General hospitals mixed

If the GIT is functional and accessible, EN should be attempted. The indications for PN in the patient with liver failure are similar to those for general hospitalized patients. In most cases, PN in the patient with liver failure can be accomplished via the administration of standard mixed amino acids (Fig. 139-2). 

One potential problem in the parenteral nutrition of children with acute renal failure is the presence or absence of histidine from the mix. In the "Renal Failure Intravenous Diet" (Table 1) currently in use at the Massachusetts General Hospital (Freamine-E) histidine is not part of the mixture. 

If you have a class with biochemists, clearly the area of enzyme kinetics is practically mandatory. If biologists are mixed in with the biochemists, osmotic pressure is an important concept to cover carefully and a concept typically not well covered in general chemistry and in most physical chemistry texts or classes. A quick example what is a 2 Osmolar solution of sodium chloride Such concentration units are used when dispensing various saline solutions in hospitals. What is the origin of the unit A 1 M NaCl solution dissociates into two ions that would double the osmotic pressure of a non dissociating solute. Thus, the 1 M solution of NaCl becomes a 2 Osmolar solution. Other examples abound - the bursting pressure of a cell relates to the osmotic pressure of the serum in which the cell finds itself. 

When Japanese star anise was mixed into a commercially sold herbal tea, perhaps inadvertently consumption of the tea was associated with adverse events in 63 Dutch consumers (1). Their symptoms occurred 2-4 hours after they drank the tea and included general malaise, nausea, and vomiting. In 22 cases hospitalization was required, and 16 had generalized tonic-clonic seizures. All made a full recovery after withdrawal of the herbal tea. Anisatin is a non-competitive GABA receptor antagonist, which causes nervous system hyperactivity, and the authors believed that this mechanism explained the high rate of seizures in these patients. 

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