ABSTRACT
Thirty consecutive patients (19-71 years of age) undergoing abdominal operations and having feeding catheter jejunostomy tubes placed, were prospectively randomized and studied for tolerance to elemental (amino acid) or polymeric (intact protein isolates) dietary formulas. The groups were matched for sex, age, height, weight, operations, and caloric goal. Nutritional profiles of the patients were similar preoperatively. The number of stools/day and stool consistency were direct indicators of tolerance; nutrient intake was an indirect indicator. Diarrhea is defined as greater than or equal to five stools/day. We found no significant difference between the groups. There were no patients with diarrhea on days 1 or 2. Formula intake as an indirect measure of tolerance was not significantly different for the two groups from days 1-4. On day 5, intake of the elemental group exceeded that of the polymeric group (p less than 0.02). Enteral caloric intake as percent of caloric goal did not differ. Nitrogen intake, urinary nitrogen, serum prealbumin, body weight, serum sodium, and serum potassium did not differ significantly between the two groups throughout the study. Serum chloride decreased significantly (105 to 99.8 mEq/L) in the elemental group (p less than 0.03). Our study shows that patients undergoing routine gastrointestinal operations will tolerate early enteral feedings (day 1) and that there is no significant difference in tolerance to elemental or polymeric dietary formulas.
Subject(s)
Enteral Nutrition , Food, Formulated , Postoperative Care , Adult , Aged , Catheters, Indwelling , Defecation , Diarrhea/etiology , Electrolytes/blood , Energy Intake , Female , Food Additives , Humans , Jejunostomy , Male , Middle Aged , Nitrogen/metabolism , Nutrition Assessment , Nutritional Status , Organic Chemicals , Prospective Studies , Weight LossABSTRACT
A retrospective review of 771 patients' charts in two acute care hospitals was performed to determine likelihood of malnutrition (LOM) at admission and to assess the effect of LOM on costs and charges. Using accepted criteria, LOM was present in 59 and 48% of medical and surgical patients, respectively. Patients with LOM were 2.6 or 3.4 times as likely to have a predefined minor or major complication, respectively; and 3.8 times as likely to die as patients without LOM (all p less than 0.001). In every diagnosis-related group, the mean length of stay was longer for LOM patients (range 1.1-12.8 excess days). Accountants converted charges to direct variable costs using departmental cost-to-charge ratios. LOM status increased excess costs and charges per patient by $1738 and $3557, respectively (p less than 0.0001). When complications occurred, LOM patients incurred $2996 or $6157 excess costs and charges per patient (p less than 0.01). Serum albumin was the strongest clinical predictor of cost. The hospitals' cost of providing enteral or parenteral nutrition support was $18 or $102 per day, respectively. Too few patients received early nutrition support to assess efficacy. Nonetheless, the costs associated with malnutrition warrant early detection and aggressive treatment.
Subject(s)
Hospitalization/economics , Nutrition Disorders/economics , Adult , Cost-Benefit Analysis , Costs and Cost Analysis , Enteral Nutrition/economics , Female , Humans , Length of Stay/economics , Male , Nutrition Disorders/therapy , Parenteral Nutrition/economics , Retrospective Studies , Serum Albumin/analysisABSTRACT
To determine if vitamin D deficiency would retard the ability of muscle to hypertrophy in response to mechanical stress, we severed the gastrocnemius tendon on one leg of rats in each of three groups, the treatment of which differed only in the amount of vitamin D in the diet. After 1 week the increased size of the soleus and plantaris in the leg in which the gastrocnemius was severed relative to that of the sham operated leg, was determined for each rat. Despite differences in body weight and serum calcium among the groups, we found no difference in the percent of muscle hypertrophy. We conclude that muscle hypertrophy can occur in response to local mechanical forces despite a deficient hormonal environment that otherwise retards growth.
Subject(s)
Muscles/pathology , Vitamin D Deficiency/pathology , Animals , Hindlimb , Hypertrophy/etiology , Male , Physical Exertion , Rats , Vitamin D Deficiency/complicationsSubject(s)
Hypoglycemia/drug therapy , Insulin/metabolism , Phenformin/pharmacology , Phenytoin/pharmacology , Adult , Dietary Carbohydrates , Female , Glucose Tolerance Test , Humans , Hyperinsulinism/drug therapy , Insulin Secretion , Male , Middle Aged , Phenformin/adverse effects , Phenformin/therapeutic use , Phenytoin/adverse effects , Phenytoin/therapeutic useABSTRACT
A 29-year-old man with a marfanoid habitus, peculiar mucosal neuromas of the lips and tongue, high arched palate, hyperplastic corneal nerves, and hypertension was found at operation to have medullary carcinoma of the thyroid, parathyroid hyperplasia, and pheochromocytoma. These symptoms and findings are characteristic of multiple endocrine adenomatosis (MEA IIb) syndromes.
