Availability of insulin from total parenteral nutrition solutions

Insulin is frequently required in total parenteral nutrition (TPN) solutions to control hyperglycemia. The purpose of this study was to evaluate the recovery of human insulin from standard TPN solutions with and without lipids and from TPN solutions with specialized amino acid formulations and to compare it to the insulin recovery from normal saline. All solutions were mixed in currently utilized PVC-free bags (ethylene vinyl acetate) and drained through PVC-containing tubing. Human insulin (Humulin-R) was spiked with 125I-labeled insulin and then added in concentrations of 10, 25, and 50 units to 1-liter bags containing 39-g amino acids (10% Freamine-III; or 6.9% Freamine HBC; or 8% Hepatamine), 257-g dextrose, electrolytes (Hyperlyte-R), 1000 units of heparin, MVI-12, and MTE-5 Concentrate. Alternate sets of bags contained 125 ml of 20% Intralipid and an appropriate amount of sterile water to keep the final volume at 1 liter. Actual clinical conditions of preparation, storage, and administration were simulated in this in vitro experiment. Multiple samples were collected during the 8-hr infusion period directly in gamma counter vials. All experiments and assays were done in triplicate. Our findings indicate that human insulin availability in TPN solutions is much higher (90%-95%) than the 50% suggested in the literature. Insulin recovery was not appreciably altered by adding lipids or by using Freamine HBC. Insulin recovery from TPN solutions was significantly reduced if they contained Hepatamine (87% and 88%, p less than 0.05) as compared to Freamine (90% and 94%).(ABSTRACT TRUNCATED AT 250 WORDS)     

精氨酸增强的TPN与常规TPN对大肠癌病人免疫功能影响的比较研究

目的：探讨精氨酸增强的ＴＰＮ对大肠癌病人免疫功能及粘膜免疫屏障的作用。方法：２０例大肠癌病人随机分为常规ＴＰＮ组和ＴＰＮ＋Ａｒｇ组，分别接受常规ＴＰＮ和ＴＰＮ＋Ａｒｇ治疗共５天，检测基前、后外周血ＣＤ３、ＣＤ４、ＣＤ８、ＩｇＧ、 ＩｇＭ、ＩｇＡ和粘膜固有层用药第５天ＣＤ３、ＣＤ４、ＣＤ８的变化。并观察用药５天的小笔工、密度。结果：（１）常规ＴＰＮ组行ＴＰＮ后外周血ＣＤ３、ＣＤ４下降，ＣＤ８升高，Ｃ     

Determinants of insulin availability in parenteral nutrition solutions

BACKGROUND: Management of hyperglycemia in patients receiving parenteral nutrition (PN) often includes the addition of regular insulin to the PN solution. A literature review has shown insulin availability in such solutions to range from 10% to 95%. This discrepancy in availability may be due to differences in the composition of the PN solution, the final concentration of insulin, or the assay method used to determine insulin concentrations. The purpose of this study was to evaluate insulin recovery from a standard PN solution used at our medical center. METHODS: Solutions were manually prepared in our pharmacy according to standard practice. Multivitamins and trace elements were added to 1 of 2 L of solution each day. Each of 3 simulated patients received 2 L of solution per day for 3 consecutive days. Samples from each bottle were drawn at baseline, 1 hour after the start of infusion, and 1 hour before the end of infusion and were subsequently analyzed for immunoreactive insulin levels by radioimmunoassay. RESULTS: Recovery of insulin from solutions containing multivitamins and trace elements was much greater (95%) than from those without (5%). CONCLUSIONS: The presence of multivitamins and trace elements is a major determinant of insulin availability in PN solutions. Additional research is necessary to determine the mechanism mediating this effect and to assess its clinical significance.     

严重烧伤病人的全肠外营养

我们对9例烧伤总面积平均为42%,Ⅲ°面积平均为26%的病人,应用18F氨基酸作为氮源,进行全肠外营养治疗的前瞻性研究.结果表明,在适当的氮/热卡比例下,大部分病例(7/9)可获得正氮平衡.2例病人未获得正氮平衡,说明营养支持的效果除烧伤面积,深度,还有其它影响因素,有待于进一步研究.     

A computerised program for TPN

A computerised program devised to manage patients undergoing TPN has been operating in the Parenteral and Enteral Nutrition Unit of the II Clinica Chirurgica of the University of Rome. The program includes sections to manage information, monitoring and therapy. The package was compiled using the new Language C, which is well adapted to our model. In a pilot study the program was successfully applied to the management of 15 patients. Computers and information technology have developed to the point where they are well suited to this type of biological application. Language C, which in this study, was used for the first time in this field, offers practically unlimited possibilities for development.     

Effects of infusion of branched chain amino-acids enriched TPN solutions on plasma amino-acid profiles in sepsis and trauma patients

Total parenteral nutrition with branched chain amino-acids enriched solutions has been advocated in patients with sepsis and stress because of favourable effects on nitrogen balance, protein synthesis and immune competence. The rationale for the use of BCAA-enriched solutions is based on their potential to correct the plasma amino-acid imbalances seen in these patients. In a 7-day prospective randomised study we investigated the effects on plasma amino-acid concentrations of a standard amino-acid solution (15.6% BCAA) and a branched chain amino-acid enriched solution (50.2% BCAA) in 101 parenterally fed patients with carefully assessed sepsis and/or stress scores. The infusion of the BCAA-enriched solution led to an imbalance of the essential plasma amino-acids. The branched chain amino-acids valine, leucine and isoleucine increased significantly while the non-BCAA essential amino-acids decreased significantly. In the standard solution the non-BCAA-essential amino-acids increased significantly with a slow and insignificant rise in the levels of the branched chain amino-acids. We conclude that infusion of a BCAA enriched TPN formulation induced amino-acid profile derangements that can be considered ill-suited to the achievement of anti-catabolic effects.     

妊娠剧吐患者两种静脉营养输注方式的效果观察

目的观察妊娠剧吐患者两种静脉营养输注方式的效果。方法选取我院妇科100例妊娠剧吐需进行静脉营养治疗的患者,按照配置三升袋营养液方式及传统非三升袋分为2组,输注三升袋配置营养液者50例(观察组),传统方式连续依次输注葡萄糖、10%Kcl、脂肪乳和氨基酸等营养液者50例(对照组),观察疗效及不良反应,进行数据统计和效果观察。结论三升袋营养液可明显改善孕吐患者营养状况,纠正电解质效果好,尿酮体转阴快,且操作方便,安全性高,不良反应少,值得推广。