Comparison of modified amino acids and standard amino acids in parenteral nutrition support of thermally injured patients.

Twenty thermally injured patients who could not tolerate enteral nutrition support were randomized to receive parenteral nutrition (PN) with either modified amino acids (MAA) or standard amino acids (SAA). There was no significant difference between groups for age, sex, weight, percent BSA area burn, percent third-degree burn, or operative procedures. N balance (NB) was measured and serum was harvested for circulating fibronectin (Fn), somatomedin-C/insulin-like growth Factor I (Sm-C), prealbumin (PA), and retinol-binding protein (RBP) analysis on days 1, 4, 7, 14, 21, and 28 of PN. The patient groups received similar doses of PN for a similar number of days. Fn did not change significantly from baseline in either group and there was no significant difference between groups. Sm-C increased significantly from baseline at day 7 in the SAA group and in both groups on day 14, but there was no significant difference between groups. PA and RBP increased significantly from baseline on day 7 in the MAA group and in both groups on days 14, 21, and 28. RBP was significantly higher in the MAA group only on day 21, and there was no significant difference between groups for PA. NB increased significantly from baseline for all study days; however, there was no significant difference between groups. PN in thermally injured patients significantly improves NB and increases visceral protein concentrations. However, there appears to be no difference between PN with MAA or SAA.

Absorption of ciprofloxacin administered through a nasogastric or a nasoduodenal tube in volunteers and patients receiving enteral nutrition.

The absorption of ciprofloxacin was higher when administered through a nasoduodenal tube than through a nasogastric tube, indicating that even though acidic gastric pH is needed for rapid disintegration, dissolved ciprofloxacin might not be stable in the gastric environment. If the length of exposure or the different gastric environment in each individual affects the overall absorption of ciprofloxacin, this could explain the reported variability in ciprofloxacin absorption and suggests the need for the development of an enteric-coated tablet. Further studies are needed to fully characterize the absorption of ciprofloxacin in patients with different illnesses, gastric transit times, gastrointestinal environments and of different ages.

Use of fibronectin and somatomedin-C as nutritional markers in the enteral nutrition support of traumatized patients.

Enteral nutrition support was provided to 12 critically ill, traumatized patients by continuous NG infusion with a nutritionally complete formula for at least 7 consecutive days. Serum for fibronectin (Fn) and somatomedin-C (Sm-C) was collected and nitrogen balance (NB) was measured on days 1, 4, 7, 14, 21, and 28 of the study period. Estimated energy and protein requirements were based, respectively, on the patient's calculated basal energy expenditure multiplied by a stress factor and urea nitrogen excretion (plus 4) during 24-h urine collections. Enteral feedings were started 5.3 +/- 3.8 days after injury; patients received an average of 33.2 +/- 3.9 kcal/kg.day and 1.5 +/- 0.4 g protein/kg.day. Fn concentrations increased significantly (p less than .05) from baseline on study days 7, 14, 21, and 28, whereas NB increased significantly (p less than .05) on study days 4, 7, 14, 21, and 28. Significant correlations were found between Fn and NB (r = .52, p less than .005), Fn and cumulative caloric intake (r = .54, p less than .005), and Fn and cumulative nitrogen intake (r = .62, p less than .005). There were no significant changes observed with Sm-C concentrations during the study period. Measurement of Fn concentrations appears to have potential as a nutrition support marker in traumatized patients, particularly in monitoring short courses of nutrition support. The role of Sm-C as a nutrition marker requires further investigation.

Use of fibronectin and somatomedin-C as markers of enteral nutrition support in traumatized patients using a modified amino acid formula.

The purpose of this study was to evaluate the use of serum fibronectin and serum somatomedin-C as nutritional markers during enteral nutrition support (ENS) of critically ill, traumatized patients using an enteral product containing high concentrations of branched-chain amino acids. Twelve critically injured patients received a standard enteral formula with 30 g of a 44% branched-chain amino acid supplement added to each liter of formula. Fibronectin concentration, somatomedin-C concentration, and nitrogen balance were measured on study days 1, 4, 7, 14, 21, 28 or until adequate oral intake began. Both fibronectin and somatomedin-C concentrations increased significantly from baseline by day 7 of ENS. Nitrogen balance increased significantly from baseline by day 4. On days 14 and 21, only somatomedin-C and nitrogen balance increased significantly from baseline. Nitrogen balance was significantly correlated with somatomedin-C concentration (r = 0.53, p less than 0.01), cumulative caloric intake (r = 0.68, p less than 0.01), and cumulative nitrogen intake (r = 0.72, p less than 0.01). The results of this study suggest that serum somatomedin-C is useful and serum fibronectin has potential in monitoring nutrition support response in critically ill, traumatized patients.