Administration Of Amino Acid Solution Research Articles

Early versus late administration of amino acids in preterm infants receiving parenteral nutrition.

Observational studies in preterm newborns suggest that delay in administering amino acids could result in a protein catabolic state and could impact on growth and development. To determine the effect of early administration of amino acids in premature newborns on growth, neurodevelopmental outcome, mortality and clinically important side effects. The standard search strategy of the Neonatal Review Group as outlined in The Cochrane Library was used. Relevant randomised controlled trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2012 I ssue 9 ), MEDLINE, EMBASE and CINAHL from their earliest dates to September 2012. The trial registry portal of the World Health Organization's International Cilinical Trial Registry Platform and ClinicalTrials.gov (US National Institute of Health) was searched to identify ongoing and completed but unpublished studies. Randomised controlled trials comparing early administration of amino acids with late administration in premature newborn infants were included. Early administration of amino acid solution was defined as the administration of amino acids in isolation or with total parenteral nutrition within the first 24 hours of birth; late initiation was defined as the administration of amino acids in isolation or with total parenteral nutrition after the first 24 hours of birth. The primary outcome measures were growth, neurodevelopmental outcome and mortality at 28 days. The secondary outcomes were biochemical abnormalities, sepsis and mortality. Both review authors independently selected trials, assessed trial quality and extracted data from the included studies. We contacted authors for further information. Fixed-effect analyses were performed. The treatment effect was expressed as mean difference for continuous variables and as risk difference and risk ratio for dichotomous variables. All results included 95% confidence intervals (CIs). Seven randomised controlled trials were included in this review. One randomised controlled trial reported no difference in crown-heel length and occipitofrontal head circumference by day 10. Four trials that enrolled 93 premature infants showed positive nitrogen balance (The mean difference with 95% CI was 250.42 (224.91 to 275.93 P value < 0.00001). Four trials showed a significant difference in the level of blood urea nitrogen (BUN) in the first 48 hours (P value < 0.00001). Early administration of amino acids did not result in metabolic acidosis in the first 24 hours. There is no available evidence of the benefits of early administration of amino acids on mortality, early and late growth and neurodevelopment. There is evidence from four randomised controlled trials included in this review that early administration of amino acids is associated with a positive nitrogen balance. The clinical relevance of this finding is not known. Acid-base status and ammonia levels were normal in the infants who received amino acids early. Given the small number of infants in the randomised controlled trials included in this review, the clinical heterogeneity among them, and the lack of data on important clinical outcomes, there is insufficient evidence to guide practice regarding the early versus late administration of amino acids to infants less than 37 weeks gestation.

90Y-Edotreotide for Metastatic Carcinoid Refractory to Octreotide

Metastatic carcinoid is an incurable malignancy whose symptoms, such as diarrhea and flushing, can be debilitating and occasionally life-threatening. Although symptom relief is available with octreotide, the disease eventually becomes refractory to octreotide, leaving no proven treatment options. The goal of this study was to evaluate the clinical effect of using (90)Y-edotreotide to treat symptomatic patients with carcinoid tumors. Patients enrolled had metastatic carcinoid, at least one sign/symptom refractory to octreotide, and at least one measurable lesion. Study treatment consisted of three cycles of 4.4 GBq (120 mCi) (90)Y-edotreotide each, once every 6 weeks. Ninety patients were enrolled in the study. Using Southwest Oncology Group tumor response criteria, 67 (74.%) of 90 patients (95% CI, 65.4% to 83.4%) were objectively stable or responded. A statistically significant linear trend toward improvement was demonstrated across all 12 symptoms assessed. Median progression-free survival was significantly greater (P = .03) for the 38 patients who had durable diarrhea improvement than the 18 patients who did not (18.2 v 7.9 months, respectively). Adverse events (AEs) were reported in 96.7% (87 of 90) of patients. These AEs consisted primarily of reversible GI events (76 of 90), which could be caused in part by concomitant administration of amino acid solution given to reduce radiation exposure to the kidneys. There was one case each of grade 3 oliguria and grade 4 renal failure, each lasting 6 days. (90)Y-edotreotide treatment improved symptoms associated with malignant carcinoid among subjects with no treatment alternatives. Treatment was well-tolerated and had an acceptable expected AE profile.

Role of amino acid infusion in delayed recovery from neuromuscular blockers

This case report highlights the anaesthetic management of a patient who had residual muscle paralysis following neuromuscular blockade, which was attributed to hypothermia and corrected by administration of amino acid solution. The various causes of residual neuromuscular blockade should be considered when treating such a patient. Amino acid infusion has been found to hasten the recovery from neuromuscular block due to vecuronium bromide aggravated by hypothermia.

Subacute toxicity test of AMI-U-II, a new amino acid solution for renal failure (author's transl)

Subacute toxicity test of AMI-U-II was carried out using male and female JCL:SD rats. The animals were given intravenously AMI-U-II (80, 40 and 20ml/kg) or reference solution (80 and 40ml/kg) for five weeks. Tachypnea, depression of spontaneous activity, blepharoptosis and edema of face were observed in rats treated with AMI-U-II or reference solution at highest dose. Food consumptions and gaining body weight were slightly reduced in male of these animals, but water intakes were increased in both sexes. Autopsies of the animals which died during five weeks showed pulmonary congestion and/or edema, ascites and pleural effusion. Microscopically, hydropic degeneration of liver cells and dilation of renal tubules and Bowman's capsules were shown. It seems likely that most of these findings were caused by hypervolumic administration of amino acid solution.

Augmentation of urinary amylase output by excessive diuresis in rats and abolition of this phenomenon by pancreatectomy

Effects of diuresis on urinary amylase output were observed in control and pancreatectomized rats on the administration of tap water, glucose and amino acid solution. (1) Urine volume and urinary amylase output were increased as the concentration of glucose solution was increased. Amylase output in the urine revealed a positive correlation with the urine volume. (2) Augmentation of urinary amylase output was also observed in diuretic rats produced by the administration of amino acid solution. (3) Augmentation of urinary amylase output was not found in pancreatectomized rats, although the urine volume was more pronouncedly increased compared to control rats. (4) The urinary amylsae output revealed a positive correlation with the ratio of amylase clearance to creatinine clearance by the kidney in control rats, while the output remained unchanged over relatively wide range of the ratio in pancreatectomized rats. Above evidences indicated that urinary amylase output was significantly augmented by excessive diuresis and that the increased urinary amylase output originated from the pancreas

Further observations of epidemic diarrhea of the newborn: I. Observation of a biphasic type of clinical course II. Therapeutic measures including prophylactic and therapeutic use of gamma globulin

<h2>Summary</h2> In an outbreak of epidemic diarrhea of the newborn involving sixty-three infants, there were fifteen deaths. The incidence of the disease and the death rate were higher among the premature infants. In eleven instances a biphasic clinical course was encountered, in which after clinical and biochemical improvement there suddenly developed ominous symptoms with a state of collapse and death for eight of the infants. Control of the outbreak was not obtained until the entire department was closed to admissions and thoroughly cleaned before it was reoccupied. An etiologic bacterial agent was not discovered, and virologic studies could not be performed. Therapeutic measures included maintenance of hydration, correction ofacidosis, modification of feeding, and administration of amino acid solution, plasma, and whole blood. Neither sulfonamide nor penicillin therapy seemed to influence the clinical course of epidemic diarrhea of the newborn, and in a limited series the intramuscular administration of gamma globulin had no apparent prophylactic or therapeutic effect.