Home parenteral nutrition.

Home parenteral nutrition is a life-sustaining mode of therapy for patients with short bowel syndrome that is unresponsive to conventional therapy. It requires learning specialized skills through an intensive training program and carefully following this program in a home setting. This training can be best provided by a group of health care specialists including a physician, nurse, dietitian, psychiatrist, social worker, and pharmacist who are knowledgeable about the issues that face the patient requiring home parenteral nutrition. The resources of career medical centers ar most appropriately utilized to provide the support needed to successfully undertake a home parenteral nutrition program. The nutritional requirements of these truly long-term patients have to be more accurately defined to guarantee that macronutrient and micronutrient requirements are being adequately provided for over the many years of required treatment. Fluid delivery systems and techniques for infection-free long-term venous catheterization have to be perfected. Home parenteral nutrition is a valuable life support system for patients with gut failure. Although expensive, it costs substantially less than in-hospital parenteral nutrition and can return the patient to a near normal life at home.

Clinical nutritional assessment: a perspective.

The negative implications of hospital malnutrition have been wall documented and demand recognition. Nutritional assessment consists of anthropometric, biochemical, clinical, and dietary indexes and forms the objective basis for diagnosis of protein-calorie malnutrition as well as the mechanism by which nutritional adequacy of aggressive alimentation (enteral and parenteral) is evaluated. In the ideal setting, extensive nutritional assessment consists of numerous tests, measurements, and continuous monitoring performed by a specialist whose primary area of expertise is nutritional assessment and clinical nutritional support. In the absence of this service, significant protein-calorie malnutrition should be suspected if the patient has recently lost weight exceeding 10 per cent of usual weight, has a serum albumin of less than 3.5 gm. per deciliter, or exhibits any pathologic state with nutrition-related manifestations.