Measurement of metabolism in multiple organ failure.

Despite the emphasis on surgical nutrition, clinical research and practice are usually based on gross estimation of caloric requirements and no specific knowledge of caloric balance. One reason for this is the difficulty of measuring O2 and CO2 exchange in critically ill patients. We designed a system for intensive care unit (ICU) bedside measurement of O2 consumption (VO2), CO2 production (VCO2), respiratory quotient (RQ), and indirect calorimetry (E). We measured these variables daily in 57 surgical ICU patients at risk for multiple organ failure. Measured VO2 and E varied widely (+/- 40%) from estimated values. Seventeen patients had a cumulative negative balance of at least 10,000 calories; 13 died. This caloric deficient was reversed by caloric intake in three of these patients; one died. Fifteen patients had positive caloric balance. Only four of these died, but the CO2 load produced by hypercaloric feeding created ventilator weaning problems in some patients. Ventilator weaning was facilitated by decreasing total calories and substituting fat for carbohydrate to reduce the RQ. The incidence of multiple organ failure was higher in patients with large caloric deficits, although cause and effect are not inferred. We conclude that respirometry and indirect calorimetry are helpful for management and essential for nutritional research.

Survey of knowledge among primary health care workers in diabetes.

The knowledge of diabetes mellitus held by allied health professionals in Kentucky and the short-term and long-term effectiveness of a symposium in altering this knowledge was studied. The groups investigated consisted of: 136 primary health workers (nurses, dieticians, health educators, and other health professionals) surveyed before and after the 12-hour symposium (group 1); 37 of these primary health professionals studied again one year after the first symposium (group 2); and 26 nurses who work at a university hospital, and who did not attend the symposium (group 3). Before training, all groups performed similarly on this survey. Group 1 scored 58.5 +/- 0.2% correct, group 2, 56.9 +/- 3.1% correct, and group 3, 52.7 +/- 5.0% correct. Performance did not correlate with educational level, job description, or geographic location within Kentucky. There was a negative correlation between performance and age for group 1 (r = -0.3494, P < .001). Follow-up studies immediately after the symposium showed that a significant improvement occurred in the performance of group 1 and group 2 on this knowledge survey (correct score +/- SEM = 82.5 +/- 0.3%, and 81.7 +/- 2.4% respectively, P < .005) compared to pretraining scores. A repeat survey of group 2 one year later showed a significant deterioration of knowledge (P < .05), but not to pretraining levels (mean correct score = 69.2 +/- 3.4% at one year versus 56.9 +/- 3.1% before training, P < .02). These results suggest that more emphasis on professional education in diabetes and study of effective methods for providing this education is required.

Mineral and vitamin status on high-fiber diets: long-term studies of diabetic patients.

High-fiber diets have a beneficial impact on glucose metabolism of selected persons with diabetes mellitus. A major concern is the long-term effects of fiber intake on mineral and vitamin status. We measured serum concentrations of selected minerals and vitamins and also assessed three fat-soluble vitamins in 15 patients fed high-fiber diets for an average of 21 mo. Average values for serum calcium, phosphorus, alkaline phosphatase, iron-binding capacity, magnesium, and hemoglobin values were normal. Vitamin B12 and folic acid concentrations in serum were also normal. Indirect assessment suggested that these patients had adequate intakes of the fat-soluble vitamins A, D, and K. These preliminary observations suggest that high-fiber diets containing a wide variety of natural foods are well tolerated for up to 51 mo; we failed to detect evidence suggesting mineral or vitamin deficiency in these patients.