation. Consequently, the vitamins were removed and the patient was instructed to take a multivitamin daily by mouth.