title: Effectiveness and tolerance to highly concentrated vs conventional TPN formulas.
abstract: Conventional total parenteral nutrition regimens (TPN-C) involve concentrations of dextrose/protein which necessitate administration of 2.5-4 liters/day to meet target nutritional needs. Although this is frequently acceptable, certain clinical settings mandate a volume-restricted (VR) approach. This study compares a VR TPN regimen (TPN-VR) involving the use of 25% dextrose and 9.5% amino acid with D17.5 AA 5.0 (TPN-C). The two groups were compared for adequacy of nutritional delivery, balance, and tolerance. Twenty patients received the TPN-VR (Group 1) and 20 patients received TPN-C (Group 2). The groups were comparable in age, sex, injury severity, and APACHE 2 scores. Harris-Benedict (BEE) x 2 and 2 g/protein/kg of ideal body weight were delivered by the second day of TPN. A 27% reduction in administered fluid was achieved in Group 1 (P < 0.001). Metabolic cart data in both groups demonstrated that delivered calories exceeded REE. The average RQ in Group 1 was 0.84 and in Group 2 was 0.90 (P > 0.1). There was no significant difference between the two groups in nitrogen balance, mean serum bilirubin levels, PT and PTT, serum albumin levels, and triglycerides (P > 0.20). SGPT and alkaline phosphatase levels were significantly higher in Group 2 (P < 0.001). Group 2 received an average of 22% more carbohydrate than Group 1 and 45% required insulin compared to 25% in Group 1 (P < 0.01). In summary, TPN-VR is comparable to TPN-C in terms of effectiveness of delivery, nutritional balance, and tolerance.
authors.affiliation: Department of Surgery, University of New Mexico, School of Medicine, Albuquerque 87131-5341.
authors.forename: F W
authors.initials: FW
authors.lastname: Clevenger
authors.forename: D
authors.initials: D
authors.lastname: Gerding
authors.forename: E
authors.initials: E
authors.lastname: Steinle
authors.forename: D J
authors.initials: DJ
authors.lastname: Rodriguez
authors.forename: T M
authors.initials: TM
authors.lastname: Osler
mesh_terms: D000328:Adult; D002153:Calorimetry, Indirect; D003422:Critical Care; D005260:Female; D006801:Humans; D008297:Male; D009747:Nutritional Physiological Phenomena; D010289:Parenteral Nutrition, Total / Q000379:methods* / Q000706:statistics & numerical data; D011182:Postoperative Care; D014947:Wounds and Injuries / Q000628:therapy