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Effect of Starvation and Total Parenteral Nutrition on Electrolyte Homeostasis in Normal Man

Department of Surgery and General Clinical Research Center, The New York Hospital-Cornell Medical Center, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

John P. Roberts, M.D.

Department of Surgery and General Clinical Research Center, The New York Hospital-Cornell Medical Center, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

Glenn D. Horowitz, M.D.

Department of Surgery and General Clinical Research Center, The New York Hospital-Cornell Medical Center, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

James D. Albert, M.D.

Department of Surgery and General Clinical Research Center, The New York Hospital-Cornell Medical Center, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

Kevin J. Tracey, M.D.

Department of Surgery and General Clinical Research Center, The New York Hospital-Cornell Medical Center, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

G. Tom Shires, M.D.

Department of Surgery and General Clinical Research Center, The New York Hospital-Cornell Medical Center, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

Stephen F. Lowry, M.D.

Department of Surgery and General Clinical Research Center, The New York Hospital-Cornell Medical Center, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

Elemental balances, and skeletal muscle membrane potential (Em) and biopsy were utilized to evaluate electrolyte homeostasis and body composition in 11 healthy adult volunteers after 10 days of starvation. This controlled, acute malnutrition was followed by refeeding for 10 days with two different, commonly used, total parenteral nutrition (TPN) solutions. Six subjects were refed with crystalline amino acids and dextrose (dextrose group), while five subjects received amino acids, dextrose, and lipid (lipid group). During starvation, negative balances for potassium, phosphorous, magnesium, and nitrogen were observed in both groups. When compared to starvation, total parenteral nutrition produced statistically significant (p < 0.05) equilibrium or positive electrolyte and nitrogen balances for both, the dextrose and lipid groups. During TPN, there was a significantly (p < 0.001) positive chloride balance in the lipid group when compared to the dextrose group. At the conclusion of the 10-day period of TPN, there was a decrease ( p < 0.05) in skeletal muscle Em. This change, in concert with the electrolyte balance data obtained during parenteral repletion, lead us to postulate that restoration of lean tissue protein and cellular function does not occur at a rate which might be inferred from the positive nitrogen balance observed in this model. A persistent defect in cellular function which was evident after starvation, suggests that a brief period of TPN is insufficient to restore skeletal muscle integrity. (Journal of Parenteral and Enteral Nutrition 12:109-115, 1988)

Journal of Parenteral and Enteral Nutrition, Vol. 12, No. 2, 109-115 (1988)
DOI: 10.1177/0148607188012002109


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