Unidad de práctica para optar al título de Químico Farmacéutico / Autor no autoriza el acceso a texto completo de su documento / La administración de los nutrientes que cubren las necesidades proteicas de los pacientes que carecen de su tracto gastrointestinal funcional se realiza a través de la entrega de aminoácidos vía inyectable incluidos en las preparaciones de nutrición parenteral. El producto Aminoven® 15% corresponde a una solución acuosa estéril de aminoácidos con taurina para adultos, a la cual, de acuerdo a la normativa vigente, se le debe determinar el contenido. Las metodologías analíticas por HPLC disponibles para el análisis de aminoácidos requieren de un pretratamiento de la muestra, ante lo cual se escogió la derivatización de aminoácidos por medio de 6-Aminoquinolil-N-hidroxisuccinimidil carbamato (AQC), dado su fácil protocolo de derivatización como también la posibilidad de detectar los derivados resultantes en HPLC de fase reversa por fluorescencia y por ultravioleta (UV). Se determinó la concentración de trabajo de la muestra, la gradiente y el pH óptimo del método, como también la resolución de todos los peaks de aminoácidos y taurina presentes en la muestra en un sólo cromatograma tras modificar la metodología analítica original. Sin embargo, la completa implementación de la metodología no logró llevarse a cabo debido a la gran cantidad de aminoácidos presentes en la muestra y en muy diferentes concentraciones lo que obligó a invertir gran cantidad de tiempo en el ajuste de la metodología

The goal of Total Parenteral Nutrition (TPN) is to provide protein and non-protein energy in order to promote nitrogen retention and meet energy requirements. Controversy exists on whether glucose or lipid is the optimal source of non-protein energy. A randomized clinical trial was conducted for one week to compare the effects of TPN providing 34% of non-protein energy as lipid (Group 1; n = 7) to those of hypertonic glucose TPN (Group 2; n = 6). Indices of nitrogen retention, metabolic abnormalities, physiologic stress, and fat clearance were measured. The energy and protein intakes of Group 1 exceeded those of Group 2 from days 0 to 7 (p $<$ 0.05). Nitrogen balance improved significantly in both groups (p $<$ 0.005). Group 1 achieved zero nitrogen balance within two days; Group 2 never achieved net positive nitrogen balance. Significant elevations in insulin levels (p $<$ 0.025) were associated with both TPN admixtures. However, between the two groups the changes in nitrogen balance, albumin, glucose, fructosamine, insulin, liver enzymes, bilirubin, cortisol, and free fatty acid levels were not statistically different. It would appear that the lipid-carbohydrate TPN is more beneficial for patients who require TPN for a short period of time, but due to the small sample size and short study period further research is recommended.

No description available.

Parenteral nutrition is a therapy that supplies patients with all their nutritional requirements intravenously, thus eliminating the need for oral alimentation. The therapy was first introduced in the United States to hospitalized patients in the late 1960's. The benefit of long-term parenteral nutrition was soon recognized, and a program for ambulatory or home parenteral nutrition (HPN) was developed. In British Columbia, the first HPN patient was begun on such therapy in 1972. Since then, more than 50 British Columbians have received HPN. In March 1986, there were 24 patients on the program. The average annual cost per patient was $29,278 and the total 1986 operating budget was $702,660, not including costs for equipment or hospital training. Up to now, there has been no analytical assessment of the HPN program in B.C. This thesis describes the current home parenteral nutrition situation in B.C. and makes recommendations for its improvement. It looks at overall clinical outcomes (both physiological and psychosocial), at the results with different subgroups of the population, and at the cost of the HPN program in B.C., and also considers the potential of this therapy for children. In Chapter 2, the literature is reviewed and organized to cover a general description of HPN therapy, a summary of the results obtained from a number of academic centers, a review of HPN therapy in childhood and the psychosocial issues of concern to HPN patients. Chapter 3 provides a detailed description of the current HPN situation in B.C. The study methodology is described in Chapter 4 and the results in Chapter 5. The study is a descriptive analysis. Due to the lack of any obvious control group, a comparative evaluation per se was not possible. However, a Seattle study by Robb, reported in 1983, does allow for some comparison. The main sources of data were: 1. A Patient Questionnaire: The questionnaire was modelled on that used by the Seattle group. 23 B.C. patients, either on HPN at the time of questioning, or previously on the therapy, were surveyed. 19 (83%) responded. 2. A Health Professional Questionnaire: This questionnaire was compiled especially for and sent to all known health care workers in B.C. in the HPN field. 19 professionals, including physicians, nurses, pharmacists, dieticians, and administrators, were surveyed. 17 responded for a response rate of 89%. The patient survey provided basic demographic information, a description of HPN therapy received, as well as data on clinical outcomes, both physiological and psychosocial. Results showed that patient age, length of time on HPN, numbers of hours per week devoted to HPN, occupation and place of residence were the most important variables for predicting patient outcomes. Thus, patients that were older, had been on HPN less than one year, or spent more than 80 hours per week preparing and administering HPN solutions, had more physiological complaints and showed interference with more daily activities and personal relationships. Patients who were employed, rated the HPN experience more positively. Overall, patients found the HPN experience to be a positive one, although this was not true for a small group of patients. Data also indicated that B.C. patients achieved physiological results similar to the Seattle group, and to other centers reported in the literature, but appeared to have more interference with daily activities and personal relationships than did patients from the Seattle study. The health professional survey indicated that professionals considered the current situation in B.C. to be good with respect to patient training and the complication rate achieved. However, patient follow-up and the psychosocial support provided to patients were rated only fair to poor. These health care professionals cited problems with the program's organization, the need to standardize service to all patients, and the need to provide patients with pre-mixed solutions. In conclusion, some recommendations are made for improvement in the B.C. HPN program. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

No description available.

No description available.

En el Hospital Edgardo Rebagliati Martins, el aporte de lípidos en la Nutrición Parenteral Total (NPT), viene dándose por ácidos grasos de cadena larga. En el presente estudio se compararon los niveles plasmáticos de carnitina de pacientes que reciben NPT basada en TCL y los que reciben NPT basada en TCL/TCM por tiempo prolongado (≥7 días). Previamente se determinaron los niveles plasmáticos de carnitina en personas aparentemente sanas, pacientes con desnutrición severa y pacientes que reciben NPT por más de 20 días. Al final del estudio se hallaron los siguientes valores medios de carnitina plasmática, expresadas en µmol/L: personas aparentemente sanas 34,26; que se halla dentro de los valores normales, en pacientes con desnutrición severa 68,29; pacientes con NPT por más de 20 días 23,64; pacientes con NPT basada en TCL (≥7 días) 43,27; pacientes con NPT basada en TCL/ TCM (≥7 días) 26,68; hallándose sólo diferencia significativa al comparar los grupos que reciben NPT basada TCL y los que reciben NPT basada en TCL/TCM (≥7 días), p meno a 0.05. Palabras Clave: Carnitina, Ácidos grasos, Nutrición parenteral Total, Lípidos. / -- At the Edgardo Rebagliati Martins Hospital, the contribution of the lipids in Total Parenteral Nutrition (TPN) is given by long chain fatty acids (LCT). This study compared the plasma levels of carnitine in patients receiving TPN based on LCT and patients receiving TPN -based LCT/MCT (≥ 7 days). Previously, had been determinated the plasmatics levels of carnitine in apparently healthy people, severe malnutrition patients and patients receiving TPN for more than 20 days. At the end of this study, we found the next plasmatics carnitine medium values, showed in µmol/L: apparently healthy people 34,26; this is within the normal values, in severe malnutrition patients 68,29; and patients receiving TPN for more than 20 days 23,64; patients with TPN based on LCT (≥ 7 days) 43,27; patients with TPN based LCT/MCT (≥ 7 days) 26,68; We met only significant difference when comparing groups receiving TPN based LCT and patients receiving TPN-based TCM / TCL (≥ 7 days), p menor a 0.05. Key Words: Carnitine, Fatty acids, Total Parenteral Nutrition, Lipids.

Determina la potencia de la insulina cristalina (IC) disponible en las mezclas de Nutrición Parenteral Total (NPT) 2 en 1 y 3 en 1 previa a su administración, en dos marcas; comercial y genérica, frente a un estándar de referencia en iguales condiciones. Utiliza un modelo experimental mediante un diseño cruzado, aleatorizado, comparando los efectos producidos por la IC frente a los producidos por el estándar de referencia en ratones normoglicemicos. Los resultados muestran que en condiciones experimentales, la potencia en las mezclas de NPT 2 en 1 es para la IC comercial 100.7% (IC 95% = 89.1; 114.0); para la IC genérica 97.0% (IC 95% = 79.0; 119.2) y en las mezclas de NPT 3 en 1 es para la IC comercial 99.2%(IC 95% = 87.40; 112.7) y para la IC genérica 101.5% (IC 95% = 86.2; 119.5). El estudio aporta evidencia a favor que la IC disponible en las mezclas de NPT 2:1 y 3:1 mantiene su potencia dentro de los límites establecidos por la monografía oficial vigente USP previa a su administración, así como no se muestra una diferencia significativa en las dos marcas; comercial y genérica en las mezclas de NPT referidas. El estudio, asimismo, constituye una referencia para las unidades o servicios especializados de terapia nutricional y metabólica.

Es un documento que contiene las prácticas del curso Soporte Nutricional: Enteral y Parenteral (NU96), que corresponde al ciclo 2014-1.Desarrolla la competencia de Nutricionista Clínico.

Aluminum is a known contaminant of parenteral nutrition (PN) solutions and it has been suspected to play a role in the development of parenteral nutrition associated cholestasis (PNAC). The primary purpose of my research was to monitor the relationship between serum aluminum level and the development of PNAC in the infants with gastrointestinal failure who required PN therapy. The secondary purpose was to develop a neonatal piglet model to compare different doses of aluminum or PN therapy with known aluminum level was associated with the development of PNAC. Sixteen infants with gastrointestinal pathology were enrolled in the study. Serum aluminum and bilirubin (direct and indirect) concentrations were determined on day 0, 7, 14, and 21 of PN therapy. Five of sixteen (31.3%) infants developed PNAC by day 21. Serum aluminum levels in infants receiving PN peaked at day 7 of therapy and declined thereafter. There was no direct correlation between serum direct bilirubin and serum aluminum levels. Twenty-four piglets, 2 to 4 days old, were placed into four groups: Control group (n=5); Low Al (aluminum) group (n=7), intravenous (iv) injection with aluminum dose at 20 ìgkg-1day-1; High Al (aluminum) group (n=6), iv with aluminum dose at 1500 ìgkg-1day-1; PN (parenteral nutrition) group (n=6), PN solutions with a mean aluminum intake at 37.8±14.3 ìgkg-1day-1. The experiment period was 21 days. Serum bilirubin was significantly (p<0.05) elevated in the High Al and PN groups. Liver aluminum concentration was significantly (p<0.05) elevated in all the experimental groups and the relationship was dose dependant. Serum, and urine concentrations of aluminum were significantly (p<0.05) elevated in High Al but not the Low Al and PN groups. Serum aluminum concentration was not correlated with serum total bilirubin levels. Cholestasis developed by 21 days in five infants and in the piglets of two experimental groups (the High Al group and the PN group). High dose injection of aluminum may play a role in the development of PNAC in the neonatal piglets. The impact of aluminum may depend on the amount of pareternal aluminum intake and the presence of other potential factors such as lack of enternal feeding and individual physiological abilities.