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Isosmolar coma during parenteral alimentation with protein hydrolysate in excess of 4 gm/kg/day
Insights
Rapidly increasing protein hydrolysate in parenteral nutrition can cause isosmolar coma in infants. A gradual protein increase to 4 gm/kg/day is recommended for safe intravenous nutrition.
Area of Science:
- Pediatric critical care medicine
- Neonatal nutrition
- Clinical biochemistry
Background:
- Parenteral nutrition (PN) is crucial for infants unable to receive enteral feeding.
- Determining safe protein administration rates in neonates is essential to prevent adverse effects.
- Previous studies have not fully elucidated the risks of rapid protein loading in infants.
Purpose of the Study:
- To investigate the occurrence and characteristics of isosmolar coma in infants receiving PN.
- To identify the threshold for protein administration that may precipitate this adverse event.
- To establish safe guidelines for protein infusion rates in neonatal PN.
Main Methods:
- Case series of four infants who developed isosmolar coma during PN.
- Analysis of clinical presentation, serum osmolality, and urine specific gravity.
- Evaluation of the effect of discontinuing protein-containing solutions.
Main Results:
- Isosmolar coma developed within 6-12 hours in infants receiving protein hydrolysate at or above 4 gm/kg/day.
- Coma was characterized by normal serum osmolality and elevated urine specific gravity.
- Clinical signs rapidly reversed upon discontinuation of the protein solution.
Conclusions:
- Rapid increases in protein hydrolysate infusion can lead to isosmolar coma in infants.
- A protein load not exceeding 4 gm/kg/day, administered gradually, is advised for safe neonatal PN.
- This finding necessitates careful titration of protein in intravenous nutrition for infants.
Abstract:
Isosmolar coma occurred during the first week of parenteral nutrition in four infants when the amount of protein hydrolysate infused was rapidly increased to or above 4 gm/kg/day. Coma developed within a 6- to 12-hour period and was characterized by (1) a normal serum osmolality, (2) an elevated urine specific gravity, and (3) the rapid reversal of the clinical signs when the protein containing solution was discontinued. A very gradual increase in protein content to a total of no more than 4 gm/kg/day is advised to provide an adequate yet safe protein load for intravenous nutrition.