1/15. failure to thrive: a case study in comprehensive care.Infants who fail to grow normally may occasionally have a serious organic disease; the majority, however, are suffering from inadequate caloric intake because of a disturbance of the infant-mother relationship. Diagnostic evaluation can usually be brief and institution of therapy often leads to dramatic improvement. This Grand Rounds illustrates the contribution each member of the health-care team can make in solving the immediate problem of failure to thrive and helping provide a wholesome environment for the child's future.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
2/15. Successful intradialytic parenteral nutrition after abdominal "Catastrophes" in chronically hemodialysed patients.OBJECTIVE: To assess the therapeutic contribution of intradialytic parenteral nutrition (IDPN) in four acutely ill, hypercatabolic, hemodialysed patients. All underwent major surgery, complicated by infection and malnutrition. DESIGN: A retrospective clinical study. SETTING: An in-center hemodialysis unit, at a tertiary referral hospital. patients: Patient 1: a young woman, with a good renal transplant. Developed gastric lymphoma, which required gastrectomy. After cessation of immunosuppression, "lost" her kidney and returned to hemodialysis. Received IDPN for 4 months and recovered well from severe malnourishment. Patient 2: an elderly, malnourished man, on continuous ambulatory peritoneal dialysis (CAPD). Developed biliary peritonitis and bacteremia. In a 3-month period, the patient had four operations. Maintained on IDPN for 4 months. Patient 3: a young and obese man, who suffered from life-threatening staphylococcal aureus peritonitis, resulting in widespread bowel adhesions. Underwent repeated aspirations of purulent ascites, laparoscopy, and explorative laparotomy. IDPN was administered for 4 months and stopped on the patient's request. Patient 4: a young man, who after cadaveric renal transplantation remained hospitalized for 6 months because of acute rejection and peritoneal and retroperitoneal abscesses. Had major surgery performed seven times. Received IDPN for 6 months, and is now well. RESULTS: All four patients benefited from 4 to 6 months of IDPN, as an integral part of intensive supportive and nutritional treatment. weight loss was halted, as patient appetite returned and oral nutrition became adequate. Estimated daily protein intake reached 1.2 g/kg, while caloric intake rose to nearly 30 kcal/kg/d (Table 3). Mean serum albumin levels increased from 25.5 g/L /- 0.9 g/L to 38.0 g/L /- 1.5 g/L. No adverse side effects were seen from IDPN. CONCLUSION: IDPN is a worthwhile part of treatments used in the catabolic, postoperative hemodialysed patient. It is safe and efficient when used over a 6-month period in trying to attenuate existing, or worsening malnutrition in these patients. It should be commenced at an early stage in these patients, after attempts at oral nutritional support have been deemed inadequate.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
3/15. role of cofactors in the treatment of malnutrition as examplified by magnesium.In the absence of appropriate amounts of metabolically important cofactors such as magnesium, replenishment of malnourished patients with protein and carbohydrate will exaggerate the underlying abnormality even though the primary deficiency is corrected. The malnourished patients cannot utilize the food substances provided unless they have within their cells commensurate amounts of all the necessary cofactors required for the metabolism of the food supplied. This therapeutic problem in malnutrition is illustrated by three different examples of clinical deterioration when caloric and vitamin replenishment have been undertaken in the face of magnesium deificiency.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
4/15. Nutrition strategies in neurotrauma.A basic understanding of metabolic alterations that occur following neurotrauma is essential for addressing nutritional requirements. Interventions must be research based and must focus on the support of metabolic alterations, minimizing the effect of catabolism and optimizing caloric delivery to meet metabolic demand. The goal of accuracy in the delivery of nutritional support is to ensure a reduction in patient morbidity. nutritional support requires an ongoing, daily assessment of caloric goals, protein requirements, patient responses, and assessment of nutritional laboratory values. Using this strategy, neurotrauma patients will have the greatest opportunity for a positive outcome.- - - - - - - - - - ranking = 2keywords = caloric (Clic here for more details about this article) |
5/15. Remarkable improvement of growth and developmental retardation in Crohn's disease by parenteral and enteral nutrition therapy.The patient, an 18-yr-old male (admission ht 153 cm, wt 30 kg), had been suffering from growth arrest and intermittent abdominal pain since he was 13 yr old, which was left untreated. Examinations on admission disclosed almost normal pituitary function, while levels of testosterone and somatomedin C were low. Roentgenological examination revealed extensive skip-stenotic lesions and longitudinal ulcers in the ileum, diagnostic of Crohn's disease. Therapy involving high-caloric parenteral and enteral alimentation resulted in a marked increase in both ht and wt, and improvement in roentgenological and colonoscopical findings. The interrelation between Crohn's disease and malnutrition with reference to some reports in the literature is discussed.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
6/15. Beneficial effect of prolonged total parenteral nutrition in a very malnourished cystic fibrosis patients.A very malnourished cystic fibrosis (CF) patient was treated with integrative parenteral nutrition (PN). With a mean caloric supplementation of 2,550 Kcal/day a weight gain of 6.5 Kg was achieved. In spite of severe pulmonary complications (pneumotorax and pneumomediastinum), pO2 increased from 53 to 72 mmHg and pCO2 from 38 to 56 mm Hg. General conditions improved, appetite was restored and the patient cleared off continuous oxygen therapy; he left the hospital and did not present any more pulmonary exacerbations. In the following 8-month period he maintained a daily caloric intake of 80 Kcal/kg with a further weight gain of 4.5 Kg.- - - - - - - - - - ranking = 2keywords = caloric (Clic here for more details about this article) |
7/15. Aggressive oral refeeding in hospitalized patients.malnutrition is an important clinical condition leading to increased morbidity and mortality. This report describes an aggressive oral refeeding program of high-caloric foods, which was instituted in severely anorectic patients because of their refusal to eat meals or supplements. After ascertaining a patient's favorite sweet, hospital personnel and family collaborated in providing the food. Frequently, sweets were the patient's only intake for weeks. We saw a gradual return of appetite, inclusion of other foods in the diet, and overall clinical improvement in comorbid conditions. These cases suggest that aggressive oral refeeding with high-caloric foods is an underutilized therapy for multiply impaired elderly patients.- - - - - - - - - - ranking = 2keywords = caloric (Clic here for more details about this article) |
8/15. Functional changes during nutritional repletion in patients with lung disease.In conclusion, the weight loss in COPD is associated with hypermetabolism. Under these circumstances, caloric intake may be insufficient to meet increased metabolic demands, thereby contributing to progressive weight loss. This is in contrast to depleted surgical patients who have energy expenditures 5% below predicted. There is an increased VE in patients receiving a high-carbohydrate diet, secondary to an increased VCO2 that is similar to that seen in patients with neither COPD nor weight loss. Neither diet composition, whether high-carbohydrate or high-fat, nor refeeding have any effect on PaCO2. However, ventilatory drive does appear to be influenced by nutritional repletion. There was an increased sensitivity to PaCO2, independent of diet composition, during a high caloric intake. Respiratory and skeletal muscle function increased, particularly strength, endurance, and work efficiency, indicating that the increased metabolic demand can be well tolerated. It should be noted, however, that refeeding the COPD patient must be done as a preventive measure at the start of weight loss. patients with long-term weight loss and end-stage COPD appear unable to tolerate any increase in metabolic demand; consequently, they cannot improve respiratory and skeletal muscle function through refeeding.- - - - - - - - - - ranking = 2keywords = caloric (Clic here for more details about this article) |
9/15. Atypical presentation of childhood acquired immune deficiency syndrome mimicking Crohn's disease: nutritional considerations and management.A child with acquired immune deficiency syndrome became severely malnourished presumably as a result of multiple gastrointestinal infections, with numerous organisms including campylobacter, giardia, and cryptosporidium. These opportunistic infections preceded laboratory evidence of immune deficiency. Despite severe diarrhea and marked weight loss, there was no laboratory evidence of significant malabsorption. By using nasogastric feedings, we were successful in promoting a 60% weight gain, and a rise in serum albumin from 1.2 to 4.3 g/dl. While eventual outcome was not altered, this particular patient's clinical course was improved. We suggest that malnutrition should not be accepted as inevitable and that malabsorption should not be assumed in similar acquired immune deficiency syndrome patients. Appropriate studies for malabsorption should be done, and high caloric enteral feedings should be used whenever feasible.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
10/15. regeneration of jejunal mucosa during recovery from malnutrition and pancreatic insufficiency.A patient with a history of alcohol abuse, who presented with severe malnutrition, was subjected to serial jejunal biopsies during his hospitalization. The improvement in villous size and absorptive cell ultrastructure paralleled his clinical recovery. It is concluded that the caloric and trophic benefits of food, the pancreatic and vitamin replacement therapy and withdrawal of alcohol, all played an integral part in the regeneration of the jujunal mucosa.- - - - - - - - - - ranking = 1keywords = caloric (Clic here for more details about this article) |
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