This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Geibig, C. B. Articles by Tutschka, P. Search for Related Content PubMed PubMed Citation Articles by Geibig, C. B. Articles by Tutschka, P. Social Bookmarking                         What's this?

Parenteral Nutrition for Marrow Transplant Recipients: Evaluation of an Increased Nitrogen Dose

Nutritional Support Service, Department of Pharmacy, Metabolic Support Team, Department of Pharmacy, Department of Nutrition and Dietetics, and the Bone Marrow Transplant Program, The Ohio State University Hospitals, Columbus, Ohio

Julie PontingG Owens, PHARM. D.

Nutritional Support Service, Department of Pharmacy, Metabolic Support Team, Department of Pharmacy, Department of Nutrition and Dietetics, and the Bone Marrow Transplant Program, The Ohio State University Hospitals, Columbus, Ohio

Jay M. Mirtallo, M.S., R.PH., FASHP, FASCP

Nutritional Support Service, Department of Pharmacy, Metabolic Support Team, Department of Pharmacy, Department of Nutrition and Dietetics, and the Bone Marrow Transplant Program, The Ohio State University Hospitals, Columbus, Ohio

Diana Bowers, M.S., R.D.

Nutritional Support Service, Department of Pharmacy, Metabolic Support Team, Department of Pharmacy, Department of Nutrition and Dietetics, and the Bone Marrow Transplant Program, The Ohio State University Hospitals, Columbus, Ohio

Marcia Nahikian-Nelms, M.ED., R.D.

Nutritional Support Service, Department of Pharmacy, Metabolic Support Team, Department of Pharmacy, Department of Nutrition and Dietetics, and the Bone Marrow Transplant Program, The Ohio State University Hospitals, Columbus, Ohio

Peter Tutschka, M.D.

Nutritional Support Service, Department of Pharmacy, Metabolic Support Team, Department of Pharmacy, Department of Nutrition and Dietetics, and the Bone Marrow Transplant Program, The Ohio State University Hospitals, Columbus, Ohio

The use of total parenteral nutrition in bone marrow transplant (BMT) recipients is well recognized. These patients as a result of treatment with chemotherapy and immunosuppressive agents undergo catabolic stress. The metabolic effect of an increased nitrogen dose during total parenteral nutrition (TPN) was studied in 28 BMT patients. Patients were given TPN formulas providing a nitrogen intake of either 267 ± 44 mg of N/kg/d or 330 ± 60 mg of N/kg/d. Total calories, nonprotein and protein, were held constant at 40 kcal/ kg/d for all patients. Data was collected for three periods posttransplant beginning at 3 days posttransplant through day 16. Both study TPN formulas improved patient weight and TIBC values over baseline. Nitrogen balance (NB) values were not significantly different at any study period. However, an overall group effect favored the H-N formula (p < 0.01). BMT patients undergo catabolic stress which was reflected by average values of 24-hour urine urea nitrogen increasing from 8.1 ± 4 g/d at baseline to 19.8 ± 7.2 g/d at period 3 (p < 0.01). The H-N formula did not differentially increase blood urea nitrogen or serum creatinine levels. Metabolic cart measures also showed no increase in metabolic rate, oxygen consumption, carbon dioxide production, or percent contribution of protein to total metabolic expenditure. Providing a caloric intake of 40 kcal/ kg/d was excessive, where 30 to 35 kcal/kg/d would meet metabolic demands. Pertinent clinical outcomes including length of stay, relapse rate, and survival were monitored, but no conclusions could be drawn in this study. The H-N formula was more effective in reducing loss of lean body mass without causing detrimental metabolic effects in BMT patients. (Journal of Parenteral and Enteral Nutrition 15:184-188, 1991)

Journal of Parenteral and Enteral Nutrition, Vol. 15, No. 2, 184-188 (1991)
DOI: 10.1177/0148607191015002184


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				D. A. August, M. B. Huhmann, and the American Society for Parenteral and Enteral Nu A.S.P.E.N. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation JPEN J Parenter Enteral Nutr, September 1, 2009; 33(5): 472 - 500. [Full Text] [PDF]

				T. T. Mosby, R. D. Barr, and P. B. Pencharz Nutritional Assessment of Children With Cancer Journal of Pediatric Oncology Nursing, July 1, 2009; 26(4): 186 - 197. [Abstract] [PDF]

				F. R Sattler, N. Rajicic, K. Mulligan, K. E Yarasheski, S. L Koletar, A. Zolopa, B. Alston Smith, R. Zackin, B. Bistrian, and for the ACTG 392 Study Team Evaluation of high-protein supplementation in weight-stable HIV-positive subjects with a history of weight loss: a randomized, double-blind, multicenter trial Am. J. Clinical Nutrition, November 1, 2008; 88(5): 1313 - 1321. [Abstract] [Full Text] [PDF]

				J. S. Scolapio, V. B. Tarrosa, G. L. Stoner, A. Moreno-Aspitia, L. A. Solberg Jr, and E. J. Atkinson Audit of Nutrition Support for Hematopoietic Stem Cell Transplantation at a Single Institution Mayo Clin. Proc., July 1, 2002; 77(7): 654 - 659. [Abstract] [PDF]

				T. W. Mattox Specialized Nutrition Management of Patients Receiving Hematopoietic Stem Cell Transplantation Nutr Clin Pract, February 1, 1999; 14(1): 5 - 15. [Abstract] [PDF]

				K. Ringwald-Smith, R. Williams, E. Horwitz, and M. Schmidt Determination of Energy Expenditure in the Bone Marrow Transplant Patient Nutr Clin Pract, October 1, 1998; 13(5): 215 - 218. [Abstract] [PDF]

				W. L. Macias, K. J. Alaka, M. H. Murphy, M. E. Miller, W. R. Clark, and B. A. Mueller Impact of the Nutritional Regimen on Protein Catabolism and Nitrogen Balance in Patients With Acute Renal Failure JPEN J Parenter Enteral Nutr, January 1, 1996; 20(1): 56 - 62. [Abstract] [PDF]

				A. L. Buchman Parenteral Nutrition in Bone Marrow Transplant Patients JPEN J Parenter Enteral Nutr, March 1, 1992; 16(2): 192 - 192. [PDF]