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Biomedical subjects

M Lindholm

Publications and source records attributed to M Lindholm.

35 records · Page 2Linked to original sources
PubMed1986

Intralipid disappearance in critically ill patients.

Intralipid elimination patterns were compared in 25 healthy controls, 12 patients recovering from uncomplicated cholecystectomy, and 25 critically ill patients. The intravenous fat tolerance test revealed a similar fractional removal rate (k2) in healthy controls and critically ill patients, but k2 was increased in cholecystectomy patients. The concentration of cross-reactive protein (CRP) correlated positively to the concentration of total triglyceride and low-density lipoprotein-triglyceride, and negatively to low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol. The extrapolated zero-time concentration of Intralipid in the critically ill patients was only one-third of the value in healthy controls. After this initial loss, however, Intralipid was removed from the circulation after first-order kinetics. These low concentrations of Intralipid were not correlated with concentrations of CRP. Possible explanations for this phenomenon include a change in the configuration of the lipid particles, the so-called creaming phenomenon, and/or immediate and substantial uptake of the emulsion by certain organs.

Acute Disease↗
PubMed1985

Agglutinate formation in serum samples mixed with intravenous fat emulsions.

The degree of fat agglutination (the so-called "creaming phenomenon") was measured in sera from 51 critically ill patients, 200 ambulatory patients and 24 healthy volunteers. A 400-microliter serum sample was mixed with 10 microliter of a fat emulsion (Intralipid), incubated at 37 degrees C, and examined after 2, 6, and 24 h. Almost all samples from critically ill patients exhibited creaming, as did 31% of the samples from ambulatory patients. Serum samples from healthy volunteers were incubated with purified C-reactive protein (CRP). At a CRP concentration of 40 mg/L, creaming was always observed. Creaming also occurred at normal serum levels of CRP, but at increased concentrations of other serum proteins. Finally, the creaming test was performed with 12 different fat emulsions, mixed with sera from critically ill and healthy subjects. Healthy sera produced no creaming and sera from critically ill patients invariably showed creaming with every emulsion.

Agglutination↗
PubMed1985

Phosphate supplementation in parenteral nutrition.

Pronounced serum phosphate deficiency has been shown to be deleterious when starting parenteral nutrition in severely malnourished patients. The consequences of phosphate deficiency and the need for phosphate supplementation in critically ill patients are not well known. Thirty ICU patients randomized into two groups were studied. The patients received complete parenteral nutrition with and without addition of extra phosphate. The low phosphate group got 7.5 mmol phosphate (from the phospholipids in the fat emulsion) and the high phosphate group got 60-80 mmol phosphate/day. There were no significant differences in serum phosphate or calcium levels between the groups. In the high phosphate group the phosphate balance was positive and calcium balance zero while in the low phosphate group both phosphate and calcium balances were negative. The phosphate content in a standard nutrition programme is not sufficient to create a positive phosphate balance. With the addition of 80 mmol phosphate/day a positive balance was achieved. It is hard to establish guidelines for the administration of phosphate in ICU patients. 20-40 mmol may normally be satisfactory but we have shown that ICU patients may need and can tolerate up to 80 mmol/day.

Adult↗
PubMed1984

Plasma catecholamine and free fatty acid levels during infusion of lipid emulsion in critically ill patients.

The fractional elimination rate of exogenous fat, and fat-mobilizing lipolysis in relation to plasma catecholamine (CA) levels were studied in seven ventilator-treated ICU patients. Blood levels of CA, triglycerides, cholesterol and free fatty acids (FFA) were also analyzed before and during constant infusion of a soybean oil emulsion (Intralipid). Triglyceride concentrations rose significantly during the infusion. FFA levels also increased significantly within 30 min after the infusion was begun, reflecting fatty acids derived from Intralipid triglycerides. Plasma norepinephrine levels showed large interindividual variations and were inversely related to FFA concentrations. No correlation was found between plasma CA levels and the fractional removal rate of fat. These data suggest a deficiency of substrate in these critically ill patients.

Adult↗
PubMed1983

Interrelations between lipoprotein and the elimination of exogenous triglycerides from the circulation in intensive care patients.

The interrelations between the fractional turnover rate (k2) of exogenous triglycerides from the circulation and the serum lipoproteins have been studied in 34 intensive care patients who were classified into two groups depending on the severity of the clinical condition. Group I included 13 patients in relatively good clinical condition after elective surgery and Group II consisted of 21 critically ill patients. The k2 values were increased in Group I while Group II patients had K2 values similar to healthy male controls. Low concentrations of total serum TG, VLDL-TG and total serum cholesterol were found in Group I and LDL-TG was raised more than threefold and HDL cholesterol decreased by over 50 percent in Group II. In both groups the cholesterol/TG ratio in VLDL was higher than that of the controls. The negative correlations between K2, total serum TG and VLDL-TG in controls were also found in Group I. In contrast to the control group a positive correlation between K2 and the cholesterol/TG ratio in VLDL was found in Group I, whereas the only correlations found in Group II were between K2 and the concentration of both total serum cholesterol and LDL cholesterol. There was no correlation with HDL lipids in any of the groups. Qualitative changes in the lipoprotein composition and altered characteristics in the tissues which remove Intralipid particles from the circulation may be responsible for many of the changes observed.

Journal Article↗
PubMed1982

Rate of elimination of the intralipid fat emulsion from the circulation in ICU patients.

The rate of removal of Intralipid was studied in 2 groups of intensive care patients by analysis of the fractional removal rate after a single iv dose and by analysis of the removal rate during a constant infusion of Intralipid which immediately followed. The patients in group I were moderately ill after uncomplicated surgery whereas group 2 patients were critically ill and had a mortality of 44%. The fractional removal rate was 2-fold greater in group 1 than group 2 and controls; the 2 latter groups had similar rates of removal. During the constant infusion of Intralipid, 0.42 g/min for 3 h, group 1 patients were found to have a first order removal rate with a constant plasma concentration of Intralipid. The rate constants were not different during the entire infusion from those obtained by the single injection. In all of the group 2 patients, a zero order removal rate was present as the concentration of Intralipid particles increased linearly with time. Group 2 patients had cleared all Intralipid within 6 h after the end of the infusion. Some patients were treated with heparin and/or insulin for clinical reasons. The removal rates were not influenced in either group by these drugs. Thus, moderately traumatized patients were found to clear plasma from Intralipid at recommended infusion rates. However, in critically ill patients, the infusion rate of Intralipid may have to be adjusted below the maximal elimination capacity to avoid Intralipid accumulation in plasma.

Adolescent↗
PubMed1981

Lipid infusion in critically ill patients. Acute effects on hemodynamics and pulmonary gas exchange.

Hemodynamics, pulmonary diffusing capacity (DLCO) blood gases, oxygen consumption (VO2) and carbon dioxide excretion (VCO2) were studied in healthy volunteers and ventilator-treated, critically ill patients before and during infusion of lipid emulsion for 4 h. Triglyceride levels rose from 1.0 mmole/L to 8.5 mmole/L in the volunteers and from 1.4 mmole/L to 6.3 mmole/L in the patients after h. No adverse effects on cardiovascular performance were observed. Increases in VO2, and VCO2 and cardiac output were found in both groups, while RQ remained constant. No changes in DLCO and blood gases occurred.

Adolescent↗
PubMed1981

Hemodynamic effects of hyperosmolal glucose infusion in the critically ill patient.

A 30% glucose solution was infused for 4 h at a rate of 1.53 ml . kg-1, corresponding to 10 g . kg-1 . 24 h-1 in 8 critically ill patients requiring parenteral nutrition. The osmotic load resulted in an expanded blood volume due to hemodilution. Stroke volume (SV) increased, while peripheral vascular resistance (PVR) and pulmonary capillary wedge pressure (WP) decreased. Otherwise, no major effects on the circulation were observed. Thus, during these experimental conditions, the heart seems to cope very well with the increased osmotic load.

Adolescent↗
PubMed1977

A comparison between the influence of halothane or fentanyl and droperidol anaesthesia on the adrenergic receptor response in human adipose tissue in vitro.

A comparison was made between the adrenergic receptor response in vitro in human adipose tissue obtained under halothane and neuroleptanaesthesia. In both groups the net release of glycerol was significantly stimulated (P less than 0.01) by the combined alpha- and beta-adrenergic agonist, 1-noradrenaline. In the halothane group, the lipolysis was further increased by the addition of phentolamine (an alpha-adrenergic blocking agent). No such effect could be demonstrated in specimens from the fentanyl/droperidol group. This difference in response was most probably explained by the fact that droperidol had quite a long-lasting alpha-adrenergic blocking property, which totally obliterated the effect of another alpha-adrenergic blocking agent. The findings stress the importance of using a standardized procedure, including the choice of anaesthetic agents, when human adipose tissue is sampled for metabolic studies in vitro. The results also indicate the possibility of a difference in metabolic effects in vivo between the two procedures.

Adipose Tissue↗
PubMedDate not supplied

Pronounced dyslipoproteinemia in intensive care patients.

Concentrations of triglycerides (TG) and cholesterol in serum and in lipoproteins were determined in two groups of intensive care patients. Group I included 17 moderately ill, postelective surgery patients, and group II, 23 critically ill patients. All were studied in an intensive care situation. The lipoprotein lipid concentrations were compared with those from a group of healthy men and women. In group I, both TG and cholesterol concentrations in serum were decreased, whereas in group II, only cholesterol concentration was lowered and the TG concentration was close to control values. In the lipoproteins, marked abnormalities were found. The most striking was an increase in low density lipoprotein (LDL)-TG and a decrease in high density lipoprotein (HDL)-cholesterol concentrations. In group II, 5/18 males had a LDL-TG concentration above any control value and 21/23 had a HDL-cholesterol concentration below any value in the control group. In addition, the alpha-lipoprotein (HDL) band on electrophoresis was often grossly abnormal with a broad or double-peaked band. There was a highly significant negative correlation between LDL-TG and HDL-cholesterol concentrations. Patients who received conventional treatment with insulin or heparin had similar lipid concentrations as those not given these drugs. The time effect on lipoprotein changes was analyzed in 11 patients, from whom samples were drawn repeatedly during the intensive care period. A tendency was found for LDL-TG to increase and HDL-cholesterol to decrease with time. The mechanisms causing the lipoprotein changes are not presently known; however, possible explanations include liver function impairment, gastrointestinal tract paralysis, physical inactivity, the catabolic state as such, and combinations.

Adult↗
PubMedDate not supplied

Time course for the changes of serum lipoproteins and apolipoprotein T concentrations after major surgical trauma in man.

Trauma induces changes in the serum lipoprotein pattern in man. A characteristic apolipoprotein, named apolipoprotein T existing in its isoforms T-I to T-IV, in the high density lipoprotein (HDL) fraction of serum, also appears in response to trauma. In this report eight patients operated on for abdominal aortic aneurysms were studied concerning the time dependency in changes of serum lipoproteins and the appearance of apolipoprotein T. Blood samples for lipoprotein analysis were taken preoperatively, postoperatively on days 1, 2, 4, 6 and thereafter twice a week until discharge from the hospital. The serum lipoprotein concentrations were compared with those from a group of healthy men. The most striking abnormalities were found in serum VLDL where both concentrations of triglycerides and cholesterol decreased during the first 2 days by more than 50%, compared to the initial level, and remained low for about 1 week. Also the concentration of LDL cholesterol in serum decreased about 40% from the preoperative value during the first days. Serum HDL cholesterol either increased during the first 2 days in those patients with a low preoperative concentration or stayed on a subnormal level during the first 4 days. After day 4 the serum HDL cholesterol decreased and reached the minimum level on days 10 to 13. Already on day 1 after trauma apolipoprotein T had reached a high level in order to stay high for several weeks. The apolipoprotein T isoforms had different appearance with time and varied independently of serum cholesterol in HDL.

Aged↗