Peripheral parenteral nutrition in geriatric wards.

Poor nutritional status significantly contributes to morbidity and mortality in elderly. Malnutrition and denutrition are amenable to interventions aimed to improve outcomes in acute conditions so that nutritional support is frequently initiated during hospitalisation. If the enteral route remains the first evidence-based choice when the gut is functional, this approach may be difficult to perform in some "geriatric" situations like delirium, agitation, coma or pulmonary congestion. In the first days of the acute condition, when the patient is still stable, an alternative to the enteral route may also be considered. Although there is no evidence that parenteral nutrition is better than enteral nutrition, the peripheral intravenous route may be of interest especially when the enteral route is contraindicated. Moreover, the technique of peripheral parenteral nutition reduces central cannulation-related complications like pneumothorax. We emphasize here the place of this alternative method for a short duration nutritional support when supplement of caloric intake is needed. We discuss indications, a practical approach, our experience and analyze the evidences for this complementary nutritional support.

Clinical usefulness of the mini nutritional assessment (MNA) scale in geriatric medicine.

OBJECTIVE: This study was undertaken to estimate the prevalence of malnutrition in elderly patients hospitalized with an acute illness, as well as to assess the clinical usefulness of standardized nutritional assessment upon admission by means of the MNA scale. DESIGN: A prospective study. SETTING: A large size regional university hospital. SUBJECTS: There were 175 patients (113 women and 62 men) with a mean age of 79.7 + 8.5 years admitted for an acute problem. Death occurred in 11 patients (6.3%). METHODS: Upon admission, demographic (age, gender, origin) and medical (disease, drugs) data were recorded for each patient; the MNA questionnaire (score: 0-30) was administered and Katz score (7-28) calculated. At hospital discharge, data included Katz score, outcome (death/survival), and destination. RESULTS: The mean MNA score was 20.5 + 5.1 and the prevalence of severe malnutrition (MNA <17) was 21.7%. Further, 48.6% of elderly were at risk of malnutrition (MNA between 17 and 24). There was no association between MNA and age or gender, but underweight was a sign of low MNA values (P <.001). MNA scores were inversely related to Katz scores at both admission and hospital discharge (P <.001). Patients originating from nursing homes had a poorer nutritional status than those living at home (MNA: 18.4 against 22.3, P <.001). The number of drugs taken per patient (5.2 + 2.8) was found to be correlated with MNA (P =.049). MNA scores were on average significantly higher (P <.001) in survivors (20.9) than in nonsurvivors (14.1). CONCLUSIONS: The study clearly demonstrates the high prevalence of malnutrition and the clinical usefulness of the MNA scale in geriatric medicine. The MNA score upon admission reflects the patient's nutritional condition, degree of autonomy (Katz score), living conditions and current treatment. It is also predictive of patient's outcome (death or survival).

Apomorphine stimulation of vasopressin- and oxytocin-neurophysins. Evidence for increased oxytocinergic and decreased vasopressinergic function in schizophrenics.

Apomorphine challenge tests (0.5 mg SC) were performed in 14 normal male volunteers and in 9 male schizophrenic inpatients, drug-free for at least 2 wk. In the normal volunteers, apomorphine induced an increase of serum growth hormone (GH) (maximum at 40 min), of vasopressin-neurophysin (hNpI) (maximum at 20 min), and oxytocin-neurophysin (hNpII) (maximum at 20 min). The release of neurophysins was independent of digestive side effects. In the schizophrenics, the GH level and release pattern were similar to those in the controls. The basal level of hNpI was reduced (t0: 0.42 +/- 0.1 ng/ml in the schizophrenics and 0.66 +/- 0.05 ng/ml in the controls, p < 0.02). In contrast, the basal level of hNpII was increased (3.34 +/- 0.04 ng/ml in the schizophrenics to 0.92 +/- 0.21 ng/ml in the controls, p = 0.001). The response to apomorphine was blunted, with no significant release of hNpI or of hNpII. Although the hNpII data are consistent with an increased dopaminergic tone, the psychopathological meaning of the increased basal oxytocinergic and decreased vasopressinergic functions remains to be defined.