Bakgrund: Tidigare forskning har visat att parenteral nutrition ges till patienter som befinner sig i livets slutskede även om den medicinska nyttan är oklar. Syfte: Att genom en vetenskaplig litteraturöversikt beskriva sjuksköterskors erfarenheter av vad som är betydelsefullt i arbetet med parenteral nutrition för patienter i livets slutskede. Metod: Examensarbetet är utformat som en litteraturöversikt. Tretton artiklar med kvalitativ och kvantitativ design valdes ut. Artiklarna söktes på databaserna CINAHL och Pubmed Resultat: Delaktighet i vårdteam var av stor betydelse, ett fungerade samarbete där sjuksköterskan ville och fick möjlighet att arbeta som omvårdnadsansvarig upplevdes av sjuksköterskan resultera i god personcentrerad vård. Erfarenhet och egna känslor spelar en betydande roll i hur mycket sjuksköterskan vågar och vill vara delaktig i beslut angående PN i livets slutskede, och vilken relation som skapas med patientens närstående. Slutsats: Ökad kunskap om parenteral nutrition i livets slutskede och personcentrerad vård behövs för att sjuksköterskorna ska våga vara aktivt delaktig och stärka patienten i livets slutskede. / Background: Previous research shows that parenteral nutrition is administered to patients who are at the end of life, even though the medical benefit is unclear. Aim: Through a scientific literature review describe nurses' experiences of what is important in the work of parenteral nutrition for patients in the end of life. Method: A literature review, based on 13 articles with both qualitative and quantitative design. The articles were searched on databases CINAHL and PubMed Result: Participation in care team was of great importance, a working partnership where the nurse wanted and had the opportunity to work as a care manager experienced by nurse’s result in good person-centered care. Experience and own emotions play a significant role in how much the nurse dare and want to be involved in decisions regarding PN at the end of life , and the relationship that is created with the patient's relatives. Conclusion: Increased knowledge of parenteral nutrition in palliative care and person-centered care needed for nurses to dare to be actively involved and to strengthen the patient in the final stages of life.

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.

Submitted by (edna.saturno@ufrpe.br) on 2016-11-03T13:33:50Z No. of bitstreams: 1 Rosangela Maria Nunes Da Silva.pdf: 985135 bytes, checksum: 202f5add90240bc25bb5337368194719 (MD5) / Made available in DSpace on 2016-11-03T13:33:50Z (GMT). No. of bitstreams: 1 Rosangela Maria Nunes Da Silva.pdf: 985135 bytes, checksum: 202f5add90240bc25bb5337368194719 (MD5) Previous issue date: 2010-02-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This research aimed to evaluate the influence of Vitamin E administered by intramuscular injection (IM), on hematological, biochemical, physiological and electrocardiographic parameters of young goats at the dry period (DP), and at the rainy period (RP), in semiarid of Paraiba. For this were used, for each period, 12 crossbred males, at the age of 60 ± 12 days, and mean weight of 12 ± 2,5 kg, which were distributed into two groups (n=6), called Control Group (CG) and Treatment Group (TG).Animals of the CG had not received any kind of treatment, while the others of the TG received vitamin E (20mg/kg IW), once a week, during 112 days. During this time and for each period was realized in gaps of 14 days (M0, M1, M2,M3, M4, M5, M6, M7 and M8) blood cells analysis, biochemical dosages and evaluation of physiological and electrocardiographic parameters. The obtained data were compared by the t-test (p<0.05), and by the non-parametric Mann-Whitney test (p<0.05). At DP, for CG and TG, the statistical significance was demonstrate at 42 (M3), 98 (M7) and 56 days (M4) for red blood cells variables, with higher means for the no treated animals. There was no significant difference for the means related to white blood cells analysis. At RP it was observed that the Corpuscular Hemoglobin Mean Concentration (MCHC), at 28 days (M2), was statistically significant with the means of TG higher than the CG, while the count of Monocytes at 42 days (M3) and of Segmented Neutrophils at 56 days (M4) was significantly higher for CG. For biochemical parameters, at DP, there was not observed significant statistical variations. At RP, for CG and TG, the statistical significance was observed at 98 days (M7) for Globulins and Albumin:Globulin ratio, and at 28 days (M2) for Creatinine. At DP, for CG and TG, there was no significant difference for Body Temperature (BT) and Cardiac Frequency (CF), however at 28 days (M2) was observed statistical significance for Respiratory Frequency (RF), at 14 days (M1) for QRSms complex and at 84 days (M6) for RmV wave. At RP, for CG and TG, no statistical significance was verified for physiological parameters, however was showed significant difference for Pms wave at 70 (M5) and 98 days (M7) and for PRms gap at 84 days (M6). It was concluded that the doses, the way and the frequency ofadministration of vitamin E, purposed in this research, promote a increase for erythrocytes values, at DP; vitamin E suggests turn better the phagocytosis function of Neutrophils at RP; it exercises no influence on serum biochemistry at DP, however is efficient to maintain the normal concentration of Globulins and Albumin:Globulin ratio at RP; it can be used in young goats to improve the immunologic answers; it exercises no influence on physiological parameters, being these influenced by the environmental temperatures; vitamin E does not present effects on cardiac electrophysiology of young goats in semiarid. / Objetivou-se com esta pesquisa avaliar a influência da vitamina E administrada por via intramuscular (IM), sobre os parâmetros hematológicos, bioquímicos, fisiológicos e eletrocardiográficos de caprinos jovens nas épocas seca (ES) e chuvosa (EC), do semiárido paraibano. Foram utilizados, para cada época, 12 animais, machos, sem raça definida, com idade de 60 ± 12 dias e peso de 12 ± 2,5 kg, distribuídos em dois grupos (n=6), denominados Grupo Controle (GC) e Grupo Tratamento (GT). Aos animais do GC não foi administrado nenhum tipo de tratamento, enquanto no GT, administrou-se vitamina E (20 mg/kg IM), a cada sete dias, durante 112 dias. Durante este período e para cada época, realizou-se com intervalos de 14 dias (M0, M1, M2, M3, M4, M5, M6, M7 e M8) hemograma, dosagens bioquímicas e avaliações dos parâmetros fisiológicos e eletrocardiográficos. Os dados obtidos foram comparados pelo teste t de Student (p<0,05) e pelo teste não-paramétrico de Mann-Whitney (p<0,05). Na ES, nos GC e GT, a significância estatística foi demonstrada aos 42 (M3), 98 (M7) e 56 dias (M4) para as variáveis eritrocitárias, com médias superiores nos animais tratados. Não houve diferença significativa quanto às médias relativas ao leucograma. Na EC observou-se no hemograma que a Concentração de Hemoglobina Corpuscular Média (CHCM), aos 28 dias (M2), foi estatisticamente significativa com as médias do GT maior que as do GC, enquanto que a contagem dos Monócitos aos 42 dias (M3) e dos Neutrófilos segmentados aos 56 dias (M4) foram significativamente superiores no GC. Não foram verificadas variações estatisticamente significativas para as variáveis bioquímicas na ES, em nenhum momento. Na EC, nos GC e GT, a significância estatística foi observada aos 98 dias (M7) para as variáveis Globulinas e relação Albumina: Globulina, e aos 28 dias (M2) para a Creatinina. Na ES, nos GC e GT, não houve diferença significativa para a Temperatura Corporal (TC) e Frequência Cardíaca (FC), porém aos 28 dias (M2) observou-se significância estatística para as variáveis Frequência Respiratória (FR), aos 14 dias (M1) para o complexo QRSms e aos 84 dias (M6) para a onda RmV. Na EC, nos GC e GT, nenhuma significância estatística foi verificada com relação aos parâmetros fisiológicos, porém foi evidenciadodiferença significativa para a onda Pms aos 70 (M5) e 98 dias (M7) e intervalo PRms aos 84 dias (M6). Conclui-se que a dose, a via e a frequência de administração da vitamina E, propostos nesta pesquisa, promovem aumento dos valores eritrocitários, na ES; a vitamina E sugere melhorar as funções de fagocitose dos Neutrófilos na EC; ela não exerce influência sobre a bioquímica sérica na ES, porém é eficiente em manter as concentrações normais de Globulinas e a relação Albumina:Globulina na EC; pode ser usada em caprinos jovens para maximizar a resposta imune; ela não exerce influência sobre os parâmetros fisiológicos, sendo estes influenciados pela temperatura ambiental; a vitamina E não apresenta efeitos sobre a eletrofisiologia cardíaca de caprinos jovens no semiárido.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2017-03-31T14:29:05Z No. of bitstreams: 1 Deivid Nogueira Rafael.pdf: 793444 bytes, checksum: 5b5e4d5dc5b6a608b2bf1eb8da2900b8 (MD5) / Made available in DSpace on 2017-03-31T14:29:06Z (GMT). No. of bitstreams: 1 Deivid Nogueira Rafael.pdf: 793444 bytes, checksum: 5b5e4d5dc5b6a608b2bf1eb8da2900b8 (MD5) Previous issue date: 2017-12-08 / Errors involving medications are frequent in health care, causing preventable adverse events of different severities. In this case, prescriptions have great importance in this prevention when elaborated in a readable and complete form. Among the evolutions of the digital era in health care, one of them is the electronic prescription, which is the procedure where the prescriber elaborates the prescription using dedicated software and sends it by electronic means. The objective of this work was to analyze the evolution of the implantation of electronic prescription software in a compounding center, specialized in the preparation of parenteral nutrition. Qualitative exploratory and quantitative descriptive approaches were adopted in a single case study. In the qualitative approach, structured interviews were elaborated, based on theoretical assumptions, applied to the managers and the responsible for Software development. For the evaluation of the data and compilation of the results, a content analysis was used, grouping the questions by similarity and by creating categories. In the quantitative approach, a survey was made about the number of "deviations" in the period from 2006 to 2015, evaluating the impact of the implementation of electronic prescriptions and a comparison with the prescriptions sent by fax and e-mail. The obtained results indicated that the use of electronic prescription software and pharmacist care reduces considerably the number of deviations in prescriptions. The electronic prescription acts as an important tool to help the prescriber to reduce redoing prescriptions as well as possible errors of interpretation when compared to prescriptions sent manually by fax or e-mail. / Os erros envolvendo medicamentos são frequentes na área da saúde, causando eventos adversos preveníveis de diferentes gravidades. Nesse caso, as prescrições possuem grande importância nessa prevenção, quando elaboradas de forma completa e legível. Dentre as evoluções da era digital, na área da saúde, uma delas é a prescrição eletrônica que é o procedimento onde o prescritor elabora a prescrição utilizando um Software dedicado e o envia por meio eletrônico. O objetivo deste trabalho foi analisar a evolução da implantação de um Software de prescrição eletrônica em uma farmácia de manipulação especializada, Compounding Center, no preparo de nutrições parenterais. Foram adotadas abordagens qualitativa exploratória e quantitativa descritiva em um estudo de caso único. Na abordagem qualitativa foram realizadas entrevistas estruturadas, elaboradas a partir de um construto, baseado em pressupostos teóricos, aplicadas aos gestores e ao responsável pelo desenvolvimento do Software. Para a avaliação dos dados e compilação dos resultados foi utilizada a análise de conteúdo, agrupando as perguntas por semelhança e criando-se categorias. Na abordagem quantitativa foi realizado um levantamento do número de “desvios” no período de 2006 a 2015, avaliando o impacto da implantação da prescrição eletrônica e um comparativo com as prescrições enviadas via fax e e-mail. Os resultados obtidos indicaram que a utilização do Software de prescrição eletrônica e a atenção farmacêutica, reduziram consideravelmente a quantidade de desvios nas prescrições. A prescrição eletrônica atua como uma importante ferramenta no auxílio do prescritor reduzindo possíveis retrabalhos e possíveis erros de interpretação, se comparadas às prescrições enviadas manualmente via fax ou e-mail.

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.

The topic of the diploma thesis is micronutrients at home parenteral nutrition. In the theoretical part, parenteral nutrition is analyzed, including advantages and disadvantages, indications and contraindications. Intestinal failure is described as the most basic indication for the introduction of long-term / home parenteral nutrition. Following is the characterization and classification of micronutrients and a description of the consequences of their deficiency or surplus. Micronutrients are particularly important as cofactors and coenzymes in enzymatic reactions that would not be possible without them. The key question is whether the plasma levels show the actual state of the stock of the micronutrient in the organism, if the drop in most of the micronutrients that we find in patients reflects the actual deficiency to be substituted, or whether this decrease is an expression of their shift to other segments, the severity of the health condition. In the practical part of the diploma thesis are evaluated the levels of selected micronutrients (vitamin D, vitamin B12, folic acid, iron) in the group of patients with indication of home parenteral nutrition. The evaluation was based on laboratory analysis of patients' results. Key words: Parenteral nutrition, micronutrients, deficiency, surplus

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Se determinaron cuantitativamente los marcadores bioquímicos hepáticos: Transaminasa glutámica oxalacética (TGO), Transaminasa glutámico pirúvica (TGP), bilirrubina total (BT), bilirrubina directa (BD) y gamma glutamil transferasa (GGT) para evaluar los efectos de la nutrición parenteral en la función hepática de recién nacidos prematuros mayores de 27 semanas y menores de 37 semanas en la unidad de Neonatología del Hospital Nacional Edgardo Rebagliati Martins. Treinta recién nacidos pre término fueron evaluados antes de iniciar la nutrición parenteral (nivel basal =con NP1), a los 7±2 días de iniciada la nutrición parenteral (con NP2), al momento de la suspensión de la nutrición (sin NP1) y finalmente a los 7±2 días de suspendida la nutrición parenteral (sin NP2). En la evaluación del perfil hepático, se encontró los siguientes valores: TGO=28,63 UI; TGP= 7,37 UI; BT=9,03 UI; BD=0,845 UI; GGT= 110,41 U durante el periodo de administración de NP y los siguientes valores: TGO= 28,73 UI; TGP= 10,53 UI; BT= 6,36 UI; BD= 1,35 UI; GGT= 128,38 UI durante el periodo sin NP. Se encontró diferencias estadísticamente significativas para TGO, TGP y GGT entre los niveles basales versus los niveles a los 7±2días del periodo de administración de NP y diferencias significativas para TGP, BT, entre los niveles basales versus los niveles a los 7±2días del periodo sin NP. Cuando se comparó las medias de los marcadores hepáticos globales (con NP y sin NP) se encontró una diferencia estadísticamente significativa en TGP, BT y BD con una correlación de Pearson significativa sólo en BT y GGT. También se determinó la presencia de peróxidos en mezclas de nutrición parenteral encontrándose: 299,87; 155,11; 212,92 y 284,55 μmoles a las 0, 5,18 y 24 horas de la mezcla respectivamente, en mezclas de NP foto expuestas y 278,01; 142,28; 183,39 y 258,58 μmoles a las 0, 5, 18 y 24 horas respectivamente en mezclas de NP foto protegidas. Se encontraron diferencias estadísticamente significativas de peróxidos globales (NP foto expuesta y NP foto protegida) en los tiempos 0h-5h, 0h-18h, 5h-24h y 18-24h. No se encontraron diferencias estadísticamente significativas de peróxidos entre las mezclas de NP foto expuestas y foto protegidas. / -- We have done the cuantitative determinations of hepatic markers: Glutamic oxalacetic transaminase (GOT), Glutamic piruvic transaminase (GPT), total bilirrubin (TB), direct bilirrubin (DB) and Gamma glutamiltransferase (GGT) to evaluate the effect of parenteral nutrition in the hepatic function of preterm infants from 27 to 37 weeks in the Neonatology unit of Hospital Nacional Edgardo Rebagliati Martins. Thirty preterm infants were evaluated before parenteral nutrition started (baseline levels), in 7± 2 days from initiation of parenteral nutrition, on the day of suspension of parenteral nutrition 0± 2 days) and finally in the 7± 2 days of suspension of parenteral nutrition. Regarding the hepatic evaluation, we found the following hepatic markers values in the PN administration period: GOT= 23,63 UI; GPT= 7,37 UI; TB= 9,03 UI; DB= 0,845 UI; GGT= 110,41 UI and the following values in the period of absence of parenteral nutrition: GOT= 28,73 UI; GPT= 10,53 UI; TB= 6,36 UI; DB= 1,35 UI; GGT= 128,38 UI. There are significant differences for GOT, GPT and GGT when baseline levels are compared against values from 7±2 days during the PN administration period. There are significant differences for GPT, TB when we compared baseline levels versus levels at 7±2 days during the period of absence of PN. When we compared the different hepatic markers means globally, we found significant difference in GPT, TB, DB, with a Pearson`s correlation only in TB and GGT. We performed an extra research for this study. It was determined the presence of peroxides in parenteral nutrition mixtures. We found the following concentration means for peroxides in the photo exposed PN mixtures: 299,87; 155,11; 212,92; 284,55 μmol at 0,5,18 y 24 hours from the mixture, and the following concentration means for photo protected PN mixtures: 278,01; 142,28; 183,39; 258,58 μmol at 0, 5, 18 y 24 hours respectively. Significant differences regarding global peroxides (PN photo exposed and PN photo protected) were found in 0h-5h, 0h-18h, 5h-24h, 18-24h. We did not find significant differences of peroxides between PN photo exposed and PN photo protected mixtures. / Tesis

Desde el punto de vista nutricional es necesario conocer la concentración sérica de algunos minerales en niños, adultos, ancianos y para poder interpretar los resultados es imprescindible compararlos con valores de referencia, en diferentes grupos etéreos. Se tomaron 60 muestras de sangre, 30 muestras de pacientes hospitalizados y 30 muestras de pacientes como grupo control, a los cuales se les tomó las muestras al inicio, en el intermedio y al final del tratamiento. Este trabajo se realizó en el hospital Essalud “Edgardo Rebagliati Martins” en la unidad de soporte nutricional (USNA). Los niveles de zinc (Zn), se determinaron en suero libre de hemólisis por espectrofotometría de absorción atómica. Se determinó que los pacientes tratados con Nutrición parenteral total (NPT) tuvieron un incremento en la concentración de Zinc de 74.3 a 84.53 ug/dl que equivale al 13 %. Los pacientes varones tratados con Nutrición parenteral total (NPT) tuvieron un incremento en la concentración de Zinc de 79.79 a 87.14 ug/dl que equivale al 9.21%. Y las pacientes mujeres tratados con Nutrición parenteral total (NPT) tuvieron un incremento en la concentración de Zinc de 73.4 a 82.77 ug/dl que equivale al 13.17 %. Los resultados fueron óptimos ya que se pudo comprobar que el zinc ayuda en la rápida recuperación de pacientes hospitalizados. / From the nutritional point of view it is necessary to know the serum concentration of some minerals in children, adults, older people and to be able to interpret the results. It is essential to compare them with values of reference, in different old age groups. Sixty blood samples, 30 samples of hospitalized patients and 30 samples of patients like group were taken control, to which it took the samples them at the beginning, in the interval and at the end of the treatment. This work was carried out at the hospital Essalud “Edgardo Rebagliati Martins”, Lima in the nutritional support unit (USNA). The zinc levels (Zn), were determined in free serum of hemolysis by atomic absorption spectrofotometry . Then were determined that the patients dealt with total parenteral Nutrition (NPT) had an increase in the Zinc concentration from 74,3 to 84,53 ug/dl that is equivalent to the 13%. The patient men dealt with total parenteral Nutrition (NPT) had an increase in the Zinc concentration from 79,79 to 87,14 ug/dl that is equivalent to the 9,21%. And the patient women dealt with total parenteral Nutrition (NPT) had an increase in the 82,77 Zinc concentration from 73,4 to ug/dl that is equivalent to 13,17%. The results were optimal since it was possible to be verified that the zinc helps in the fast recovery of hospitalized patients. / Tesis

Intravenous feeding of patients with essential and balanced nutrition is required when enteral feeding is not tolerated, therefore indicating the need for Total Parenteral Nutrition (TPN). This life-saving therapy is also associated with the increase risk of intrahepatic cholestasis. The incidence of TPN-related hepatobiliary complications is common in both adults and infants on TPN. Previous work in in vivo models suggested that one of the potential contributing factors is the aluminum contamination of TPN solutions. The mechanism by which aluminum contributes to the PNAC development, though, was unknown. Aluminum as a risk factor may influence a number of hepatocellular functions to lead to cholestasis but one possible mechanism is the potential for aluminum to cause dysfunction of those transporters responsible in the maintenance of bile flow. To provide some initial information regarding the role of aluminum as a contributing factor to cholestasis and the possible underlying mechanism, cytotoxicity studies were conducted to determine whether aluminum causes direct toxicity of HepG2 cells. Furthermore, the influence of aluminum on the mRNA expression of hepatic biliary transporters (BSEP, MRP2, MATE1, NTCP) and nuclear transcription factor (FXR) in HepG2 cells using real-time RT-PCR analysis was assessed. Since inflammation is a component of cholestasis, these investigations also involved the use of an inflammatory stimulus, lipopolysaccharide (LPS), to determine whether the effects of aluminum were exacerbated by underlying inflammation. My data suggest that for the canalicular hepatic transporters MATE1 and BSEP, aluminum at higher concentration alone as well as with LPS caused increased mRNA expression levels. In addition to this, BSEP mRNA expression was preserved and that of MATE1 was increased on LPS exposure. Given the particular importance of BSEP in the maintenance of bile flow and reported effects of drug-induced inhibition of BSEP to cause hepatic cholestasis, the influence of aluminum on BSEP (and MATE1) protein expression and activity warrant investigation. Further studies may identify that inhibition of BSEP function (and possibly MATE1) by aluminum contamination of total parenteral nutrition formulations may explain, in part, the intrahepatic cholestasis associated with parenteral nutrition.