Asunto(s)
Planificación en Salud Comunitaria/organización & administración , Continuidad de la Atención al Paciente/organización & administración , Hospitales Filantrópicos/normas , Enfermedad Crónica , Relaciones Comunidad-Institución , Necesidades y Demandas de Servicios de Salud , Humanos , Estados UnidosAsunto(s)
Redes Comunitarias/organización & administración , Atención a la Salud/organización & administración , Hospitales Comunitarios/normas , Garantía de la Calidad de Atención de Salud/métodos , Participación de la Comunidad , Continuidad de la Atención al Paciente/organización & administración , Conducta Cooperativa , Atención a la Salud/normas , Humanos , Modelos Organizacionales , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Innovación Organizacional , Estados UnidosAsunto(s)
Planificación en Salud Comunitaria/economía , Relaciones Comunidad-Institución/economía , Obtención de Fondos/métodos , American Hospital Association , Conducta Cooperativa , Obtención de Fondos/organización & administración , Instituciones de Salud/economía , Inversiones en Salud , Objetivos Organizacionales , Estados UnidosRESUMEN
Serial liver enzyme and bilirubin concentrations were measured in 100 patients undergoing total parenteral nutrition. Between the eighth and tenth days, serum glutamic-pyruvic transaminase levels rose to 5.4 times pretotal parenteral nutrition levels; serum glutamic-oxalacetic transaminase, 2.8 times; bilirubin, 2.3 times, and lactic dehydrogenase, 1.5 times. These elevations were transient, lasting four to ten days. Biopsies of the liver taken during maximal elevations demonstrated marked periportal fatty change. A second elevation of serum glutamic-pyruvic transaminase, serum glutamic-oxalacetic transaminase, alkaline phosphatase and lactic dehydrogenase occurred in one-third to one-half of those patients receiving total parenteral nutrition for longer than a 20 day period. These elevations were more prolonged, and no biopsies were taken. Amino acid solutions contain conversion products of tryptophan, an amino acid that is unstable in the presence of the preservative sodium bisulfite which is added to all commercially available protein solutions. Infusion of these products into rats, either alone or as part of total parenteral nutrition solutions, resulted in periportal fatty change of the livers identical to that seen in our patients receiving total parenteral nutrition. A toxic effect of tryptophan conversion products in total parenteral nutrition solutions is proposed.