|
|
Home Parenteral Nutrition—A 3-Year Analysis of Clinical and Laboratory Monitoring
Jan U. Burnes, RN, CNSN
Division of Gastroenterology, Department of Internal Medicine, Division of Surgery, Rochester Methodist Hospital, Mayo Clinic, Rochester, Minnesota, and Jacksonville, Florida
Stephen J.D. O'Keefe, MD, MSc, FRCP
Division of Gastroenterology, Department of Internal Medicine, Division of Surgery, Rochester Methodist Hospital, Mayo Clinic, Rochester, Minnesota, and Jacksonville, Florida
C. Richard Fleming, MD
Division of Gastroenterology, Department of Internal Medicine, Division of Surgery, Rochester Methodist Hospital, Mayo Clinic, Rochester, Minnesota, and Jacksonville, Florida
Richard M. Devine, MD
Division of Gastroenterology, Department of Internal Medicine, Division of Surgery, Rochester Methodist Hospital, Mayo Clinic, Rochester, Minnesota, and Jacksonville, Florida
Sharon Berkner, RPH
Division of Gastroenterology, Department of Internal Medicine, Division of Surgery, Rochester Methodist Hospital, Mayo Clinic, Rochester, Minnesota, and Jacksonville, Florida
Linda Herrick, RN, MSN
Division of Gastroenterology, Department of Internal Medicine, Division of Surgery, Rochester Methodist Hospital, Mayo Clinic, Rochester, Minnesota, and Jacksonville, Florida
We report a 3-year analysis (1986 to 1989) of the management of 63 home parenteral nutrition patients, 40 with short-bowel syndrome and 23 with chronic intestinal obstruction with or without intestinal resection. Intravenous fluid requirements varied from 0.9 to 6 L/day, and the content of glucose varied between 46 and 531 g/day, protein varied from .0 to 85 g/day, fat from .0 to 100 g/day, sodium from 37 to 695 mEq/day, potassium from 30 to 220 mEq/day, chloride from 60 to 760 mEq/day, and acetate from 0 to 200 mEq/day. Body weight was normalized and well maintained in the majority of patients, but using the strict definition of deficiency as the presence of one abnormal value during 3 years, more than half had abnormal plasma chloride, glucose, alkaline phosphatase, serum glutamic oxaloacetic transaminase, total protein, albumin, selenium, and iron concentrations, and more than a third had low calcium, magnesium, vitamin D, and vitamin C levels. Normochromic anemia was seen in 73% and high blood creatinine associated with low urine volumes in 42%. Most (78%) returned to relatively normal lifestyles, but employability was occasionally impaired by loss of third-party insurance coverage resulting from a therapy that may cost $100,000 per year. Overall mortality was low (5% per year), but 73% needed readmission to hospital, mainly for suspected catheter sepsis. The results indicate that home parenteral nutrition has allowed many patients to survive gut failure and return to work but problems with chronic fluid, electrolyte and micronutrient deficiencies, catheter sepsis, and insurance coverage often restrict optimal rehabilitation. (Journal of Parenteral and Enteral Nutrition 16:327-332, 1992)
Journal of Parenteral and Enteral Nutrition, Vol. 16, No. 4,
327-332 (1992)
DOI: 10.1177/0148607192016004327
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
A. U Spencer, D. Kovacevich, M. McKinney-Barnett, D. Hair, J. Canham, C. Maksym, and D. H Teitelbaum
Pediatric short-bowel syndrome: the cost of comprehensive care
Am. J. Clinical Nutrition,
December 1, 2008;
88(6):
1552 - 1559.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. E. Matarese, S. J. O'Keefe, H. M. Kandil, G. Bond, G. Costa, and K. Abu-Elmagd
Short Bowel Syndrome: Clinical Guidelines for Nutrition Management
Nutr Clin Pract,
October 1, 2005;
20(5):
493 - 502.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. C. Rubin, E. A. Swietlicki, H. Iordanov, C. Fritsch, and M. S. Levin
Novel goblet cell gene related to IgGFcgamma BP is regulated in adapting gut after small bowel resection
Am J Physiol Gastrointest Liver Physiol,
November 1, 2000;
279(5):
G1003 - G1010.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Cavicchi, P. Beau, P. Crenn, C. Degott, and B. Messing
Prevalence of Liver Disease and Contributing Factors in Patients Receiving Home Parenteral Nutrition for Permanent Intestinal Failure
Ann Intern Med,
April 4, 2000;
132(7):
525 - 532.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Reddy and M. Malone
Cost and Outcome Analysis of Home Parenteral and Enteral Nutrition
JPEN J Parenter Enteral Nutr,
September 1, 1998;
22(5):
302 - 310.
[Abstract]
[PDF]
|
|
|
|
|
|
|
G. Dougherty
When Should a Child Be in the Hospital?: A. Frederick North, Jr, MD, Revisited
Pediatrics,
January 1, 1998;
101(1):
19 - 24.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Beau, P. R. Mannant, D. Pelletier, and A. Brizard
Comparison of Bone Marrow Toxicity of Medium-Chain and Long-Chain Triglyceride Emulsions: An In Vitro Study in Humans
JPEN J Parenter Enteral Nutr,
November 1, 1997;
21(6):
343 - 346.
[Abstract]
[PDF]
|
|
|
|
|
|
|
T. Rannem, M. Persson-Moschos, Wenhu Huang, M. Staun, and B. Akesson
Selenoprotein P in Patients on Home Parenteral Nutrition
JPEN J Parenter Enteral Nutr,
July 1, 1996;
20(4):
287 - 291.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. Curtas, R. Hariri, and E. Steiger
Case Management in Home Total Parenteral Nutrition: A Cost-Identification Analysis
JPEN J Parenter Enteral Nutr,
March 1, 1996;
20(2):
113 - 119.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. J.D. O'Keefe, J. U. Burnes, and R. L. Thompson
Recurrent Sepsis in Home Parenteral Nutrition Patients: An Analysis of Risk Factors
JPEN J Parenter Enteral Nutr,
May 1, 1994;
18(3):
256 - 263.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C. E. Smith
Quality of Life in Long-Term Total Parenteral Nutrition Patients and Their Family Caregivers
JPEN J Parenter Enteral Nutr,
November 1, 1993;
17(6):
501 - 506.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. J. Mailloux, M. H. Delegge, and D. F. Kirby
Pulmonary Embolism as a Complication of Long-Term Total Parenteral Nutrition
JPEN J Parenter Enteral Nutr,
November 1, 1993;
17(6):
578 - 582.
[Abstract]
[PDF]
|
|
|
|
|
|
|
B. Wolf
Home Parenteral Nutrition--A 3-Year Analysis of Clinical and Laboratory Monitoring
JPEN J Parenter Enteral Nutr,
May 1, 1993;
17(3):
300 - 300.
[PDF]
|
|
|
|
|
|
|
H. R. Freund and B. Rimon
Outcome of Home Parenteral Nutrition
JPEN J Parenter Enteral Nutr,
March 1, 1993;
17(2):
196 - 196.
[PDF]
|
|
|
|
|
