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Biomedical subjects

J M Kinney

Publications and source records attributed to J M Kinney.

204 records · Page 12Linked to original sources
PubMedDate not supplied

Response to total parenteral nutrition in the extremely malnourished patient.

Changes in serum albumin levels and body weight are often used as indicators of the efficiency of a nutritional support regimen. Patients with moderate nutritional depletion demonstrate two distinct patterns of response during refeeding. The first is characterized by a decrease in the previously expanded extracellular fluid space with a rise in serum albumin and a loss of weight and the second by continued fluid retention with weight gain and no rise in serum albumin concentration. The second pattern has been observed in patients with ongoing stress such as infection. This study examines severely malnourished patients with no apparent inflammatory complications and demonstrates that this group responds to nutritional support in a pattern similar to that seen in the stressed patient. Eight patients with profound malnutrition were studied during the 1st week of nutritional support. Nitrogen balance was measured and the findings confirmed that all patients were anabolic. Sodium balances were used as an indicator of changes in the extracellular fluid compartment. Body weight and serum albumin were assessed daily. Body weight increased from 59 +/- 4 to 62 +/- 4% of normal (p less than 0.01) while serum albumin changed insignificantly (3.00 +/- 0.27 to 2.85 +/- 0.23 g/100 ml, NS) during the initial week of an adequate nutritional support regimen (nitrogen balance was +21.0 +/- 4.3 g, p less than 0.05). These changes were associated with a positive sodium balance (+215 +/- 20 mEq, p less than 0.05). These data confirm that some extremely malnourished patients do not experience a diuresis during the initial phase of nutritional support but rather may retain water and increase body weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Indirect calorimetry in malnutrition: nutritional assessment or therapeutic reference?

The measurement of gas exchange for use in indirect calorimetry is a clinical research tool struggling to find its proper place in the care of acutely ill and nutritionally depleted patients. Some investigators have proposed that it should be used as part of the nutritional assessment. Unfortunately, in common with many other measurements for nutritional assessment, the information provided must be integrated with other information. It is recognized that factors other than malnutrition may influence the level of the metabolic rate. Despite the lack of precision and specificity, the measurement of energy expenditure provides an important reference for determining patients' requirements for energy intake. As with many other procedures in clinical medicine, the more severely ill the patient, the less the accuracy of standard formulas for estimating energy expenditure. Thus, actual measurements of energy expenditure assume special value.

Body Constitution↗
PubMedDate not supplied

Hydrolysis of mixed lipid emulsions containing medium-chain and long-chain triacylglycerol with lipoprotein lipase in plasma-like medium.

We explored the effects of plasma-like conditions on hydrolysis of medium-chain triglyceride (MCT) and long-chain triglyceride (LCT) emulsions at different mixing ratios and the effect of the physical method of mixing on lipoprotein lipase hydrolysis of mixed emulsions in vitro. Mixed emulsions with two different mixing ratios, 50% MCTs with 50% LCTs and 70% MCTs with 30% LCTs by weight, were studied. Emulsions containing both MCT and LCT oils blended in the same emulsion particle were compared with mixtures of separate pure MCT emulsion particles and pure LCT particles. MCT hydrolysis was always greater than LCT hydrolysis. In a plasma-free tris(hydroxymethyl)aminomethane-albumin buffer at pH 8.5, the physical method of mixing had substantial effects on hydrolysis; blended emulsions of MCTs and LCTs were hydrolyzed better than separate mixes of pure MCT and pure LCT particles, ie, more total free fatty acids were released. In plasma-free systems, there were no differences in rates of hydrolysis of LCTs or MCTs (as individual triglycerides) between the two different mixing ratios of 50:50 and 70:30. However, the presence of plasma markedly diminished the differences in hydrolysis between blended vs separately mixed emulsions at pH 7.4. Also, in plasma-like incubation buffer, the rates of hydrolysis of MCTs and LCTs in emulsions with 50:50 or 70:30 MCT to LCT ratios reflected the respective amounts of MCT and LCTs in the emulsions.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood↗
PubMedDate not supplied

Metabolic consequences of hypercaloric glucose infusions.

Recent studies have demonstrated that an altered pattern of substrate mobilization and fuel utilization exists in patients who are acutely ill secondary to either injury or infection. These studies have important implications regarding the nutritional support of these patients. This review addresses some of the metabolic sequelae of total parenteral nutrition with hypertonic glucose as the primary source of non-protein calories. The consequences of administering glucose calories in excess of energy requirements are considered. The patterns of gas exchange, fuel utilization and fuel storage in nutritionally depleted and hypermetabolic patients are discussed with specific reference to fat metabolism. Administration of glucose in hypercaloric quantities may produce a respiratory as well as a metabolic stress. The former appears to be related to a ventilatory stimulus associated with an increased rate of carbon dioxide production. In acutely ill patients, this response is magnified and there is also a considerable rise in oxygen consumption and free norepinephrine excretion. It is this group of patients which shows the most profound elevation in minute ventilation. The metabolic pathways and regulatory mechanisms which may be involved are discussed. A scientific approach to substrate administration in acutely ill patients can be taken only after these patterns of metabolic responses have been fully elucidated.

Carbon Dioxide↗