Enteral and Parenteral Nutrition in the Elderly Patient

  • Brad M. Dworkin
Part of the Contemporary Geriatric Medicine book series (COGM, volume 3)


The past two decades have witnessed a dramatic change in our ability to provide adequate nutrition for our patients. At the present time, this frequently involves the use of enteral tube feedings or intravenous alimentation. This chapter will provide a practical background for the use of these advanced enteral and parenteral nutritional support techniques in the geriatric patient.


Parenteral Nutrition Hepatic Encephalopathy Enteral Nutrition Total Parenteral Nutrition Geriatric Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Roe, D. A., 1983, Geriatric Nutrition, Prentice-Hall, Englewood Cliffs, NJ.Google Scholar
  2. 2.
    Jeejeebhoy, K. N. (ed.), 1983, Total Parenteral Nutrition in the Hospital and at Home, CRC Press, Boca Raton, FL.Google Scholar
  3. 3.
    Young, E. A. (ed.), 1986, Nutrition, Aging and Health, Alan R. Liss, New York.Google Scholar
  4. 4.
    Shock, N. W., 1970, Physiologic aspects of aging, J. Am. Diet. Assoc. 56:491-496.PubMedGoogle Scholar
  5. 5.
    Munro, H. N., 1981, Nutrition and aging, Br. Med. Bull. 37:83–88.PubMedGoogle Scholar
  6. 6.
    Towbin, J. D., 1981, Physiologic indices of aging, in: Aging, a Challenge to Science and Society, Vol. 1 (D. Dansen, N. W Shock, and S. M. Mario, eds.), Oxford University Press, New York, pp. 286–295.Google Scholar
  7. 7.
    Munro, H. N., 1984, Nutrition and the elderly; a general overview, J. Am. Coll. Nutr. 3:341–350.PubMedGoogle Scholar
  8. 8.
    Watkin, D. M., 1982, The physiology of aging. Am. J. Clin. Nutr. 36:750-758.Google Scholar
  9. 9.
    Forbes, G. B. and Reina, J. C., 1980, Adult lean body mass declines with age: Some longitudinal observations, Metabolism 19:653-663.Google Scholar
  10. 10.
    Novak, L. P., 1972, Aging, total body potassium, fat free mass and cell mass in males and females between the ages of 18 and 85 years, J. Gerontol. 27:438–443.PubMedGoogle Scholar
  11. 11.
    Forbes, G. B., 1976, The adult decline in lean body mass. Hum. Biol. 48:161–173.PubMedGoogle Scholar
  12. 12.
    Korenchevsky, V., 1961, in: Physiological and Pathological Aging (G. H. Bourne, ed.). Karger, Basel.Google Scholar
  13. 13.
    Watkin, D. M., 1980, Nutrition for the aging and the aged, in: Modern Nutrition in Health and Disease (R. S. Goddhart and M. E. Shils eds.), Lea & Febiger, Philadelphia, pp. 781–813.Google Scholar
  14. 14.
    Sugarman, B. and Munro, H. N., 1980, Altered accumulations of zinc by aging human fibroblasts in culture. Life Sci 26:915–920.PubMedGoogle Scholar
  15. 15.
    Andrews, J., Letcher, M., and Brook, M., 1969, Vitamin C. supplementation in the elderly: A 17 month trial in an old persons’ home, Br. Med. J. 2:416–418.PubMedGoogle Scholar
  16. 16.
    Roth, G. S., 1975, Age related changes in glucocorticoid binding by rat splenic leukocytes: Possible cause of altered adaptive responsiveness, Fed. Proc. 34:183–185.PubMedGoogle Scholar
  17. 17.
    Mandy, R. B., Barrows, C. H., Spanias, A., Meredith, A., Stone, J. L., and Norris, A. H., 1966, Nutrient intakes and energy expenditure in men of different ages, J. Gerontol. 21:581–587.Google Scholar
  18. 18.
    Gregerman, R. L, 1967, in: Endocrines and Aging (L. Gitman, ed.), MSF Information, New York, pp. 161–173.Google Scholar
  19. 19.
    Munro, H. N. and Young, V. R., 1978, Protein metabolism in the elderly, Postrad. Med. 63:143–152.Google Scholar
  20. 20.
    Rudman, D. and Bleiser, J. C., 1983, Protein and energy undernutrition, in: Harrison’s Principles of Internal Medicine (R. G. Petersdorf, ed.), McGraw-Hill, New York, pp. 436–439.Google Scholar
  21. 21.
    Coward, W. A. and Lann, P. G., 1981, The biochemistry and physiology of kwashiorkor and marasmus, Br. Med. Bull. 37:19–24.PubMedGoogle Scholar
  22. 22.
    Alleyne, G. A. O., Hay, R. W., Pioca, D. L, Stanfield, J. P., and Whitehead, R. G., 1977, Protein Energy Malnutrition, Arnold, London.Google Scholar
  23. 23.
    Saudek, G. D. and Felig, P., 1976, The metabolic events of starvation. Am. J. Med. 80:117–126.Google Scholar
  24. 24.
    Gahill, G. F., 1970, Starvation in man, N. Engl. J. Med. 282:668–675.Google Scholar
  25. 25.
    Viteri, F. E. and Torun, B., 1980, Protein-calorie malnutrition, in: Modern Nutrition in Health and Disease, (R. S. Goodhart and M. E. Shils, eds.). Lea &: Febiger, Philadelphia, pp. 697–720.Google Scholar
  26. 26.
    Masoro, E., 1976, Physiologic changes with aging, in: Nutrition and Aging (M. Winick, ed.), Wiley, New York, pp. 61–76.Google Scholar
  27. 27.
    Chandra, R. K., 1983, Nutrition, immunity and infection: Present knowledge and future directions, Lancet 1:688-691.PubMedGoogle Scholar
  28. 28.
    Heymsfield, S. M., Smith, J., Redd, S., and Whitworth, H. B., 1981, Nutritional support in cardiac failure, Surg. Clin. North Am. 61:635–652.PubMedGoogle Scholar
  29. 29.
    Rhoads, J. E., 1980, The impact of nutrition on infection, Surg. Clin. North Am. 60:41–47.PubMedGoogle Scholar
  30. 30.
    Daly, J. M., Dudrick, S. J., and Copeland, E. M., 1980, Intravenous hyperalimentation: Effect on delayed cutaneous hypersensitivity in cancer patients, Ann. Surg. 192:587–592.PubMedGoogle Scholar
  31. 31.
    Brennan, M. F., 1981, Total parenteral nutrition in the cancer patient, N. Engl. J. Med. 305:375–382.PubMedGoogle Scholar
  32. 32.
    Muller, J. M., Dienst, C., Brenner, U., and Pichlamaier, H., 1982, Preoperative parenteral feeding in patients with gastrointestinal carcinoma. Lancet 1:68–71.PubMedGoogle Scholar
  33. 33.
    Mullen, S. L., Buzby, G. P., Mathews, D. C., Smale, B. F., and Rosato, E. F., 1980, Reduction of operative morbidity by combined preoperative and postoperative nutritional support, Ann. Surg. 192:604-613.PubMedGoogle Scholar
  34. 34.
    Koretz, R. L., 1984, What supports nutritional support. Dig. Dis. Sci. 29:577–588.PubMedGoogle Scholar
  35. 35.
    Lo, B. and Dornbrand, L., 1984, Guiding the hand that feeds: Caring for the demented elderly, N. Engl. J. Med. 311:402–405.PubMedGoogle Scholar
  36. 36.
    Miles, S., 1985, The terminally ill elderly: Dealing with the ethics of feeding, Geriatrics 40:112–120.PubMedGoogle Scholar
  37. 37.
    Mitchell, C. O. and Lipschitz, D. A., 1982, Detection of protein-calorie malnutrition in the elderly. Am. J. Clin. Nutr. 35:395-406.Google Scholar
  38. 38.
    Grant, J. P., Custer, P. B., and Thrulow, J., 1981, Current techniques of nutritional assessment, Surg. Clin. North Am. 61:437–463.PubMedGoogle Scholar
  39. 39.
    Blackburn, G. L. and Thornton, P. A., 1979, Nutritional assessment of the hospitalized patient, Med. Clin. North Am. 53:1103–115.Google Scholar
  40. 40.
    Margen, S., 1979, Evaluation of nutritional status in the outpatient setting, Med. Clin. North Am. 63:1095–1101.PubMedGoogle Scholar
  41. 41.
    Gray, G. E. and Gray, L. K. 1980, Anthropometric measurements and their interpretation: Principles, practices and problems, J. Am. Diet. Assoc. 77:534–538.PubMedGoogle Scholar
  42. 42.
    Karbeck, J. M., 1984, Assessment of nutritional status of the elderly, Nutr. Support Serv. 4:23–33.Google Scholar
  43. 43.
    Shuran, M. and Nelson, R. A., 1986, Updated nutritional assessment and support of the elderly. Geriatrics 41:48-70.PubMedGoogle Scholar
  44. 44.
    Vitale, J. J. and Santos, J. I., 1985, Nutrition and the elderly: Nutrition assessment and education. Postgrad. Med. 78:79-89.PubMedGoogle Scholar
  45. 45.
    Morley, J. E., 1986, Nutritional status of the elderly. Am. J. Med. 81:679-695.PubMedGoogle Scholar
  46. 46.
    Kohrs, M. B. and Czajka-Narins, D. M., 1986, Assessing the nutritional status of the elderly, in: Nutrition, Aging and Health, (E. A. Young, ed.), Alan R. Liss, New York, pp. 25–59.Google Scholar
  47. 47.
    Baker, J. P., Detsky, A. S., Wesson, D., etal, 1982, Nutrition assessment: A comparison of clinical judgement and objective measurements, N. Engl. J. Med 306:969–972.PubMedGoogle Scholar
  48. 48.
    Michel, L., Serrano, A., and Malt, R. A., 1981, Nutritional support of hospitalized patients, N. Engl. J. Med. 304:1147–1152.PubMedGoogle Scholar
  49. 49.
    Heymsfield, S. B., Bethel, R. A., Ansley, J. D., Nixon, D. W., and Rudman, D., 1979, Enteral hyperalimentation: An alternative to central venous hyperalimentation, Ann. Intern. Med. 90:63-71.PubMedGoogle Scholar
  50. 50.
    Sundaram R., Megna, D., and Sibley, J., 1979, Long-term tube feeding in the aged, NY State J. Med. 79:1226.Google Scholar
  51. 51.
    Rombeau, J. L. and Barot, L. R., 1981, Enteral nutritional therapy, Surg. Clin. North Am. 61:605–620.PubMedGoogle Scholar
  52. 52.
    Shils, M. E., 1977, Enteral nutrition by tube. Cancer Res. 37:2432–2439.PubMedGoogle Scholar
  53. 53.
    Rudman, D., 1979, Nasogastric hyperalimentation through a polyethylene catheter: An alternative to central venous hyperalimentation. Am. J. Clin. Nutr. 32:1112–1120.PubMedGoogle Scholar
  54. 54.
    Kaminsky, M. V., 1976, Enteral hyperalimentation, Surg. Gynecol Obstet. 143:12–16.Google Scholar
  55. 55.
    Organ, C. H. and Williams, G. R., 1983, Nutritional support for the geriatric patient, Oklahoma State Med. Assoc. 76:317–323.Google Scholar
  56. 56.
    Bernard, M. A. and Rombeau, J. L., 1986, Nutritional support for the elderly patient, in: Nutrition, Aging and Health (E. A. Young, ed.), Alan R. Liss, New York, pp. 229–258.Google Scholar
  57. 57.
    Randall, H. T., 1984, Enteral nutrition: Tube feeding in acute and chronic illness, J. Parent. Ent. Nutr. 8:113–136.Google Scholar
  58. 58.
    Clark, N. G. and Blackburn, G. C., 1982, Nutritional devices and hyperalimentation in the elderly, Med. Instrumentation 16:257–258.Google Scholar
  59. 59.
    Murphy, L. M. and Hostetler, C., 1981, Tube feeding reconsidered, Natl. Intravenous Ther. Assoc. 4:409-413.Google Scholar
  60. 60.
    Gustke, R. F., Varma, R. R., and Soergel, K. H., 1970, Gastric reflux during perfusion of the small bowel. Gastroenterology 59:890–895.PubMedGoogle Scholar
  61. 61.
    Miller, K. S. and Sahn, S. A., 1986, The technique of enteral feeding tube insertion, J. Grit. Illness 1:51–58.Google Scholar
  62. 62.
    Albibi, R. and Mallum, R. W., 1983, Metoclopramide: Pharmacology and clinical application, Ann. Intern. Med. 98:86-95.PubMedGoogle Scholar
  63. 63.
    Schulze-Delrien, K., 1981, Metoclopramide, N. Engl. J. Med. 305:28–33.Google Scholar
  64. 64.
    Whatley, K., Turner, W. W., Dey, M., et al, 1984, When does metoclo-pramide facilitate transpyloric intubation? J.Parent. Ent. Nutr. 8:679-681.Google Scholar
  65. 65.
    Kittinger, J. W., Sandler, R. S., and Heizer, W. D., 1987, Efficacy of metoclopramide as an adjujunct to duodenal placement of small-bore feeding tubes: A randomized, placebo-controlled, double-blind study, J. Parent. Ent. Nutr. 11:33–37.Google Scholar
  66. 66.
    Gallo, S. Ramirez, A., Elizondo, J., et al., 1985, Endoscopic placement of enteral feeding tubes, J. Parent. Ent. Nutr. 9:747–749.Google Scholar
  67. 67.
    Hearne, B. E. and Daly, J. M., 1983, Enteral nutrition, in: Nutrition/ Metabolism in the Surgical Patient (J. Kirkpatrick, ed.), Futura, Mt. Kisco, NY.Google Scholar
  68. 68.
    Gasson, J. E., 1982, Feeding stomas: Gastrostomy and jejunostomy: Fart I: Surgical procedures and complications, Clin. Gastroenterol. 11:337–344.PubMedGoogle Scholar
  69. 69.
    Ponsky, J. L. and Ganderer, M. W. L., 1981, Percutaneous endoscopic gastrostomy: A nonoperative technique for feeding gastrostomy, Gastroin-test. Endosc. 27:9–11.Google Scholar
  70. 70.
    Kirby, D. F., Craig, R. M., Tsang, T. K., et al, 1986, Percutaneous endoscopic gastrostomies: A prospective evaluation and review of the literature, J. Parent. Ent. Nutr. 10:155–159.Google Scholar
  71. 71.
    Page, G. P., Ryan, J. A., and Haff, R. G., 1976, Continual catheter administration of an elemental diet, Surg. Gynecol. Obstet. 142:184–188.PubMedGoogle Scholar
  72. 72.
    Page, C. P., 1981, Needle-catheter jejunostomy, Clin. Consult. 1:5–10.Google Scholar
  73. 73.
    Ryan, J. A. and Page, C. P., 1984, Intrajejunal feeding: Development and current status J.Parent. Ent. Nutr. 8:187–198.Google Scholar
  74. 74.
    Koretz, R. L. and Meyer, J. H., 1980, Elemental diets-Facts and fantasies, Gastroenterology 78:393–410.PubMedGoogle Scholar
  75. 75.
    Fairfall-Smith, R., Abunassar, R., Freeman, J. B., and Maroun, J. A., 1980Google Scholar
  76. 76.
    Rational use of elemental and nonelemental diets in hospitalized patients, Ann. Surg. 192:600–603.Google Scholar
  77. 76.
    Maurney, M. and Wilmore, D. W., 1981, Rational decision making in nutritional care, Surg. Clin. North Am. 61:571-582.Google Scholar
  78. 77.
    Cape, R. D. T., 1983, Geriatrics, in:Nutritional Support of Medical Practice (H. A. Schneider, C. A. Anderson, and D. B. Coursin, eds.). Harper & Row, Philadelphia, pp. 369–385.Google Scholar
  79. 78.
    Food and Nutrition Board, National Academy of Sciences, 1980, Recommended Dietary Allowances, National Academy of Sciences, Washington, DC.Google Scholar
  80. 79.
    Caldwell, M. D. and Kennedy-Caldwell, C., 1981, Normal nutritional requirements, Surg. Clin. North Am. 61:489–507.PubMedGoogle Scholar
  81. 80.
    Munro, H. N., 1980, Nutritional requirements in health, Crit. Care Med. 8:2–8.PubMedGoogle Scholar
  82. 81.
    Schneider, E. L., Vining, E. M., Hadley, E. C., etal, 1986, Recommended dietary allowances and the health of the elderly, N. Engl. J. Med., 314:157-160.PubMedGoogle Scholar
  83. 82.
    Beaumont, D. M. and James, O. F., 1985, Aspects of nutrition in the elderly, Clin. Gastroenterol. 14:811–827.PubMedGoogle Scholar
  84. 83.
    Freedman, M. L. and Ahronheim, J. C., 1985, Nutritional needs of the elderly: Debate and recommendations,Geriatrics:45-59.Google Scholar
  85. 84.
    Elwyn, D. H., 1980, Nutritional requirements of adult surgical patients, Grit. Care Med. 8:9–20.Google Scholar
  86. 85.
    Clark, N. G., 1982, Nutritional support of elderly patients: II. Proposed answers, Clin. Consult. Nutr. Support 2:5–10.Google Scholar
  87. 86.
    Harris, J. A. and Benedict, F. G., 1919, A Biometrie Study of Basal Metabolism in Man, Carnegie Institution (Carnegie Institution of Washington, Publication no. 279), Washington, DC.Google Scholar
  88. 87.
    Wilmore, D. W., 1977, Energy requirements for maximum nitrogen retention, in: Clinical Nutrition Update: Amino Acids (H. L. Greene, M. A. Holliday, and H. N. Munro, eds.), American Medical Association, Chicago.Google Scholar
  89. 88.
    Harper, A. E., 1978, Recommended dietary allowances for the elderly. Geriatrics 33:73–80.PubMedGoogle Scholar
  90. 89.
    Clark, N. G., Rappaport, J. I., Dcala, C., and Blackburn, G. L., 1984, Protein requirements in chronically ill elerly, J. Parent. Ent. Nutr. 8:99 (abstract).Google Scholar
  91. 90.
    Gersovitz, M., Motil, K., Munro, H. N., Scrimshaw, N. S., and Young, V. R., 1982, Human protein requirements: Assessments of the adequacy of the current recommended dietary allowance for dietary protein in elderly men and women. Am. J. Clin, Nutr. 35:6-14.Google Scholar
  92. 91.
    Heimburger, D. C., Young, V. R., Bistrian, B. R., et al, 1986, The role of protein in nutrition, with particular reference to the composition and use of enteral feeding formulas. A consensus report, J. Parent. Ent. Nutr. 10:425–430.Google Scholar
  93. 92.
    Fischer, J. E. and Alexander, J. W. (eds.), 1982, Relevance of Nutrition to Sepsis: Report of the Third Ross conference on Medical Researach, Ross Laboratories, Columbus, OH.Google Scholar
  94. 93.
    Shils, M. E., 1979, Nutritional problems induced by cancer, Med. Clin. North Am. 63:1009–1025.PubMedGoogle Scholar
  95. 94.
    Brennan, M. F., 1977, Uncomplicated starvation versus cancer cachexia, Cancer Res. 37:2359–2364.PubMedGoogle Scholar
  96. 95.
    Warnold, I., Lundholm, K., and Schersten, T., 1978, Energy balance and body composition in cancer patients. Cancer Res. 38:1801-1807.PubMedGoogle Scholar
  97. 96.
    Maie, J., Burkinshaw, L., Oxby, C., Holmfield, J. H. M., and Hill, G. L., 1982, The effect of gastrointestinal malignancy on resting metabolic expenditure, Br. J. Surg. 69:443–446.Google Scholar
  98. 97.
    Young, V. R., 1977, Energy metabolism and requirements in the cancer patient. Cancer Res. 37:2336–2347.PubMedGoogle Scholar
  99. 98.
    Barot, L. R., Rombeau, J. L., Feurer, I. D., and Muller, J. L., 1982, Caloric requirements in patients with inflammatory bowel disease, Ann. Surg. 195:214–219.PubMedGoogle Scholar
  100. 99.
    Holliday, M. A., Menry-Richardson, K., and Portale, A., 1979, Nutritional management of chronic renal disease, Med. Clin. North Am. 63:945-962.PubMedGoogle Scholar
  101. 100.
    Steffee, W. P., 1981, Nutritional support in renal failure, Surg. Clin. North Am. 61:661–670.PubMedGoogle Scholar
  102. 101.
    Mezey, E., 1978, Liver disease and nutrition. Gastroenterology 74:770–783.PubMedGoogle Scholar
  103. 102.
    Shils, M. E., Bloch, A. S., and Chernoff, R., 1977, Liquid formulas for oral and tube feedings, J. Parent. Ent. Nutr. 1:89–96.Google Scholar
  104. 103.
    Shils, M. E., Bloch, A. S., and Chernoff, R., 1976, Liquid formulas for oral and tube feeding, Clin. Bull. 6:151–158.PubMedGoogle Scholar
  105. 104.
    Chernoff, R., 1981 Nutritional support: Formulas and delivery of enteral feeding, J. Am. Diet. Assoc. 79:426–429.PubMedGoogle Scholar
  106. 105.
    Letsou, A., 1987, Nutritional product chart enteral formulas, Nutr. Support Serv. 7:12–21.Google Scholar
  107. 106.
    Heimburger, D. C. and Weinsier, R. L., 1985, Guidelines for evaluating and categorizing enteral feeding formulas according to therapeutic equivalence, J. Parent. Ent. Nutr. 9:61–67.Google Scholar
  108. 107.
    Crossland, S. S., Geelhoed, G. W., Guy, D. G., Cook, D. A., and Rebone, J. W. 1980, Preoperative nutritional support for bowel surgery patients, Con-temp. Surg. 16.Google Scholar
  109. 108.
    Fairfull-Smith, R. J. and Freeman, J. B., 1980, Immediate postoperative enteral nutrition with a nonelemental diet, J. Surg. Res. 29:236–239.PubMedGoogle Scholar
  110. 109.
    Russell, R. L, 1975, Progress report: Elemental diets. Gut 16:68–79.Google Scholar
  111. 110.
    Smith, J. L., Arteaga, C., and Heymsfield, S. B., 1982, Increased ureagene-sis and impaired nitorgen use during infusion of a synthetic amino acid formula: A controlled trial, N. Engl. J. Med. 306:1013–1018.PubMedGoogle Scholar
  112. 111.
    Smith, J. L. and Heymsfield, S. B., 1983, Enteral nutrition support: Formula preparation from modular ingredients, J. Parent. Ent. Nutr. 7:280-288.Google Scholar
  113. 112.
    Smith, J., Horowitz, J., Henderson, M., and Heymsfield, S., 1982, Enteral hyperalimentation in undernourished patients with cirrhosis and ascities, Am. J. Clin. Nutr. 35:56–72.PubMedGoogle Scholar
  114. 113.
    Hoyumpa, A., Desmond, P. V., Avant, G. R., Roberts, R. K., and Shenker, S., 1979, Hepatic encephalopathy. Gastroenterology 76:184-195.PubMedGoogle Scholar
  115. 114.
    Fischer, J. E., 1982, Amino acids in hepatic coma. Dig. Dis. Sci. 27:97–102.PubMedGoogle Scholar
  116. 115.
    Weber, F. L. and Reiser, B. J., 1982, Relationship of plasma amino acids to nitrogen balance and portal-systemic encephalopathy in alcoholic liver disease, Dig. Dis. Sci. 27:103–110.PubMedGoogle Scholar
  117. 116.
    Fischer, J. E. and Bower, R. H., 1981, Nutritional support in liver disease, Surg. Clin. North Am. 61:653–660.PubMedGoogle Scholar
  118. 117.
    Eriksson, L. S., Persson, A., and Wahren, J., 1982, Branched-chain amino acids in the treatment of chronic hepatic encephalopathy, Gut 23:801–806.PubMedGoogle Scholar
  119. 118.
    Rocchi, E., Cassanelli, M., Gibertini, P., et al, 1985, Standard or branched-chain amino acid infusions as short-term nutritional support in liver cirrhosis, J. Parent. Ent. Nutr. 9:447–451.Google Scholar
  120. 119.
    Wahren, J., Dennis, J., Desurmont, P., Eriksson, L. S., Escoffier, J. M., Ganthier, A. P., Hagenfeldt, L., Michel, H., Opolon, P., Paris, J. C., and Veyrac, M., 1983, Is intravenous administration of branched chain amino acids effective in the treatment of hepatic encephalopathy? A multicenter study, Hepatology 3:475–480.PubMedGoogle Scholar
  121. 120.
    Rossi-Fanelli, F., Riggio, O., Cangiano, C., Cascino, A., Donciliis, D., Merili, M., Stortoni, M., and Giunchi, G., 1982, Branched-chain amino acids vs. lactulose in the treatment of hepatic coma: A controlled study. Dig. Dis. Sci. 27:929–935.PubMedGoogle Scholar
  122. 121.
    Cerra, F. B., Cheung, N. K., Fischer, J. E., et al, 1985, Disease-specific amino acid infusion (F080) in hepatic encephalopathy: A prospective, randomized double-blind controlled trial, J. Parent. Ent. Nutr. 9:288–295.Google Scholar
  123. 122.
    Christie, M. L., Sack, D. M., Pomposelli, J., etal, 1985, Enriched branched-chain amino acid formula versus a casein-based supplement in the treatment of cirrhosis, J. Parent. Ent. Nutr. 9:871-678.Google Scholar
  124. 123.
    Walser, M., 1983, Nutritional support in renal failure: Future directions. Lancet 1:340–342.PubMedGoogle Scholar
  125. 124.
    Walser, M., Mitch, W. E., and Collier, V. U., 1979, The effect of nutritional therapy on the course of chronic renal failure, Clin. Nephrol. 11:66–70.PubMedGoogle Scholar
  126. 125.
    Yeung, C. K., Smith, R. C., and Hill, G. L., 1979, Effect of an elemental diet on body composition: A comparison with intravenous nutrition. Gastroenterology 77:652–657.PubMedGoogle Scholar
  127. 126.
    Allardyce, D. B. and Groves, A. C., 1974, A comparison of nutritional gains resulting from intravenous and enteral feeding, Surg. Gynecol. Obstet. 139:179–184.PubMedGoogle Scholar
  128. 127.
    Cataldi-Betcher, E. L., Seltzer, M. H., Slocum, B. A., and Jones, K. W., 1983, Complications occurring during enteral nutrition support: A prospective study, J. Parent, Ent. Nutr. 7:546-552.Google Scholar
  129. 128.
    Brown, R. O., Carlson, S. D., Cowan, G. S. M., et al, 1987, Enteral nutritional support management in a university teaching hospital: team vs non-team, J. Parent. Ent. Nutr. 11:52–56.Google Scholar
  130. 129.
    Steinheber, F. U., 1985, Aging and the stomach, Clin. Gastroenterol. 14:657–688.PubMedGoogle Scholar
  131. 130.
    White, W. T., Acuff, T. E., Sykes, T. R., and Dobbie, R. P., 1979, Bacterial contamination of enteral nutrient solutions: A preliminary report, J. Parent. Ent. Nutr. 3:459–461.Google Scholar
  132. 131.
    Gill, K.J., 1981 Contaminated enteral feeds, Br. J. Med. 282:1971.Google Scholar
  133. 132.
    Anderson, K. R., Norris, D. J., Godfrey, L. B., Avent, C. K., and Butter-worth, C. E., 1984, Bacterial contamination of tube feeding formulas, J. Parent. Ent. Nutr. 8:673–678.Google Scholar
  134. 133.
    Valentine, R. J. and Turner, W. W., 1985, Pleural complications of nasoen-teric feeding tubes, J. Parent. Ent. Nutr. 9:605–607.Google Scholar
  135. 134.
    Olbrantz, K. R., Gelfand, D., Chaplin, R., et al., 1985, Pheumothorax complicating enteral feeding tube placement, J. Parent. Ent. Nutr. 9:210-211.Google Scholar
  136. 135.
    Vanlandingham, S., Simpson, S., Daniel, P., and Newmark, S. R., 1981, Metabolic abnormalities in patients supported with enteral tube feeding, J. Parent. Ent. Nutr. 5:322–324.Google Scholar
  137. 136.
    Telfer, N. and Persoff, M., 1966, The effect of tube feeding on the hydration of elderly patients, J. Gerontol. 20:536–543.Google Scholar
  138. 137.
    Heymsfield, S. B., Bethel, R. A., Ansely, J. D., Gibbs, D. M., Feiner, J. M., and Nutter, D. O., 1978, Cardiac abnormalities in cachetic patients before and during nutritional repletion. Am. Heart J. 95:584–594.PubMedGoogle Scholar
  139. 138.
    Harris, R., 1983, Cardiovascular diseases in the elderly, Med. Clin. North Am. 67:379–394.PubMedGoogle Scholar
  140. 139.
    Poindexter, S. M., Dean, W. E., and Dudrick, S. J., 1986, Nutrition in congestive heart failure, Nutr. Clin. Pract. 1:83–88.Google Scholar
  141. 140.
    Jeejeebhoy, K. N., 1979, Is more better? Is weight water? The significance of weight gain during parenteral nutrition with amino acids. Gastroenterology 77:799–800.PubMedGoogle Scholar
  142. 141.
    Davidson, M. B., 1979, The effect of age on carbohydrate metabolism: A review of the English literature and a practical approach to the diagnosis of diabetes mellitus in the elderly. Metabolism 28:688–705.PubMedGoogle Scholar
  143. 142.
    Nasr, H., 1983, Endocrine disorders in the elderly, Med. Clin. North Am. 67:481–495.PubMedGoogle Scholar
  144. 143.
    Horowitz, D. L., 1982, Diabetes and aging. Am. J. Clin. Nutr. 36:803–808.Google Scholar
  145. 144.
    Rudman, D., Racette, D., Rudman, I. W., et al., 1986, Hyponatremia in tube-fed elderly men, J. Chronic. Dis. 39:73–80.PubMedGoogle Scholar
  146. 145.
    Sheldon, G. F. and Baker, C., 1980, Complications of nutritional support. Grit. Care Med. 8:35–37.Google Scholar
  147. 146.
    Jhangiani S., Prince L., Holmes, R., et al., 1986, Clinical zinc deficiency during long-term total enteral nutrition, J. Am. Geriatr. Soc. 34:385–388.PubMedGoogle Scholar
  148. 147.
    Solomons, N. W., 1986, Trace elements in nutrition of the elderly. 1.) Established RDAs for iron, zinc, and iodine. Postgrad. Med. 79:231–242.PubMedGoogle Scholar
  149. 148.
    Stefee, W. B., 1980, Nutrition intervention in hospitalized geriatric patients, Bull. NY Acad. Med. 56:564–574.Google Scholar
  150. 149.
    Organ, C. H. and Finn, M. P., 1977, The importance of nutritional support for the geriatric surgical patient, Geriatrics 32:77–84.PubMedGoogle Scholar
  151. 150.
    Ausman, R. K., 1981, A standardized approach to parenteral nutrition for the geriatric patient, J. Am. Geriatr. Soc. 19:172–176.Google Scholar
  152. 151.
    A.S.P.E.N. Board of Directors. 1986, Guidelines for use of total parenteral nutrition in the hospitalized adult patient. J. Parent. Ent. Nutr. 10:441-445.Google Scholar
  153. 152.
    Shils, M. E., 1979, Principles of nutritional therapy, Cancer 43:2093–2102.PubMedGoogle Scholar
  154. 153.
    Shils, M. E., 1972, Guidelines for total parenteral nutrition, JAMA 220:1721–1729.PubMedGoogle Scholar
  155. 154.
    Law, D. H., 1977, Total parenteral nutrition, N. Engl J. Med. 297:1104-1107.PubMedGoogle Scholar
  156. 155.
    Paul, G. J., 1979, Total parenteral nutrition: A guide for its use. Am. J. Gastroenterol. 72:186–192.PubMedGoogle Scholar
  157. 156.
    Shils, M. E., 1980, Parenteral nutrition, in: Modern Nutrition in Health and Disease (R. S. Goodhart and M. E. Shils, eds.), Lea &: Febiger, New York, pp. 1125–1152.Google Scholar
  158. 157.
    Meng, H. C., 1983, Parenteral nutrition-Principles, nutrient requirements, techniques, and clinical applications, in:Nutritional Support of Medical Practice (H. A. Schneider, C. E. Anderson, and D. B. Coursin, eds.). Harper & Row, Philadelphia, pp. 184–224.Google Scholar
  159. 158.
    Fischer, J. E., 1979, Hyperalimentation, Med. Clin. North Am. 63:973–983.PubMedGoogle Scholar
  160. 159.
    Sheldon, G. F. and Way, L. W., 1975, Total parenteral nutrition. Viewpoints Dig. Dis. 7 (3).Google Scholar
  161. 160.
    Foley, C. J. and Tideiksaar, R., 1983, Nutritional problems in the elderly, in: Contemporary Geriatric Medicine, Vol. 1 (S. Gambert, ed.). Plenum Press, New York, pp 339–370.Google Scholar
  162. 161.
    Driver, A. G. and Mlevy, M. T., 1980, Creatinine height index as a function of age. Am. J. Clin. Nutr. 33:2057 (letter to the editor).Google Scholar
  163. 162.
    Bowman, B. B. and Rosenberg, L H., 1982, Assessment of the nutritional status of the elderly, Am. J. Clin. Nutr. 35:1142–1151.PubMedGoogle Scholar
  164. 163.
    Law, D. K., Dudrick, S. J., and Abdou, N. L, 1974, The effects of protein-calorie malnutrition on immune competence of the surgical patient, Surg. Gynecol. Obstet. 139:257–266.PubMedGoogle Scholar
  165. 164.
    Freeman, J. B., 1978, Peripheral parenteral nutrition, Can. J. Surg. 21:489–492.PubMedGoogle Scholar
  166. 165.
    Orr, G., Wade, J., Bothe, A., and Blackburn, G. L., 1980, Alternatives to total parenteral anutrition in the critically ill patient. Grit. Care Med. 8:29-33.Google Scholar
  167. 166.
    Massar, E. L., Daly, J. M., Gopeland, E. M., Johnson, D. E., Voshenbach, A. C., Johnston, D., Rundell, B., and Dudrick, S. J., 1983, Peripheral vein complications in patients receiving amino acid/dextrose solutions, J. Parent. Ent. Nutr. 7:159–162.Google Scholar
  168. 167.
    Parsa, M. H., Habif, D. V., Ferren, J. M., Lipton, R., and Yoshimura, N. N., 1972, Intravenous hyperalimentation: Indications, technique and complications, Bull. NY Acad. Med. 48:920–942.Google Scholar
  169. 168.
    Daly, J. M. and Long, J. M., 1981, Intravenous hyperalimentation: Techniques and potential complications, Surg. Clin. North Am. 61:583-592PubMedGoogle Scholar
  170. 169.
    Broviac, J. W. and Scribner, B. H., 1974, Prolonged parenteral nutrition in the home, Surg. Gynecol. Obstet. 139:24–28.PubMedGoogle Scholar
  171. 170.
    Lees, C. D., Steiger, E., Hooley, R. A., Montaque, N., Srp, F., Gulledge, A. D., Wateska, L. P., and Frame, G., Home parenteral nutrition, Surg. Clin. North Am. 61:621–633.Google Scholar
  172. 171.
    Jeejeebhoy, K. N., Langer, B., Tsallas, G., Chu, R. C., Kukis, A., and Anderson, G. H., 1976 Total parenteral nutrition at home: Studies in patients surviving 4 months to 5 years. Gastroenterology 71:943-953.PubMedGoogle Scholar
  173. 172.
    Begala, J. E., Maher, K., and Cherny, J. D., 1982, Risk of infection associated with the use of Broviac and Hickman Catheters, Am. J. Infect. Cont. 10:17–23.Google Scholar
  174. 173.
    Thomas, J. H., Marthur, R. I., Pience, G. E., and Hermreck, A. S., 1980, Hickman-Broviac catheters. Indications and results. Am. J. Surg. 140:791-796.PubMedGoogle Scholar
  175. 174.
    Kaufman, J. L., Rodriquez, J. L., Madden, S. A., et. al., 1986, Clinical experience with the multiple lumen central venous catheter, J. Parent. Ent. Nutr. 10:487–489.Google Scholar
  176. 175.
    Shils, M. E., Burke, A. W., Greene, H. L., Jeejeebhoy, K. N., Prasad, A. S., and Sandstead, H. H., 1979, Guidelines for essential trace element preparations for parenteral use: A statement by an expert panel, JAMA 241:2051–2054.Google Scholar
  177. 176.
    Kartinos, N. J., 1978, Trace element formulations, in: Advances in Parenteral Nutrition (I. D. A. Johnston, ed.). University Park Press, Baltimore, pp. 233–240.Google Scholar
  178. 177.
    Parrish, G., Gibney, A., and Ethel, L., 1982, Total parenteral nutrition: An update, Nutr. Support Serv. 2:9–17.Google Scholar
  179. 178.
    Orme, J. F. and Glemmer, T. P., 1983, Nutrition in the critical care unit, Med. Clin. North Am. 67:1295–1304.PubMedGoogle Scholar
  180. 179.
    Smith, R. C., Burkinshaw, L., and Hill, G. L., 1982, Optimal energy and nitrogen intake for gastroenterological patients requiring intravenous nutrition, Gastroenterology 82:445–452.PubMedGoogle Scholar
  181. 180.
    Fink, R. I., Kolterman, O. G., Giffm, J., and Olefsky, J. M., 1983, Characterization of the insulin resistance of aging, J. Clin. Invest. 71:1523–1535.PubMedGoogle Scholar
  182. 181.
    Rowe, J. W., Minaker, K. L., Pallotta, J. A., and Flier, J. S., 1983, Mechanisms of insulin resistance in aging, J. Clin. Invest. 71:1581–1587.PubMedGoogle Scholar
  183. 182.
    Askanazi, J., Rosenbaum, S. H., Hyman, A. I., Silverberg, P. A., Milic-Emili, J., and Kinney, J. M., 1980, Respiratory changes induced by the large glucose loads of total parenteral nutrition, JAMA 243:1444-1447.PubMedGoogle Scholar
  184. 183.
    Silberman, H. and Silberman, A. W., 1986, Parenteral nutrition, biochemistry and respiratory gas exchange, J. Parent Ent. Nutr. 10:151–154.Google Scholar
  185. 184.
    Weissman, C., Askanazi, R., Rosenbaum, S. H., Hyman, A. I., Milic-Emili, J., and Kinney, J. M., 1983, Amino acids and respiration, Ann. Intern. Med. 98:41–44.PubMedGoogle Scholar
  186. 185.
    Covelli, H. D., Black, J. W., Olsen, M. S., and Beekmen, J. F., 1981, Respiratory failure precipitated by high carbohydrate loads, Ann. Intern. Med. 95:579–581.PubMedGoogle Scholar
  187. 186.
    Askanazi, J., Elwyn, D. H., Silverberg, P. A., Rosenbaum, S. H., and Kinney, J. M., 1980, Respiratory distress secondary to a high carbohydrate load: A case report. Surgery 87:596–598.PubMedGoogle Scholar
  188. 187.
    Sheldon, G. F., Peterson, S. R., and Sanders, R., 1978, Hepatic dysfunction during hyperalimentation. Arch. Surg. 113:504–508.PubMedGoogle Scholar
  189. 188.
    Buzby, G. P., Mullen, J. L., Stein, T. P., and Rosato, E. F., 1981, Manipulation of TPN caloric substrate and fatty infiltration of the liver, J. Surg. Res. 31:46–54.PubMedGoogle Scholar
  190. 189.
    Gilder, H., 1986, Parenteral nourishment of patients undergoing surgical or traumatic stress. J. Parent. Ent. Nutr. 10:88-99.Google Scholar
  191. 190.
    Palham, L. D., 1981, Rational use of intravenous fat emulsions. Am. J. Hosp. Pharm. 38:198–208.Google Scholar
  192. 191.
    Mequid, M. M., Shimmel, E., Johnston, W. C., Mequid, V., Lowell, B. D., Bourinski, J., and Nasbeth, D. C., 1982, Reduced metabolic complications in total parenteral nutrition: Pilot study using fat to replace one third of glucose calories, J. Parent. Ent. Nutr. 6:304–307.Google Scholar
  193. 192.
    Dworkin, B., Daly, J., Massar, E., Alcock, N., Dudrick, S. J., and Copeland, E. M., 1983, Intravenously administered amino acids with either dextrose of lipid as nutritional support in surgical patients, Surg. Gynecol. Obstet. 156:577–581.PubMedGoogle Scholar
  194. 193.
    Maie, J., Smith, R. C., and Hill, G. L., 1981, Glucose or fat as a nonprotein energy source: A controlled trial in gastroenterological patients requiring intravenous nutrition. Gastroenterology 80:103–107.Google Scholar
  195. 194.
    Jeejeebhoy, K. N., Anderson, G. H., Nakhooda, A. F., Greenbert, G. R., Sanderson, I., and Marliss, E. B., 1976, Metabolic studies in total parenteral nutrition with lipid in man: Comparison with glucose, J. Clin. Invest. 57:125–136.Google Scholar
  196. 195.
    Wolfe, B. M., Gulebras, J. M., Sim, A.J. W., Ball, M. R., and Moore, F. D., 1977, Substrate interaction in intravenous feeding: Comparative effects of carbohxdrate and fat on amino acid utilization in fasting man, Ann. Surg. 186:518–540.PubMedGoogle Scholar
  197. 196.
    Rossner, S., Johansson, L., Wallidus, G., and Aly, A., 1979, Intralipid clearance and lipoprotein pattern in men with advanced alcoholic liver cirrhosis. Am. J. Clin. Nutr. 32:2022–2026.PubMedGoogle Scholar
  198. 197.
    Kaminski, M. V., Abrahamian, V., Chroysomilides, S. A., Nasr, N. J., Armstrong, M. K., and Lynch, D. M., 1983, Comparative study of clearance of 10% and 20% fat emulsion, J. Parent. Ent. Nutr. 7:126–130.Google Scholar
  199. 198.
    Adamkin, D. H., Gelke, K. N., and Andrews, B. F., 1984, Fat emulsions gand hypertriglyceridemia, J. Parent. Ent. Nutr. 8:563–567.Google Scholar
  200. 199.
    Muscanitoli, M., Cangiano, C., Cascino, A., et al., 1986, Exogenous lipid clearance in compensated liver cirrhosis, J. Parent. Ent. Nutr. 10:599–603.Google Scholar
  201. 200.
    American Medical Association Department of Foods and Nutrition, 1975, Multivitamin preparations for parenteral use: A statement of the nutrition advisory group, J. Parent. Ent. Nutr. 3:258–262.Google Scholar
  202. 201.
    Robinson, L. A., Mabry, C. D., and Wright, B. T., 1982, Vitamin regimens in parenteral nutrition: A dilemma, J. Parent. Ent. Nutr. 8:563-567.Google Scholar
  203. 202.
    Yearick, E. S., Wang, M. S. L., and Pisias, S. J., 1980, Nutritional status of the elderly: Dietary and biochemical findings, J. Gerontol. 35:663–67.PubMedGoogle Scholar
  204. 203.
    O’Hanlon, P. and Kohrs, M. B., 1973, Dietary studies of older Americans, Am. J. Clin. Nutr. 31:1257–1269.Google Scholar
  205. 204.
    Kerr, G. R., Lee, E. S., Lamm, M. M., Lorimar, R. J., Randall, E., Forthofer, R. N., David, M. A., and Magnetti, S. M., 1982, Relationships between dietary and biochemical measures of nutritional status in Hanes I data, Am. J, Clin. Nutr. 35:294–308.Google Scholar
  206. 205.
    Baker, H., Frank, O., Third, I. S., Jaslow, S. P., and Louria, D. B., 1979, Vitamin profiles in elderly persons living at home or in nursing homes versus profile in healthy young subjects, J. Am. Geriatr. Soc. 27:444–450.PubMedGoogle Scholar
  207. 206.
    Nordstrom, J. W., 1982, Trace mineral nutrition in the elderly. Am. J. Clin. Nutr. 36:788–795.Google Scholar
  208. 207.
    Takagi, Y., Okada, A., Itakura, T., et al., 1986, Clinical studies on zinc metabolism during total parenteral nutrition as related to zinc deficiency, J. Parent. Ent. Nutr. 10:195–202.Google Scholar
  209. 208.
    Labbe, R. F., Rettmer, R. L., 1987, Laboratory monitoring of nutritional support, Nutr. Int. 3:1–5.Google Scholar
  210. 209.
    Datou, M. J., Schepers, G., Gee, J. P., Alberts, C. C., Eckhauser, F. E., and Kirking, D. M., 1984, Consultative total parenteral nutrition teams: The effect on the incidence of total parenteral nutrition-related complications, J. Parent. Ent. Nutr. 8:146–152.Google Scholar
  211. 210.
    Nehme, A. E., 1980, Nutritional support of the hospitalized patient: The team concept, JAMA 243:1906–1908.PubMedGoogle Scholar
  212. 211.
    Williams, W. W., 1985, Infection control during parenteral nutrition therapy, J. Parent. Ent. Nutr. 9:735–746.Google Scholar
  213. 212.
    O’Brien, D. D., Hodges, R. E., Day, A., et al, 1986, Recommendations of nutrition support team promote cost containment, J.Parent. Ent. Nutr. 10:300–302.Google Scholar
  214. 213.
    Smith, A. E., Powers, C. A., Cooper-Meyer, R. A., et al, 1986, Improved nutritional management reduces length of hospitalization in intractable diarrhea, J. Parent Eni Nutr. 10:479–481.Google Scholar
  215. 214.
    Abel, R. M., Fisch, D., and Grossman, M. L., 1983, Hemodynamic effects of intravenous 20% soy oil emulsion following coronary bypass surgey, J. Parent Ent Nutr. 7:534–540.Google Scholar
  216. 215.
    Lindeman, R. D. and Papper, S., 1975, Therapy of fluid and electrolyte disorders, Ann. Intern. Med. 82:64-70.PubMedGoogle Scholar
  217. 216.
    Shils, M. E., 1980, Magnesium, in: Modern Nutrition in Health and Disease (R. S. Goodhart and M. E. Shils, eds.). Lea & Febiger, Philadelphia, pp. 310-323.Google Scholar
  218. 217.
    Commerford, P. J. and Lloyd, E. A., 1984, Arrhythmias in patients with drug toxcity, electrolyte and endocrine disturbances, Med. Clin. North Am. 68:1051–1078.PubMedGoogle Scholar
  219. 218.
    Knöchel, J. P., 1987, Etiologies and management of potassium deficiency, Hosp. Pract 22:153–162.Google Scholar
  220. 219.
    Agus, Z. S. and Goldfarb, S., 1981, Clinical disorders of calcium and phosphate, Med. Clin. North Am. 65:385–399.PubMedGoogle Scholar
  221. 220.
    Darsee, J. R. and Nutter, D. O., 1978, Reversible severe congestive cardiomyopathy in three cases of hypophosphatemia, Ann. Intern. Med. 89:867–870.PubMedGoogle Scholar
  222. 221.
    Flemming, C. R., Lie, J. T., Mall, J. T., O’Brien, J. F., Baillie, E. E., and Thistle, J. L., 1982, Selenium deficiency and fatal cardiomyopathy in a patient on home parenteral nutrition. Gastroenterology 83:689–693.Google Scholar
  223. 222.
    Johnson, R. A., Baker, S. S., Fallon, J. T., Maynard, E. P., Ruskin, J. N., Wen, Z., Ge, K., and Cohen, H. J., 1981, An occidental case of cardiomyopathy and selenium deficiency, N. Engl. J. Med. 304:1210-1212.PubMedGoogle Scholar
  224. 223.
    Levander, O. A., Bank, R. F., 1986, Report on the 1986 A.S.P.E.N. research workshop on selenium in clinical nutrition, J. Parent. Ent. Nutr. 10:545–549.Google Scholar
  225. 224.
    Sandstead, H.H., 1980, Clinical manifestations of certain classical defiency diseases, in: Modern Nutrition in Health and Disease (R. S. Goodhart and M. E. Shils, eds.). Lea & Febiger, Philadelphia, pp. 685–696.Google Scholar
  226. 225.
    Galambos, J. T., Hersh, T., Fulenwider, J. T., Ansley, J. D., and Rudman, D., 1979, Hyperalimentation in alcoholic hepatitis. Am. J. Gastroenterol. 72:535–541.PubMedGoogle Scholar
  227. 226.
    Abel, R. M., Beck, C. H., Abbott, W. M., Ryan, J. A., Barnett, G. O., and Fischer, J. E., 1973, Improved survival from acute renal failure after treatment with intravenous essential 1-amino acids and glucose, N. Engl. J. Med. 288:695–699.PubMedGoogle Scholar
  228. 227.
    Feinstein, E. I., Blumenkrantz, M. J., Healy, M., Koffler, A., Silberman, H., Massry, S. G., and Kopple, J. D., 1981, Clinical and metabolic responses to parenteral nutrition in acute renal failure: A controlled double-blind study. Medicine 60:124–137.PubMedGoogle Scholar
  229. 228.
    Bosch, J. P., Saccaggi, A., Lauer, A., Ronco, C., Belledonne, M., and Glabman, S., 1983, Renal functional reserve in humans: Effect of protein intake on glomerular filtration, Am. J. Med. 75:943–950.PubMedGoogle Scholar
  230. 229.
    Ryan, J. A., Abel, R. M., Abbott, W. M., Hopkins, C. C., Chesney, T. M., Cooley, R., Phillips, K., and Fischer, J. E., 1974, Catheter complications in total parenteral nutrition: A prospective study of 200 consecutive patients, N. Engl. J. Med. 290:757–761.PubMedGoogle Scholar
  231. 230.
    Jones, K. W., Seltzer, M. H., Slocum, B. A., Cataldi-Betcher, E. L., Goldberger, D. J., and Wright, F. R., 1984, Parenteral nutrition complications in a voluntary hospital, J. Parent. Ent. Nutr. 8:385–390.Google Scholar
  232. 231.
    Snydman, D. R., Pober, B. R., Murray, S. A., Gorbea, H. F., Majka, J. A., and Perry, L. K., 1982, Predictive value of survellance skin cultures in total parenteral nutrition related infection. Lancet 2:1385–1388.PubMedGoogle Scholar
  233. 232.
    Faubion, W. C., Wesley, F. R., Khalidi, N., et al, 1986, Total parenteral nutrition catheter sepsis: Impact of the team approach, J. Parent. Ent. Nutr. 10:642–645.Google Scholar
  234. 233.
    Kavacevich, D. S., Faubian, W. C., Bender, J. M., et al, 1986, Association of parenteral nutrition catheter-sepsis with urinary tract infections, J. Parent Ent. Nutr. 10:639–641.Google Scholar
  235. 234.
    Petersen, F. B., Cliff, R. A., Hickman, R. O., et al, 1986, Hickman catheter complications in marrow transplant recipients, J. Parent. Ent. Nutr. 10:58-62.Google Scholar
  236. 235.
    Weinsier, R. L., Bacon, J., and Butterworth, C. E., 1982 Central venous alimentation: A prospective study of the frequency of metabolic abnormalities among medical and surgical patients, J. Parent. Ent. Nutr. 6:421-425.Google Scholar
  237. 236.
    Dudrick, S. J., Maadyen, B. V., Vauren, C. T., Ruberg, R. L., and Maynard, A. T., 1972, Parenteral hyperalimentation: Metabolic problems and solutions, Ann. Surg. 176:259–264.PubMedGoogle Scholar
  238. 237.
    Maie, J., Yule, A. G., and Hill, G. L., 1981, Effect of added insulin on body composition of gastroenterologic patients receiving intravenous nutrition-A controlled clinical trial. Gastroenterology 81:285–289.Google Scholar
  239. 238.
    Batuman, V., Dreisback, A., Maesaka, J. K., Rothkopf, M., and Ross, E., 1984, Renal and electrolyte effects of total parenteral nutrition, J. Parent. Ent. Nutr. 8:546–551.Google Scholar
  240. 239.
    Heird, W. C., Dell, R. B., Driscoll, J. M., Greblin, B., and Winters, R. W., 1972, Metabolic acidosis resulting from intravenous alimentation mixtures containing synthetic amino acids, N. Engl. J. Med. 287:943–948.PubMedGoogle Scholar
  241. 240.
    Kushner, R. F., 1986, Total parenteral nutrition-associated metabolic acidosis, J. Parent. Ent. Nutr. 10:306–310.Google Scholar
  242. 241.
    Buckalew, V. M., 1986, Hyponatremia: Pathogenesis and management, Hosp. Pract. 21:49–58.Google Scholar
  243. 242.
    Riella, M. C., Broviac, J. W., Wells, M., and Scribner, B. H., 1975, Essential fatty acid defiency in human adults during total parenteral nutrition, Ann. Intern. Med. 83:786–789.PubMedGoogle Scholar
  244. 243.
    Connor, W. E., 1975, Pathogenesis and frequency of essential fatty acid deficiency during total parenteral nutrition, Ann. Intern. Med. 83:895-896.PubMedGoogle Scholar
  245. 244.
    Lindor, K. D., Chem, B., Fleming, C. R., Abrams, A., and Hirschkorn, M. A., 1979, Liver function values in adults receiving total parenteral nutrition, JAMA 241:2398–2400.PubMedGoogle Scholar
  246. 245.
    Capron, J. P., Herve, M. A., Gineston, J. L., and Braillon, A., 1983, Metronidazole in prevention of cholestasis associated with total parenteral nutrition, Lancet 1:446–447.PubMedGoogle Scholar
  247. 246.
    Matuchansky, C., Morichau-Beauchant, M., Druart, F., and Tapin, J., 1981, Cyclic (nocturnal) total parenteral nutrition in hospitalized adult patients with severe digestive diseases, Gastroenterology 81:433–437.PubMedGoogle Scholar
  248. 247.
    Robertson, J. F. R., Garden, O. J., and Shenkin, A., 1986, Intravenous nutrition and hepatic dysfunction, J. Parent. Ent. Nutr. 10:172–176.Google Scholar
  249. 248.
    Lambert, J. R., Thomas, S. M., 1985, Metronidazole prevention of serum liver enzyme abnormalities during total parenteral nutrition, J. Parent. Ent. Nutr. 9:501–503.Google Scholar

Copyright information

© Plenum Publishing Corporation 1988

Authors and Affiliations

  • Brad M. Dworkin
    • 1
  1. 1.Section of Nutrition, The Sarah C. Upham Division of Gastroenterology, Department of MedicineNew York Medical CollegeValhallaUSA

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