Intravenous nutrition vitamin

Figure 30-1 Consequences of inadequate mineral or trace element Intake. (From Shenfdn AfAHwood AIC.Troce e/ements and vitamins in adult intravenous nutrition. In Rombeau JL, Rolandelli RH, eds. Clinical nutrition Parenteral nutrition. Philadelphia WB Saunders Co, 2001 60-79.)...

The recommended provision of vitamin A to adults during intravenous nutrition (IVN), whether this is partial or total parenteral nutrition (TEN), is 1000 fig retinol. This is usually provided as retinol palmitate and is supplied either with other fat-soluble vitamins in a mixture dissolved in a fat emulsion for intravenous feeding or is designed to be compatible with a mixture of all vitamins suitable for addition to other water-soluble nutrients. 

Shenkin A. Vitamin and essential trace element recommendations during intravenous nutrition theory and practice. Proc Nutr Soc 1986 45 383-90. 

Vitamin D and its metabolites play an important role in the maintenance of extracellular calcium concentrations and in normal skeletal structure and mineralization. Vitamin D is necessary for the optimal absorption of calcium and phosphorus. On a worldwide basis, the most common cause of hypocalcemia is nutritional vitamin D deficiency. In malnourished populations, manifestations include rickets and osteomalacia. Nutritional vitamin D deficiency is uncommon in Western societies because of the fortification of miUc with ergocalciferol. " The most common cause of vitamin D deficiency in Western societies is gastrointestinal disease. Gastric surgery, chronic pancreatitis, small-bowel disease, intestinal resection, and bypass surgery are associated with decreased concentrations of vitamin D and its metabolites. Vitamin D replacement therapy may need to be administered by the intravenous route if poor oral bioavailability is noted. Decreased production of 1,25-dihydroxyvitamin D3 may occur as a result of a hereditary defect resulting in vitamin D-dependent rickets. It also can occur secondary to chronic renal insufficiency if there is insufficient production of the 1 -a -hydroxylase enzyme for the... 

Bradley, J.A., King, R.F., Schorah, C.J., and Hill, G.L., 1978. Vitamins in intravenous feeding a study of water-soluble vitamins and folate in critically ill patients receiving intravenous nutrition. The British Journal of Surgery. 65 492-494. 

By official action of the Society of Biological Chemists and the American Institute of Nutrition, vitamin B-6 is now the approved collective name for three closely related naturally occurring compounds with potential vitamin B-6 activity pyridoxine, pyridoxal, and pyridoxamine. FYridoxine is found largely in vegetable products, whereas the pyridoxal and pyridoxamine forms occur primarily in animal products. There is no information on the relative biological activity of the three compounds in man, but in rats they are equally active if given parenterally (injected intramuscularly or intravenously). 

Manufacture of vitamin C starts with the conversion of sorbitol to L-sorbose. Sorbitol and xyHtol have been used for parenteral nutrition following severe injury, bums, or surgery (246). An iron—sorbitol—citric acid complex is an intramuscular bematinic (247). Mannitol administered intravenously (248) and isosorbide administered orally (249) are osmotic diuretics. Mannitol hexanitrate and isosorbide dinitrate are antianginal dmgs (see Cardiovascular agents). 

Alimentary biotin deficiency is rare. It may, however, occur in patients on long-term parenteral nutrition lacking biotin or in persons who frequently consume raw egg white. Raw egg white contains a biotin-binding glycoprotein, called avidin, which renders biotin biologically unavailable. Pharmacological doses of the vitamin (1-10 mg/d) are then used to treat deficiency symptoms. There are no reports of toxicity for daily oral doses up to 200 mg and daily intravenous doses of up to 20 mg [2]. 

O Parenteral nutrition (PN), also called total parenteral nutrition (TPN), is the intravenous administration of fluids, macronutrients, electrolytes, vitamins, and trace elements for the purpose of weight maintenance or gain, to preserve or replete lean body mass and visceral proteins, and to support anabolism and nitrogen balance when the oral/enteral route is not feasible or adequate. 

PN should provide a balanced nutritional intake, including macronutrients, micronutrients, and fluid. Macronutrients, including amino acids, dextrose, and intravenous lipid emulsions, are important sources of structural and energy-yielding substrates. A balanced PN formulation includes 10% to 20% of total daily calories from amino acids, 50% to 60% of total daily calories from dextrose, and 20% to 30% of total daily calories from intravenous lipid emulsion. Micronutrients, including electrolytes, vitamins, and trace elements, are required to support essential biochemical reactions. Parenteral... 

When the alcoholic first presents for treatment, his/her nutritional status should be fully assessed. Vitamin supplementation should always be a component of this treatment. In the emergency room setting, the alcoholic patient usually receives intravenous fluids containing magnesium, thiamine, and multivitamin supplements. The yellow-colored fluid is commonly called a banana bag or rally pack. A daily... 

Gerlach, T., Biesalski, H. K., Weiser, H., Haeussermann, B., and Baessler, K. H. (1989). Vitamin A in parenteral nutrition Uptake and distribution of retinyl esters after intravenous application. Am. ]. Clin. Nutr. 50,1029-1038. 

Inadequate nutrition and conditions which are complicated by malabsorption may lead to thiamine deficiency. Beriberi, a diet-deficiency disease, is especially prevalent in those parts of the East where the diet consists mainly of polished rice. The disease is characterized by neuritis but may also lead to serious heart failure. Recovery is prompt when adequate amounts of vitamin B1 are restored to the diet. Severe deficiency as can occur in alcoholics may lead to Wernicke s encephalopathy, often accompanied by Korsakoff s syndrome. Care should be taken with intravenous substitution with thiamine in these cases to prevent serious complications like vascular collapse with hypotension, respiratory distress or an-gioedema. 

Severe negative nitrogen balance may occasionally have to be corrected by hyperalimentation or total parenteral nutrition (TPN). Intravenous solutions used in TPN contain essential and nonessential amino acids, plus a source of calories in the form of fat and carbohydrate. They "spare" the administered amino acids and allow them to be used for tissue repair. The TPN fluid must also contain all other nutritional factors required for life, including essential fatty acids, vitamins, and minerals. Severe metal and essential fatty acid deficiencies have been observed in situations in which such inclusions had not been made. 

Choline, supplied as dietary PC or as free choline, is required in the diet by rats. Although it has not been established that choline is required by humans, it is probably an essential nutrient and may, in the future, be classified as an essential amine or vitamin, Its possible requirement is a concern to clinicians feeding patients by total parenteral nutrition (TpN), In this type of feeding, which may be used for a year or longer, the patient is sustained intravenously with an artificial, chemically defined diet. The choline in foods occurs mainly as PC rather than as free choline. PC is a more desirable dietary component because, when free choline is consumed in large amounts, it is degraded by the gut bacteria to produce trimethylamine, an odoriferous compound (Magil et ai, 1981). 

Many medicinal agents which have an unpalatable taste or texture can be made more acceptable for oral administration when formulated as emiflsions. Mineral-oil-based laxatives, oil soluble vitamins and high-fat nutritive preparations are frequently administered in the form of o/w emulsions. It has been shown that in some cases the absorption of drugs may be enhanced if formrJated as emulsions. Emulsions (o/w) have also been used for the intravenous administration of lipid nutrients. Radiopaque emulsions have been used as diagnostic agents in X-ray examinations. 

These various reports stress the need to supplement parenteral nutrition with thiamine-containing vitamins unless there is adequate dietary intake, and to monitor serum thiamine and erythrocyte transketolase activity so that supplementary thiamine can be given in good time, if necessary intravenously (45). Giving thiamine will not rectify the various disorders if hepatic function is severely disturbed, because then thiamine is not phosphorylated and hence remains physiologically inactive. 

A 13-year-old boy underwent bone marrow transplantation and received parenteral nutrition without vitamins. After 15 days he had acute life-threatening lactic acidosis refractory to bicarbonate and Tris. Intravenous thiamine 100 mg produced satisfactory clinical and biochemical responses. 

Tocopherols (vitamin E) occur in many food substances that are consumed as part of the normal diet. The daily nutritional requirement has not been clearly defined but is estimated to be 3.0-20.0 mg. Absorption from the gastrointestinal tract is dependent upon normal pancreatic function and the presence of bile. Tocopherols are widely distributed throughout the body, with some ingested tocopherol metabolized in the liver excretion of metabolites is via the urine or bile. Individuals with vitamin E deficiency are usually treated by oral administration of tocopherols, although intramuscular and intravenous administration may sometimes be used. 

In pharmaceutical preparations, soybean oil emulsions are primarily used as a fat source in total parenteral nutrition (TPN) regimens. Although other oils, such as peanut oil, have been used for this purpose, soybean oil is now preferred because it is associated with fewer adverse reactions. Emulsions containing soybean oil have also been used as vehicles for the oral and intravenous administration of drugs drug substances that have been incorporated into such emulsions include amphotericin, " diazepam, retinoids, vitamins, poorly water-soluble steroids, fluorocarbons, and insulin. In addition, soybean oil has been used in the formulation of many drug delivery systems such as liposomes, microspheres, dry emulsions, self-emulsifying systems, and nanoemulsions and nanocapsules. ... 

PN solutions should provide the optimal combination of macronutrients and micronutrients to meet the specific nutritional requirements of the patient. Macronutrients include water, protein, dextrose, and intravenous lipid emulsion. Micronutrients include vitamins, trace elements, and electrolytes. Both macronutrients and micronutrients are necessary for maintenance of normal metabolism. In general, macronutrients are used for energy (dextrose and fat) and as structural... 

Thiamine, also known as vitamin B, is fairly ubiquitous. Thiamine deficiency is uncommon except in alcoholics as a result of nutritional deficiencies and malabsorption. The classic clinical triad of dementia, ataxia (difficulty with walking), and eye findings may be seen, but more commonly, only forgetfulness is noted. Sometimes, thiamine deficiency can lead to vague symptoms such as leg numbness or tingling. Because thiamine is water soluble, it can be added to intravenous fluids and administered in that way. Other manifestations include beri beri, which is cardiac involvement leading to a high cardiac output, and vasodilation. Affected patients often feel warm and flushed, and they can have heart failure. 

Preparations for total parenteral nutrition (TPN) are complex formulations intended for administration by the intravenous route. TPN preparations are formulated as aqueous solutions or hydrophilic (oil-in-water) emulsions they may contain amino acids, carbohydrates, fatty acids, emulsifiers, electrolytes, trace metals, vitamins, and minerals (Hutchinson, 1998 Trissel, 2001). In certain cases, drugs are added to the preparations prior to administration. The environment is thus rather heterogeneous, and the photochemical stability of different components can vary from formulation to formulation and be hard to predict. It is necessary to perform experiments based on studies of the actual composition to obtain correct information concerning photostability of the formulation or components present. 

After infancy, coagulopathy due to dietary deficiency of vitamin K is extremely rare Vitamin K is present in many foods and also is synthesized by intestinal bacteria. Occasionally, the use of a broad-spectrum antibiotic may produce a hypoprothrombinemia that responds readily to small doses of vitamin K and reestablishment of normal bowel flora. Hypoprothrombinemia can occur in patients receiving prolonged intravenous alimentation. Patients on total parenteral nutrition should receive phylloquinone (1 mg/week, the equivalent of - 150 jig/day). 

Soya oil is an important source of dietary vitamin K, see Table 12.3 , (p.407). For two cases of warfarin resistance with intravenous soya oil emulsions, see Coumarins and related drugs + Foods Enteral and parenteral nutrition , p.406. 

Vitamins, intravenous solutions, and drugs used in nutrition Chapter 34... 

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