Parenteral food

Description:

Artificial nutrition (enteral or parenteral) is shown to the patients who is not receiving food for 7–10 days and also when independent food is not enough for maintenance of the normal nutritious status.

Parenteral food is applied at impossibility or insufficiency of natural food.

The purpose of parenteral food is providing an organism with plastic materials, energy resources, electrolytes, microelements and vitamins.

Need for parenteral food is connected with a catabolic orientation of exchange at traumatic injuries, diseases of internals, heavy infectious processes and to the postoperative period. Expressiveness of catabolic reaction is directly proportional to weight of defeat or a disease.

At any injury there can be frustration of a hemodynamics and breath leading to a hypoxia, disturbance of water and electrolytic balance, an acid-base state, hemostasis and rheological properties of blood. At the same time at a stress through a hypophysis, bark of adrenal glands, a thyroid gland standard metabolism is stimulated, power consumption increases, disintegration of carbohydrates and proteins amplifies.

Glucose reserves in the form of a glycogen (in muscles and a liver) at starvation quickly (in 12–14 hours) are exhausted, then there is a splitting of own protein to amino acids which in a liver will be transformed to glucose. This process (gluconeogenesis) is uneconomical (from 100 g of protein 56 g of glucose are developed) and leads to bystry loss of protein.

Big losses of protein negatively influence reparative processes, immunity and create conditions for development of complications. Insufficiency of food at surgical patients leads to increase in postoperative complications by 6 times, and a lethality – by 11 times (G.P.Buzby and J.L.Mullen, 1980).

Indications to parenteral food can be conditionally united in 3 groups: primary therapy at which influence of food on the disease which was a cause of infringement of the nutritive status is supposed; the maintenance therapy at which nutritive support is provided, but is absent influence on a cause of illness; indications which are in a studying stage (J.E. Fischer, 1997).

Primary therapy:

Efficiency is proved (Randomized prospective researches are conducted.)

1. Intestinal fistulas;

2. Renal failure (acute tubular necrosis);

3. A syndrome of short intestines (After an extensive enterectomy appoint full parenteral food, then carry out enteral feeding in small amounts to accelerate adaptation of intestines to a resection. At preservation only 50 cm of a small bowel, anastomozirovanny with the left half of a colon apply parenteral food is long, sometimes for life, but some patients in 1-2 years have a sharp hypertrophy of an intestinal epithelium that forces to refuse parenteral food (M.S. Levin, 1995).);

4. Burns;

5. A liver failure (an acute decompensation at cirrhosis).

Efficiency is not proved (Randomized prospective researches are conducted.)

1. A disease Krone (At a disease Krone with defeat of a small bowel full parenteral food is led to remission at most of patients. For lack of perforation of intestines the frequency of remission makes 80% (including long - 60%). The probability of closing of fistulas makes 30-40%, usually the effect is steady. At nonspecific ulcer colitis and a disease the Krone with damage of a large intestine full parenteral food has no advantages before standard practice of food.);

2. Nervous anorexia.

Maintenance therapy:

Efficiency is proved (Randomized prospective researches are conducted.)

1. Acute radiation enteritis;

2. Acute intoxication at chemotherapy;

3. Intestinal impassability;

4. Recovery of the nutritive status before surgical interventions;

5. Extensive surgical interventions.

Efficiency is not proved (Randomized prospective researches are conducted.)

1. Before heart operations;

2. Long respiratory support.

Indications in a studying stage:

1. Oncological diseases;

2. Sepsis.

There are no absolute contraindications to use of parenteral food.

After detection of indications to parenteral food it is necessary to calculate necessary components for adequate correction of a metabolic cost, the choice of optimum solutions for injection on the basis of definition of need for protein, fats, carbohydrates, vitamins, microelements and water.