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Parenteral nutrition: current status and concepts.

G D Phillips, C L Odgers

    Drugs
    |April 1, 1982
    PubMed
    Summary

    Parenteral nutrition (PN) involves specialized nutrient solutions, including updated amino acids and fat emulsions. Understanding PN principles is crucial for safe and effective clinical application in various settings.

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    Area of Science:

    • Clinical Nutrition
    • Metabolic Medicine
    • Intravenous Therapy

    Background:

    • Parenteral nutrition (PN) is viewed differently across countries, as either a nutritional therapy or an extension of intravenous fluid therapy.
    • Optimal PN application necessitates a deep understanding of various nutrient solutions and their metabolic pathways.
    • Recent advancements have refined the use of vitamins, trace elements, and substrates in PN.

    Purpose of the Study:

    • To review the evolution and current understanding of parenteral nutrition (PN) solutions and their clinical applications.
    • To highlight key changes in PN substrate composition and administration over the past decade.
    • To emphasize the importance of understanding PN principles for safe and effective patient care.

    Main Methods:

    • Review of accumulated scientific literature over the past 10 years.
    • Analysis of metabolic pathways related to PN substrates in normal, starved, and stressed states.
    • Examination of advancements in PN solution formulations, including amino acids, lipids, and newer substrates.
    • Evaluation of studies on nutrient deficiencies and recommendations for intravenous administration.
    • Assessment of various PN techniques and their application in specific patient populations.

    Main Results:

    • Excessive dextrose infusion leads to lipogenesis and increased CO2 production, prompting a shift towards lipid-based calorie sources.
    • Synthetic crystalline L-amino acid solutions have replaced older protein hydrolysates and racemic mixtures.
    • Newer fat emulsions, such as safflower oil-based ones, are emerging as alternatives to traditional soybean oil emulsions.
    • Ongoing research explores novel substrates like branched-chain amino acids, keto analogues, synthetic glycerides, and maltose.
    • Deficiencies in essential fatty acids, trace elements, and vitamins in long-term PN patients have been identified, with established recommendations for supplementation.
    • Techniques such as protein-sparing therapy, cyclic nutrition, home therapy, and PN for liver/renal failure have been refined.

    Conclusions:

    • Parenteral nutrition (PN) has evolved significantly, with updated formulations and a better understanding of substrate metabolism.
    • The clinical application of PN requires comprehensive knowledge of nutrient solutions, metabolic responses, and specialized techniques.
    • Safe preparation and infusion of PN solutions are paramount, regardless of the healthcare setting, emphasizing the need for well-understood principles by all involved professionals.

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