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High lipid : low dextrose (HL:LD) parenteral admixture (PA) is high in polyunsaturated fatty acids (PUFA) that are sensitive to peroxidation. This study evaluated the antioxidative effect of vitamin E in both HL:LD PA and in obese cats given HL:LD PA. Natural d-α-tocopherol (Vital E-300) was added to HL:LD PA at seven concentrations (8, 12, 16, 24, 32, 48, or 64 IU/g of lipid). PA were exposed to fluorescent light for 24 hours at room temperature. Hydroperoxides were measured at baseline and 24 hours hang time. Significantly lower hydroperoxide concentrations were found with > 24 IU/g of lipid at baseline (P < 0.01). A higher d-α-tocopherol concentration was required (> 48 IU/g lipid) to lower hydroperoxides at 24 hours (P < 0.0001). HL:LD PA with 40 IU/g lipid/day d-α-tocopherol was delivered intravenously to obese cats (PA Toc⁺) over 48 hours. Control cats (PA Toc⁻) received HL:LD PA without a d-α-tocopherol supplementation. Oxidative status of cats was evaluated at baseline and 24, 48, and 96 hours. Cats in both groups exhibited an increase in MDA concentration (time effect; P < 0.0001). WBC-tGSH and WBC-GPx did not change in either group of cats. RBC-tGSH and RBC-GPx changed over time (time effects; P = 0.0005; P = 0.0016, respectively) with the PA Toc⁺ cats exhibiting a higher RBC-tGSH concentration (treatment x time interaction; P = 0.012). Serum α- and γ-tocopherol concentrations increased in PA Toc⁺ cats (treatment effect; P < 0.0001). These findings suggest that d-α-tocopherol significantly alters oxidative status in vivo. / Master of Science

A hiperlipemia causa sérias complicações aos equinos hospitalizados, principalmente quando associada ao estresse, doenças e traumas. Tratamentos convencionais com soluções de heparina, glicose a 5%, insulina, entre outras, têm sido utilizados em equídeos predispostos, mas são questionados quanto ao seu real efeito. O interesse e as pesquisas em relação à utilização da nutrição clínica no equino, em especial a nutrição parenteral, vêm crescendo. Sua ação visa evitar a doença e o catabolismo através da regulação do balanço energético negativo, inclusive servindo de adjuvante às terapias já implementadas no tratamento da doença primária, fornecendo o requerimento básico nutricional para a manutenção e recuperação do organismo. Para avaliar a eficácia das soluções de nutrição parenteral em equinos que desenvolveram hiperlipidemia durante a internação, foram avaliados 14 equinos atendidos com afecções diversas e que apresentaram triglicérides séricos (TG) acima de 150mg/dl. Os mesmo foram divididos em dois grupos: grupo controle (G1), sem interferência do manejo e grupo tratamento (G2), que recebeu nutrição parenteral parcial sem lipídeos. Tais soluções eram compostas de glicose a 50%, aminoácido a 10%, oligoelementos, complexo vitamínico e eletrólitos e foram infundidas até a resolução da hiperlipidemia. Os animais dos dois grupos foram monitorados diariamente em relação aos valores de glicemia, triglicérides e colesterol. A média do tempo de redução dos TG no G1 foi de 209,2 ± 131,9 horas e no G2 foi de 34,9 ± 41,8 horas, com diferença estatística entre eles. Os valores de colesterol não acompanharam a elevação dos TG. Em relação à perda de peso e escore corporal, os dois grupos apresentaram redução durante a internação, sem diferença estatística entre eles. Nenhum animal do G2 desenvolveu hiperlipemia, ao contrário do G1, em que cinco equinos apresentaram, em algum momento da internação, triglicérides acima de 500mg/dl. Embora outros critérios devam ser utilizados na escolha dos pacientes que necessitam deste tipo de tratamento devido principalmente aos custos e necessidade de constante monitorização, conclui-se que a nutrição parenteral é um método rápido e seguro para a prevenção da hiperlipemia em equinos com hiperlipidemia durante a internação por outras enfermidades. / The hyperlipemia cause serious complications for hospitalized horses, especially when associated with stress, diseases and traumas. Conventional treatments with solutions of heparin, 5% glucose, insulin, among others, have been used in susceptible equine, but they are asked about their real purpose. The interest and research on the use of clinical nutrition in the horse, especially parenteral nutrition, growing. Its action is to avoid disease and catabolism by regulating the negative energy balance, including serving as adjuvant therapies have been implemented in the treatment of primary disease, providing the basic nutritional requirement for the maintenance and recovery of the body. To evaluate the effectiveness of parenteral nutrition solutions in horses that developed hyperlipidemia during hospitalization were evaluated 14 horses treated for various diseases and who had serum triglycerides (TG) above 150mg/dl. The same were divided into two groups: control group (G1), without interference from management and treatment group (G2), which received partial parenteral nutrition without lipids. Such solutions were composed of 50% glucose, 10% amino acid, trace elements, electrolytes and vitamin and were infused until resolution of hyperlipidemia. The animals of both groups were monitored daily in relation to blood glucose, triglycerides and cholesterol. The median reduction in TG G1 was 209.2 ± 131.9 hours and G2 was 34.9 ± 41.8 hours, with no statistical difference between them. Cholesterol values did not follow the elevation of TG. In relation to weight loss and body score, both groups decreased during hospitalization, with no statistical difference between them. No animals developed hyperlipidemia G2, unlike the G1, in which five horses had, at some time in hospital, triglycerides greater than 500mg/dl. Although other criteria should be used to select patients in need of such treatment primarily due to cost and the need for constant monitoring, it is concluded that parenteral nutrition is a rapid and reliable method for the prevention of hyperlipemia with hyperlipidemia in horses during the hospitalization for other diseases.

Publicación a texto completo no autorizada por el autor / El estudio realizado en la Unidad de Cuidados Críticos de Neonatología del Hospital Nacional Guillermo Almenara Irigoyen tuvo como objetivo evaluar las prescripciones de nutrición parenteral total, con el fin de conocer si cumplen con las recomendaciones establecidas por las guías ASPEN y ESPEN/ESPGHAN. Se evaluaron las prescripciones de pacientes neonatos que recibieron NPT de enero del 2015 a mayo del 2017. Se identificaron los diagnósticos frecuentes, se comparó el aporte calórico, los rangos mínimos y máximos de los macronutrientes: proteínas, carbohidratos y lípidos, y micronutrientes: sodio y potasio, con las recomendaciones de las guías. Se evaluaron 142 prescripciones para el 2015, 76 para el 2016 y 75 para el 2017 (enero-mayo). Los diagnósticos más frecuentes fueron SDR 30,3%, MBPN 27,6% y 25,3% para el 2015, 2016 y 2017 respectivamente. El aporte calórico incumple las recomendaciones de las guías en más de la mitad de las prescripciones en los tres años. El aporte de los macronutrientes y micronutrientes de la mayoría de las prescripciones cumplen las recomendaciones de las guías, sin embargo se presentan incumplimientos relevantes (mayor a 50%) en los aminoácidos de los RNT según ambas guías, en los lípidos de los RNPT y RNT según ASPEN, y en el sodio de los RNPT y RNT según ESPEN/ESPGHAN. Las prescripciones de NPT cumplen las recomendaciones de las guías ASPEN y ESPEN/ESPGHAN, sin embargo se evidencian aspectos importantes a mejorar, tales como el aporte de calorías, aminoácidos y sodio, a fin de asegurar el cumplimiento que establecen las guías. / Tesis

Uma solução de glicerofosfato de sódio, estéril e apirogênica para administração intravenosa, não disponível comercialmente no Brasil, foi desenvolvida e adicionada às nutrições parenterais padronizadas no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, com o objetivo de fornecer fósforo juntamente com o cálcio. Essas nutrições parenterais foram preparadas adicionando-se 4 mmol/dL de fósforo e 3,712 mmol/dL de cálcio, utilizando-se como fonte as soluções de glicerofosfato de sódio a 1 mmol/mL e gluconato de cálcio a 10%(p/v), respectivamente, e mantidas à temperatura de 5±3ºC por 0, 6, 12 e 24 horas, seguidas de 24 horas à temperatura ambiente (24±3ºC) e posteriormente avaliadas microscopicamente, quando preparadas com emulsão lipídica, com aumento de 400 vezes, e macroscopicamente após centrifugação a 6390 g. As preparações sem emulsão lipídica foram avaliadas macroscopicamente nas mesmas condições e também após a manutenção em temperaturas de 5±3ºC, 24±3ºC e 37°C, durante 96 horas. Em nenhuma formulação, contendo ou não emulsão lipídica, foi verificada a presença do precipitado de fosfato de cálcio. Conclusão: O glicerofosfato de sódio, quando adicionado às nutrições parenterais juntamente com o gluconato de cálcio em quantidades e nas condições avaliadas, não apresentou incompatibilidade in vitro. / A sterile and apyrogenic sodium glycerophosphate solution for intravenous administration, not commercially available in Brazil, was developed and added to standard parenteral nutrition formulations used at the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, in order to supply phosphorus together with calcium. These parenteral nutrition formulations were prepared by adding 4 mmol/dL phosphorus and 3.712 mmol/dL calcium using as sources solutions of 1 mmol/mL glycerophosphate and 10% calcium gluconate (w/v) and kept at a temperature (5 + 3oC) for 0, 6, 12 and 24 hours, followed by 24 hours at room temperature of 24 + 3oC. The formulations were then evaluated microscopically, at 400 X magnification, when prepared with a lipid emulsion, and macroscopically after centrifugation at 6390 g. The preparations without a lipid emulsion were evaluated macroscopically under the same conditions and also after being kept at temperatures of 5 + 3oC, 24 + 3oC and 37oC for 96 hours. No calcium phosphate precipitates were observed in any formulation containing or not a lipid emulsion. We conclude that sodium glycerophosphate, when added to parenteral nutrition formulations together with calcium gluconate in the amounts and under the conditions tested here did not present in vitro incompatibility.

Bakgrund: Behandling med parenteral nutrition innebär att näringsbehovet tillgodoses utan förtäring av föda. Behandlingen ses av anhöriga som livsavgörande och av sjuksköterskor som avancerad och resurskrävande. Syfte: Att beskriva patienters upplevelser av sin livssituation i samband med parenteral nutritionsbehandling i hemmet. Metod: En systematisk litteraturstudie med kvalitativ ansats och beskrivande syntes, där tio artiklar analyserades. Resultat: Analysen resulterade i två teman och fem subteman. De teman som framkom i resultatet var Att uppleva förändringar i vardagen och Att hantera den nya vardagen. Patienterna upplevde fysiska och sociala begränsningar samt att de var i behov av stöd från anhöriga och sjukvården. De upplevde även en oro och rädsla för komplikationer. Trots detta var patienterna tacksamma till behandlingen då den medförde en större frihet och kontroll. Slutsats: Behandling med parenteral nutrition i hemmet medför förändringar i det dagliga livet. Det innebär både möjligheter och begränsningar där patienterna uttrycker ökat behov av stöd inom flera områden. Därmed är det av betydelse för sjuksköterskor att skapa en ökad förståelse om hur patienterna upplever sin livssituation för att kunna erbjuda god omvårdnad. / Background: Treatment with parenteral nutrition means that the nutritional need is satisfied without eating. The treatment is viewed upon by relatives as life-saving and by nurses as advanced and demanding. Aim: To describe patients ́ experiences of their life situation in association with home parenteral nutrition. Method: A qualitative systematic literature study with descriptive approach, where ten articles were analyzed. Results: The analysis resulted in two themes and five subthemes. The themes that emerged was To experience changes in the daily life and To handle the new daily life. The patients experienced that they were physically and socially restricted and in need of support from relatives and healthcare. They also experienced anxiety and fear of complications. The patients were grateful despite all of this because the treatment offered them more freedom and control. Conclusion: Treatment with home parenteral nutrition resulted in changes in their everyday life. This brings possibilities and restrictions where the patients expressed an increase of support in many different areas. It is therefore important for nurses to increase their knowledge of how the patients perceive their life situation to be able to offer better care.

Thesis (M.S.)--University of Michigan, 1986.

Thesis (doctoral)--Ludwig-Maximilians Universität zu München, 1994. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1986.

Thesis (M.S.)--University of Michigan, 1986.