Anabolic agents: Adjuncts to nutrition support

Anabolic agents as adjuncts to nutrition support therapy have been used to improve malnutrition and establish anabolism. Growth hormone, insulin-like growth factor, and anabolic steroids have been studied for their potential to reverse the catabolic process and promote anabolism. This paper reviews several anabolic agents and their possible role in nutrition support therapy

Nutrition in the critically ill patient

Critical illness presents with the classic response to stress, including hypermetabolism and increased catabolism, resulting in a negative energy and nitrogen balance. These harmful events initiate the immunological response, starting with the systemic inflammatory response syndrome, which, if not resolved, may lead to multiple organ dysfunction syndrome (MODS). Furthermore, patients who do not develop early MODS manifest a compensation anti-inflammatory response syndrome, which suppresses immunity and predisposes the patient to sepsis, thereby ­increasing the risk of late MODS and ultimately death. The use of specialized nutrition support, including enteral nutrition (EN) and parenteral nutrition (PN), has been initiated in an attempt to preserve muscle wasting and decrease catabolic response. Other implementations, including hypocaloric feeding and immune-enhancing agents, have also been investigated for their help in improving outcomes in the critically ill patient

Compounding vs Standardized Commercial Parenteral Nutrition Product: Pros and Cons

Standardized commercial parenteral nutrition (PN) formulations have advantages and disadvantages as compared with PN formulations compounded using an automated compounding device. These advantages and disadvantages are discussed along with the supporting available research

Nutrition support therapy in acute kidney injury: Distinguishing dogma from good practice

Acute kidney injury (AKI) is a frequently observed complication in critically ill patients. Its presentation may range from the early risk of renal dysfunction to complete renal failure. Morbidity and mortality in the AKI patient increase with the decline of renal function. Appropriate nutrition therapy is essential in the medical management of the AKI patient. Assessment of nutritional requirements should take into account the patient’s underlying complication, comorbid medical conditions, and severity of the renal dysfunction. Various stages of AKI determine the direction of nutrition therapy. Additionally, understanding the macro- and micronutrient modifications and electrolyte and vitamin alterations that should be implemented are vital for better patient outcomes

Does the quantity of enteral nutrition affect outcomes in critically ill trauma patients?

Abstract from Clinical Nutrition Week, Orlando, FL, January 29-February 2, 2005

A comparison of efficacy of heparin 0.5 unit/ml versus heparin 1 unit/mL in parenteral nutrition administrated in the neonatal population

Abstract from Clinical Nutrition Week, Las Vegas, NV, February 8-10, 2010

Self-assessed proficiency and application of various skills learned during postgraduate pharmacy teaching skills development programs

The purpose of this study was to identify teaching skills commonly taught during the postgraduate pharmacy teaching skills development programs, to describe trainees\u27 perceived teaching proficiency, and the extent to which the learned teaching skills are applied in trainees\u27 current positions. An online survey was developed for pharmacists who completed postgraduate teaching skills development programs. The survey included demographic and program queries as well as questions on 23 teaching skills. Participants self-assessed their proficiency in and application of their learned teaching skills. The online survey resulted in 122 qualified responses. After training, the perceived proficiency in nearly all 23 teaching skills was high; however, the scores for application of teaching skills were significantly lower. A majority (91.7%) of survey respondents were engaged in experiential education. There is wide variability among the postgraduate pharmacy teaching skills development programs. Though the trainees perceived their proficiency in teaching skills to be high, the acquired teaching skills were underused

Bowel necrosis associated with enteral feeding

Abstract from Clinical Nutrition Week, Dallas, TX, February 12-15, 2006

A comparison of renal phosphorus regulation in thermally-injured and multiple trauma patients receiving specialized nutrition support

To compare phosphorus intake and renal phosphorus regulation between thermally injured patients and multiple trauma patients, 40 consecutive critically ill patients, 20 with thermal injury and 20 with multiple trauma, who required enteral tube feeding were evaluated. Phosphorus intakes were recorded for 14 days from the initiation of tube feeding which was started 1 to 3 days post-injury. Serum for determination of phosphorus concentrations was collected at days 1, 3, 7, and 14 of the study period. A 24-hour urine collection was obtained during the first and second weeks of nutrition support for urinary phosphorus excretion, fractional excretion of phosphorus, renal threshold phosphate concentration, and phosphorus clearance. Average total daily phosphorus intake during the 14-day study for thermally injured patients and multiple trauma patients was 0.99 ± 0.26 mmol/kg/d vs 0.58 ± 0.21 mmol/kg/d, respectively, p \u3c .001. Serum phosphorus concentration on the third day of observation was significantly lower in the thermally injured group than those with multiple trauma (1.9 ± 0.8 mg/dL vs 3.0 ± 0.8 mg/dL, p ≤ .01). A trend toward hypophosphatemia in the thermally injured group persisted by the seventh day of feeding (2.7 ± 1.2 mg/dL vs 3.3 ± 0.6 mg/dL, p ≤ .04). Differences in urinary phosphorus excretion was not statistically significant between the thermally injured and multiple trauma groups (271 ± 213 mg/d vs 171 ± 181 mg/d for week 1, and 320 ± 289 mg/d vs 258 ± 184 mg/d for week 2, respectively). Urinary phosphorus clearance, fractional excretion of phosphorus, or renal threshold phosphate concentrations were also not significantly different between thermally injured and multiple trauma patients. During nutrition support, serum phosphorus concentrations are lower in thermally injured patients compared with multiple trauma patients despite receiving a significantly greater intake of phosphorus. Renal phosphorus regulation does not significantly contribute to the profound hypophosphatemia observed in thermally injured patients when compared with multiple trauma patients during nutrition support

2005 American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Standards and Guidelines Survey

An online survey about the use and format of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Standards and Guidelines documents was conducted. The survey was sent to A.S.P.E.N. members, and an acceptable number of responses were received (470, or 9% of those surveyed). Most respondents indicated an overall satisfaction with the standards and guidelines and suggested format changes, many of which will be incorporated into future guidelines and standards. The results of this survey are presented here for general interest. Changes in the process with which A.S.P.E.N. produces standards and guidelines are discussed