Parenteral Supplementation Research Articles

Role of postoperative intact serum PTH as an early predictor of severe post-thyroidectomy hypocalcemia: a prospective study.

Post thyroidectomy hypocalcemia is a major sequel of thyroidectomy and continues to trouble the endocrinologists and the endocrine surgeons as there is no ideal predictive marker of hypocalcemia which has the potential to develop into a life-threatening complication. The role of early serum intact parathormone (iPTH) to predict post thyroidectomy hypocalcemia is becoming useful but the literature is still unclear regarding the optimal time of testing and the optimal cut-off value of serum iPTH. This is a prospective cohort study of 111 patients who underwent total thyroidectomy in a tertiary care endocrine surgery referral unit. Serum iPTH was measured after 20min and 4h of surgery. Receiver-Operator characteristic Curve (ROC) was used to find out of the best cut-off value of S. iPTH 20min and 4h after surgery in predicting hypocalcemia. Hypocalcemia was noted in 60 (54%) out of 111 subjects who underwent total thyroidectomy. The best cut-off values of Serum iPTH to predict hypocalcemia was found to be 4.28pmol/l at 20min post total thyroidectomy with a sensitivity and specificity of 81.7% and 51%, respectively. In addition, patients with malignancy or central lymph nodal dissection were significantly over-represented in the hypocalcemia group with serum iPTH above the threshold level of 4.28pmol/l. Below the cut off level, parenteral calcium supplementation was required in 23% (17/74) subjects while the rate was only 5.4% (2/37) patients when serum iPTH was above the cut-off level. The decline of serum iPTH below a specific level after surgery has predictive value together with other factors strictly related to patient, the thyroid disease itself and surgery. The risk of development of hypocalcemia and consequent need for calcium supplementation should be evaluated by clinical assessment along with serum PTH measurement.

Daily parenteral selenium therapy in critically ill patients: An updated systematic review and meta-analysis of randomized controlled trials.

Patients hospitalized at the intensive care unit (ICU) are more prone to oxidative stress. Antioxidants such as selenium (Se) may have beneficial effects on outcomes in these patients. Studies and systematic reviews in this field have inconclusive results. An updated systematic search was done to find clinical trials published in PubMed, Cochrane's library, ISI web of Science, Scopus, and Ovid databases from January 1980 up to April 2020, to assess the effects of daily Se supplementation on patient's survival, hospital and ICU stay, duration of mechanical ventilation, infection, acute renal failure (ARF) occurrence and serum creatinine levels. From 1394 papers found in the first step of the search, after deleting duplicate findings, 24 studies were included in this meta-analysis. Results of the pooled random-effect size analysis of 24 trials showed no remarkable effect of daily parenteral Se administration on patient's hospital and ICU stay, duration of mechanical ventilation, infectious complications, ARF, survival and serum creatinine levels (p>0.05). The subgroup analysis showed that daily parenteral Se administration (in doses higher than 1000μg/d) increased the length of ICU stay by 4.48-folds (95%CI:-0.5, 9.46, p=0.07). Parenteral Se supplementation at the first and following dose of ≤1000μg reduced the number of ARF at the hospitalized patients by 76% and 45%, respectively (p=0.02, and p=0.05). High doses of Se increases days of ICU stay, but low doses decreases the number of ARF occurrence in ICU patients. More trials are needed to assess its effect on ARF occurrence.

Effects of oral cobalamin supplementation on serum cobalamin concentrations in dogs with exocrine pancreatic insufficiency: A pilot study

The objective of this retrospective study was to evaluate serum cobalamin concentrations before and after oral cobalamin supplementation in dogs with low serum cobalamin concentrations and exocrine pancreatic insufficiency (EPI). Eighteen dogs with serum trypsin-like immunoreactivities between <1.0−2.7 μg/L (reference interval, 5.2−35 μg/L) and serum cobalamin concentrations ≤350 ng/L (reference interval, 244–959 ng/L) were enrolled. All dogs were treated with oral cyanocobalamin according to a previously described protocol (0.25–1.0 mg daily, depending on bodyweight). Median (range) serum cobalamin concentrations at inclusion was 188 ng/L (<111−350 ng/L), which increased significantly to 1000 ng/L (794−2385 ng/L; P < 0.001) after cobalamin supplementation for 19−199 days (median, 41 days). Oral cobalamin supplementation is a potential alternative to parenteral supplementation in dogs with EPI.

Efficacy of ferumoxytol versus sodium ferric gluconate in anemia management in outpatient hemodialysis patients: Aprospective cohort study.

Intravenous iron is one of the main therapies for anemia management in hemodialysis-dependent patients. Data comparing the efficacy of ferumoxytol versus other parenteral iron supplements are scarce. The objective of the study was to compare the efficacy of ferumoxytol with that of sodium ferric gluconate in outpatient hemodialysis patients. A prospective, observational study was conducted in outpatients receiving ferumoxytol 510mg once or twice quarterly compared to sodium ferric gluconate 125mg weekly in a single center hemodialysis center in Ontario, Canada. Patient demographics, hemoglobin levels, iron indices, iron doses, and erythropoiesis-stimulating agent (ESA) doses were collected. The study sample consisted of 291 observations from 173 patients. Generalized estimating equations of multiple linear regression modeling were conducted to compare the outcomes while adjusting for baseline scores. Approximately 25% of the study participants received ferumoxytol while 75% received sodium ferric gluconate. Patients treated were mainly males (58.4%), and the mean age was 68.73 (SD±13.03) years. Both groups did not show significant differences in their hemoglobin levels (Wald z=0.54; p=0.46), ESA utilization at 3 months (Wald z=0.20; p=0.65), and TSAT levels (Wald z=3.45; p=0.06). However, the iron levels (Wald z=4.24; p=0.04) and ferritin levels (Wald z=5.14; p=0.02) were higher in the ferric gluconate group (Wald z=58.78; p≤0.001), and patients who received ferumoxytol received more blood transfusions as compared to those who received sodium ferric gluconate (χ2=16.71; p≤0.001). Both iron products maintained hemoglobin levels, but patients receiving ferumoxytol had lower iron indices and received more blood transfusions compared to patients who received sodium ferric gluconate.

Appetite Stimulants for Treatment of Protein Energy Wasting of Chronic Kidney Disease

Nutritional and metabolic abnormalities, or protein energy wasting, is a common complication of chronic kidney disease, leading to significant morbidity and mortality. The cause of these abnormalities is multifactorial, and therefore, difficult to treat. The International Society of Renal Nutrition and Metabolism suggests appetite stimulants, including megestrol, dronabinol, mirtazapine, and cyproheptadine, as adjunctive treatment options in addition to parenteral or oral nutritional supplementation. This article reviews the evidence for use of these drugs as appetite stimulants and discusses their use in patients with chronic kidney disease.

Effects of Parenteral Glutamine Supplementation on Endocan Levels in Septic Patients

Effects of Parenteral Glutamine Supplementation on Endocan Levels in Septic Patients

Treatment of anemia using parenteral iron supplements

Background. Anemia occurs in 30 % of women of childbearing age worldwide. The main causes of iron deficiency and iron deficiency anemia (IDA) are the decrease in iron intake from food (vegetarian diet, unbalanced diet, anorexia, eating disorders), impaired iron absorption (celiac disease, malabsorption, concomitant digestive diseases, drug use), blood losses (menstrual bleeding, childbirth, surgery, gastrointestinal bleeding, blood donation), and the increased need for iron (children and adolescents, pregnancy and lactation, endurance exercise). In the 3rd trimester of pregnancy, the need for iron is almost 10 times higher than in the 1st trimester (7.5 vs. 0.8 mg per day).&#x0D; Objective. To describe the treatment of anemia with parenteral iron supplements.&#x0D; Materials and methods. Analysis of literature sources on this topic.&#x0D; Results and discussion. Hemoglobin content &lt;90 g/l increases the risk of miscarriage, low birth weight and gestational age, premature birth, preeclampsia and eclampsia. Low hematocrit (&lt;29 %) is accompanied by an increase in the probability of growth retardation and fetal death. On the part of the pregnant woman, tolerance to physical activity worsens, the probability of heart failure increases (in severe anemia), the condition of the thyroid gland and wound healing deteriorates. Among children born to mothers with IDA, the probability of IDA is higher than among children born to mothers with normal hemoglobin levels (47.2 % vs. 6.5 %; Colomer I. et al., 1990). Childbirth deepens IDA due to blood loss. During vaginal childbirth or cesarean section 300-500 ml of blood is lost, in case of profuse bleeding – 500-1000 ml, and in case of profuse bleeding, uterus atony, and in case of the disseminated intravascular coagulation – 2-3 L or even more. Iron supplements are prescribed for the treatment of IDA. They can be divided into oral (iron salts, iron complexes, elemental iron) and parenteral. Pregnant women are recommended to take 60 mg of iron per day from the beginning of gestation (as early as possible) until the end of pregnancy, as well as during the first 3 months of lactation. Oral iron preparations have a number of side effects: constipation, diarrhea, heartburn, nausea, and epigastric pain. This causes unsatisfactory adherence: one in five women stops taking iron supplements. Polymaltose iron complex is tolerated slightly better than iron sulfate. In case of intolerance to oral drugs, intravenous iron may be prescribed. Its advantages include fast action and good efficiency. Drugs for intravenous administration are divided into iron preparations and iron complexes with carbohydrates (carboxymaltose, sucrose, dextran). The sucrose complex of iron allows to reach the maximum level of hemoglobin much faster than iron sulfate (6.6 against 9.4 weeks). According to German and French guidelines for the treatment of anemia in pregnant women, if the hemoglobin is reduced to &lt;90 g/l, IDA should be treated with intravenous iron. In the recommendations of the Asia-Pacific region, the threshold value is 100 g/l.&#x0D; Conclusions. 1. Insufficient iron levels before pregnancy and the increased need in iron during pregnancy justify the proactive assessment and correction of IDA in pregnant women. 2. In case of moderate anemia and early stages of pregnancy, normal iron levels can be restored before delivery with the help of oral medications. 3. Intravenous iron supplements normalize iron levels faster than oral ones.

Parenteral nutrition supplements

Parenteral nutrition supplements

The role of bioactive lipids in attenuating the neuroinflammatory cascade in traumatic brain injury

Traumatic brain injury (TBI) is a major cause of morbidity, mortality, and economic burden. Despite this, there are no proven medical therapies in the pharmacologic management of TBI. A better understanding of disease pathophysiology might lead to novel approaches. In one area of increasing interest, bioactive lipids known to attenuate inflammation might serve as an important biomarker and mediator of disease after TBI. In this review, we describe the pathophysiology of inflammation following TBI, the actions of endogenous bioactive lipids in attenuating neuroinflammation, and their possible therapeutic role in the management of TBI. In particular, specialized pro‐resolving lipid mediators (SPMs) of inflammation represent endogenous compounds that might serve as important biomarkers of disease and potential therapeutic targets. We aim to discuss the current literature from animal models of TBI and limited human experiences that suggest that bioactive lipids and SPMs are mechanistically important to TBI recovery, and by doing so, aim to highlight the need for further clinical and translational research. Early investigations of dietary and parenteral supplementation of pro‐resolving bioactive lipids have been promising. Given the high morbidity and mortality that occurs with TBI, novel approaches are needed.

PSVI-21 Effect of preconditioning pre-shipment and injectable antioxidant trace elements and vitamins on growth, antioxidant status, and plasma metabolites and insulin concentration in weaned beef cattle

Abstract The aim of this study was to evaluate the effect of weaning preconditioning and parenteral supplementation of minerals and vitamin on growth and plasma total antioxidant status (TAS), glucose, NEFA, and insulin concentrations, in calves at feedlot arrival. Sixty male Angus-cross calves were randomly assigned to 4 treatments (n=15/treatment). Treatments were arranged in a 2x2 factorial design; the main factors were mineral and vitamins supplementation (supplementation (S) vs no supplementation (NS)), and preconditioning (preconditioning (P) vs. not (NP)). Supplementation was applied subcutaneously on d -45, -26 and 0 and provided Cu, Mn, Se, Zn, and vitamins A and E (Adaptador Min-Vit ®, Biogénesis Bagó). Preconditioning consisted in a 26-day period between weaning and transportation at feedlot (d0) with the animals remaining in the same location. Blood samples were collected on d -26, 0 and 15. Animals were weighted on d-45, -26, 0, 8, 15 and 29. On d0 calves were load into a truck and drove for 5-hours to the feedlot. Data were analyzed using a mixed model as a 2x2 factorial, using repeated measurements. Body weight was greater on d 0, 8 15 and 29 group on groups NP, followed by S-P, and the lowest for NS-P (Triple interaction P &amp;lt; 0.01). Treatment did not affect (P ˃ 0.1) plasma insulin and glucose concentrations. There was a triple interaction (P &amp;lt; 0.08) for plasma TAS and NEFA concentration. Plasma TAS concentration was grater due to a decrease in its concentration for the S-P and NS-NP from d0 to d8, but not in the other treatments. Plasma NEFA concentration had the greater increase in the NP groups followed by S-NP on d0. In conclusion, 26-days precondition weaning decrease body weight compare with a traditional weaning. Mineral and vitamin supplementation in precondition weaning partially reduced that effect

Characteristics of Websites Presenting Parenteral Supplementation Services in Five European Countries: A Cross-Sectional Study.

We aimed to characterize the parenteral supplementation services in Czechia, Ireland, Italy, Poland, and the United Kingdom based on their websites. We generated a list of websites by searching Google using the term “vitamin infusion” and selected cities with 250,000 citizens from each analyzed country. All search inputs were performed using the native language. Data on the features of services, indications, contraindications, offered parenteral supplements, and social media activity were obtained. We analyzed 317 websites representing 371 active facilities. Only 6 (1.9%) facilities cited the scientific sources on parenteral supplementation, but these reference were highly biased; 17.4% did not provide information regarding their personnel, while 11.9% indicated the different contraindications. The most common indications were fatigue (62.5%), immunity enhancement (58.0%), anti-aging, and physical activity (51.5%). Approximately, 11.6% of facilities claimed that some parenteral supplements can help manage certain malignancies, while 2.2% claimed that they can help manage fertility problems. The most offered intravenous supplements were vitamins C (57.4%), B12 (47.7%), and B6 (42.3%). The parenteral supplementation market offers numerous ingredients as treatment for general health problems and serious health conditions. Many analyzed websites lacked essential information, which creates concerns for regarding the quality and reliability of the services.

Long-Term Eltrombopag for Bone Marrow Failure Depletes Total Body Iron

Eltrombopag (EPAG) is a non-peptide, thrombopoietin receptor agonist approved for several forms of thrombocytopenia, as well as severe aplastic anemia in first line (combined with immunosuppressive therapy) and refractory (single agent) settings. It is effective in moderate aplastic anemia and under investigation for myelodysplastic syndrome (MDS) and other marrow failure conditions. Although aplastic anemia (AA) patients often respond to EPAG and become drug-independent, this may take months to years, and some patients remain either continuously or intermittently EPAG-dependent. Previously, we and others have reported that EPAG chelates and mobilizes iron in a cohort of AA patients. We present a larger cohort of AA/MDS patients from 4 prospective clinical trials of EPAG, and report declining iron stores on extended EPAG therapy, including some patients developing frank iron deficiency anemia (IDA) responsive to oral or parenteral supplementation, and others normalizing prior severe iron overload during extended EPAG therapy. We report the kinetics of this effect and analyze its impact, if any, upon response and relapse. 317 patients were treated with EPAG for unilineage cytopenia, AA or MDS. 206 AA patients treated on non-EPAG protocols served as historical controls. Average follow-up was 42.9 months (2.2-206.7) for EPAG and 69.6 months (6.1-196) for controls. Average time on EPAG was 9.0 months (0.4-81.1); 73 patients (23.0%) were treated for ≥ 7 months. Average baseline serum ferritin (SF) was 1757 ng/mL (29-18977) for EPAG; 1628 ng/mL (14-8438) for controls (N.S.), with iron overload (SF ≥ 1000 ng/mL) in 56.5% of EPAG patients; 53.9% of controls (N.S.). On EPAG, serum iron (2x over baseline, P &amp;lt; 1.3 x 10-39) and transferrin saturation (85.1% of patients have 100% saturation) are elevated due to binding by EPAG, while serum ferritin (SF) does not correlate with iron or transferrin saturation. These effects resolve following EPAG therapy: iron is 15% lower than baseline (P = 5.1 x 10-5), median saturation is 40%, and SF and iron correlate. No such dissociation is noted for historical controls. This implies that SF is the most reliable measure of iron status while on EPAG due to its chelating properties. EPAG duration correlates with SF fold-reduction (R2 = 0.19, P &amp;lt; 4 x 10-14). SF levels during EPAG treatment follow first order (exponential) kinetics (R2 = 0.35, P &amp;lt; 2 x 10-20), with a clearance half-life of 15.3 months, independent of baseline SF. There is minimal correlation of treatment response with SF kinetics (P = 0.04). In comparison, historical responders demonstrate a significantly slower SF clearance (P &amp;lt; 8 x 10-10) with a half-life of 47.5 months. SF half-life on EPAG is comparable to that of chelators such as deferoxamine or deferasirox used for transfusion-related iron overload in AA/MDS. This similarity in kinetics and the fact that this effect is independent of treatment response (and thus transfusion burden) support a role for EPAG in actively depleting total body iron. Of 305 evaluable patients, 62 (9.8%) had iron-depletion as measured by ferritin. 30 (7.5%) were during EPAG treatment with a median time of 55.0 months. 11 (3.6%) of patients experienced falling hemoglobin or other signs of anemia. 9 started iron supplementation or discontinued EPAG, with improvement in the 5 patients who have had follow-up. Patients with EPAG-induced IDA follow the same kinetics (15.5-month half-life) as the general cohort. Logistic models do not predict response based upon either baseline ferritin or kinetics. Furthermore, neither logistic nor Kaplan-Meier models identify any timepoint ferritin, baseline iron overload, or kinetics as predictors of relapse risk. While iron and ferritin may be biomarkers of disease and transfusion burden, they do not appear to drive outcomes, and do not support the recent hypothesis that response of marrow failure to EPAG is based on iron chelation and reversal the toxic impact of intracellular iron on hematopoietic stem cells. Our data suggest a potential role for EPAG or its derivatives as iron chelators. More importantly, they demonstrate that EPAG can deplete iron stores, paradoxically requiring supplementation in previously overloaded patients. In addition to relapse, IDA should also be considered in responders on long term EPAG with declining hemoglobin. We recommend maintaining SF greater than 100 ng/mL so that these patients may continue this life-saving therapy. Figure 1 Disclosures Young: Novartis: Research Funding. Dunbar:Novartis: Research Funding.

Association between Pre-Infusion Laboratory Characteristics and Hematologic Response in Patients Treated for Iron-Deficiency at a Tertiary Care Center

Background :A panel of laboratory tests are used to diagnose iron deficiency anemia, including hemoglobin (Hb), mean cell volume (MCV), serum ferritin, total iron binding capacity (TIBC), and iron saturation (ISAT). Newer diagnostic biomarkers include reticulocyte hemoglobin (RHb). The association between these parameters and response to intravenous iron have not been well characterized. The aim of this study was to evaluate the associations between baseline laboratory values commonly used in diagnosis of iron-deficiency anemia and improvement in hemoglobin concentration (Hb). Methods :Data was collected retrospectively using The Ottawa Hospital Data Warehouse (OHDW) reflecting practices from 3 local institutions. Patients that received at least 1 intravenous iron infusion between 2007 and 2018 were included. Patients that received intravenous iron replacement with baseline hemoglobin and at least one hemoglobin measured after the last documented iron infusion were included. Patients transfused within 90 days of the last infusion were excluded. For patients that received more than one course of iron replacement, each course was included separately if the time between the last infusion of the earlier course and the first infusion of the later course were at least 180 days apart. The primary outcome was achieving a maximum change in Hb of ≥10 g/L after the last iron infusion. Logistic regression was used to measure the association between pre-infusion laboratory characteristics (Hb, mean cell volume [MCV], platelet and reticulocyte count, reticulocyte Hb, ferritin, total iron binding capacity [TIBC], and iron saturation [ISAT]), age, sex, and presence of chronic kidney disease (CKD[serum creatinine &amp;gt;177 µmol/L]) and the primary outcome. A multivariable logistic regression model was used to adjust for baseline characteristics and the primary outcome, adjusting for iron replacement characteristics. Results :Between 2007 and 2018, a total of 8326 patients were treated with intravenous iron replacement, of whom 7185 were not transfused 90 days before the last administered dose of iron. Baseline characteristics of these patients are summarized in Table 1. The median maximum post-infusion hemoglobin was 119 g/L (interquartile range [IQR] 107-30 g/L), with a median change from pre-infusion hemoglobin of 16 g/L (IQR 5-31). The maximum Hb was measured a median of 62 days (IQR 6-144 days) after the last infusion. Results of univariable (Table 2) and multivariable (Table 3) regression are shown in Tables 2 and 3, respectively. In the multivariable model, pre-infusion Hb was the only evaluated laboratory value associated with Hb response (OR 0.48 95% confidence interval (95%CI) 0.38-0.62, p&amp;lt;0.001). Presence of CKD (OR 0.35, 95%CI 0.19-0.66, p=0.001) and the number of infusions given per course (OR 1.33, 95%CI 1.15-1.53, p&amp;lt;0.001) were also associated with hematologic response. Conclusions:In this single-center, retrospective cohort of patients treated with intravenous iron replacement and not transfused red blood cells within 90 days of the last infusion, most evaluated baseline characteristics were not associated with achieving a ≥10 g/L improvement in Hb concentration. Baseline Hb concentration was associated with Hb response, with higher baseline Hb associated with a lower probability of a 'good' Hb response. The presence of CKD was also associated with lower chance of hematologic response. The study has several important limitations including the lack of diagnostic data relating to the need for iron infusions, concomitant oral supplementation, and potential infusions outside the study site. Pre-infusion laboratory values were missing for a large proportion of patients. The strengths of the study include the large sample size and broad inclusion criteria, allowing for increased generalizability. Further exploration of serum biomarkers in the prediction of hemoglobin responses in parenteral iron supplementation is warranted in prospective studies with scheduled laboratory measurements. Disclosures No relevant conflicts of interest to declare.

Laboratory medicine and iron overload: diagnostic and therapeutic aspects

: The laboratory input is essential for the diagnosis and treatment of systemic iron overload which may be acquired (transfusions, parenteral iron supplementation) or genetic (hemochromatosis). From the diagnostic standpoint, besides clinical examination, the combination of plasma transferrin saturation and ferritinemia, provided they are rigorously interpreted, forms the usual bipodal biochemical basis for suggesting the existence of iron excess, but also its mechanism, and its severity. This duo must lead to subsequent direct evaluation of body iron load by assessing liver iron concentration (LIC). This determination is based primarily on magnetic resonance imaging (MRI) that, given its absence of invasiveness, has largely replaced the biochemical evaluation of the iron content of a liver biopsy sample. Furthermore, the decision for performing genetic testing, and for selecting the appropriate genetic tests, is guided by the biological data, together with the clinical and imaging context. From the therapeutic standpoint, plasma transferrin saturation and ferritin levels are critical for starting and following the treatments that are dominated by oral chelation or phlebotomies depending on whether anemia is present or not. Evaluating plasma non-transferrin bound iron (NTBI) and hepcidinemia remains in the field of clinical research.

Finnish Type Congenital Nephrotic Syndrome With Exon Sequencing Confirmation in Taiwan: A Case Report

Congenital nephrotic syndrome Finnish type (CNF) is a rare and severe kidney disorder starting soon after birth, characterized by premature birth, a small size for gestational age, and an enlarged placenta. Early-onset nephrosis with heavy proteinuria, hyperlipidemia, hypercoagulopathy, and an immunocompromised status often causes poor growth and early mortality if not treated promptly. The current treatment strategy of parenteral albumin supplementation, a hyper-caloric and protein-abundant diet, and medications to prevent and treat complications has improved patient outcomes by making curative renal transplantation possible. This report describes a female newborn diagnosed with CNF incidentally before the onset of symptoms. To the best of our knowledge, she was the first CNF case with a diagnosis confirmed by genetic testing (whole-exon sequencing) in Taiwan.

Nutritional Implications in Preparing Patients for Total Gastrectomy

Prophylactic total gastrectomy is recommended to prolong life in individuals who carry the CDH1 variants associated with early diffuse gastric cancer. Loss of the stomach requires life-long changes in diet and poses a risk for select vitamin and mineral deficiencies that require supplementation and monitoring. This review covers the physiology of the stomach and the pathobiology and management of individuals post-gastrectomy with altered small bowel anatomy. Enhanced recovery after surgery guidelines (ERAS) for total gastrectomy reduces complication rates, enhances healing, and lessens hospital stay. Oral vitamin B12 in pharmacologic doses is equally effective to parenteral B12 supplementation post-gastrectomy. Glucagon-like peptide 1 (GLP-1) is an important hormone involved in the vasomotor symptoms of dumping syndrome that holds promise as a target for therapy. Although the stomach is not a vital organ, its motor and physiologic functions are important for nutrition and quality of life. Prevention of malnutrition and improving quality of life are accomplished by diet education, supplementation of vitamin B12 and other at risk vitamins and minerals, and monitoring throughout life.

Parenteral nutrition supplements

Parenteral nutrition supplements

Experience With Teduglutide in Pediatric Short Bowel Syndrome: First Real-life Data.

The aim of the study was to describe the experience with teduglutide of several Spanish hospitals in pediatric patients with SBS (SBS). Seventeen pediatric patients with intestinal failure associated with SBS were treated with teduglutide. Patients received 0.05 mg · kg · day of subcutaneous teduglutide. Patients' demographics and changes in parenteral nutrition (PN) needs, fecal losses, and citrulline level initially and at 3, 6, and 12 months were collected, as well as any adverse events. Patients were receiving 55 ml · kg · day and 33 kcal · kg · day of parenteral supplementation on average at baseline (2 patients received only hydroelectrolytic solution). A total of 12/17 patients achieved parenteral independence: 3 patients after 3 months of treatment, 4 patients at 6 months, and 5 after 12 months. One patient discontinued treatment 1 year after the beginning as no changes in parenteral support or fecal losses were obtained. All others decreased their intravenous requirements by 50%. One patient suffered an episode of cholecystitis, and another one with a pre-existing cardiac disease, developed a cardiac decompensation. Teduglutide seems to be a safe and effective treatment in the pediatric SBS population with better results than in the pivotal study as well as in the adult population.

Intravenous Administration of Butaphosphan and Cyanocobalamin Combination to Late-Pregnant Dairy Cows Reduces Their Insulin Resistance After Calving.

Dairy cows suffer insulin resistance following parturition and lactogenesis. Several researchers attempted to reduce insulin resistance via dietary and parenteral supplementations of different substances to promote metabolic performance of dairy cows. Due to mechanisms of actions of butaphosphan in combination with cyanocobalamin, we hypothesized that this compound may reduce insulin resistance of dairy cows following parturition; hence, the effects of the intravenous administration of butaphosphan and cyanocobalamin to prepartum dairy cows on their insulin resistance after calving were evaluated. Twenty-four multiparous Holstein dairy cows were enrolled 3 weeks prior to parturition and divided into four equal groups, including control (Ctrl) and butaphosphan and cyanocobalamin (B+C) 1, 2, and 3. Ctrl cows received 15 mL of 0.9% NaCl solution and B+C 1, 2, and 3 groups intravenously received 2, 4, and 6 mL/100 kg BW of 10% butaphosphan and 0.005% cyanocobalamin combination over three periods of 3 consecutive days, including 21-19, 12-10, and 3-1 days before calving, respectively. Intravenous glucose tolerance test was performed weekly 1, 2, and 3 weeks after parturition to evaluate the insulin resistance phenomenon. Circulating levels of glucose, insulin, non-esterified fatty acids (NEFA), and beta-hydroxybutyric acid (BHBA) were assessed 1, 2, and 3 weeks after calving. Ctrl cows were the most insulin-resistant group, and B+C1 group was the most insulin-sensitive, followed by B+C2 and B+C3 groups. The NEFA and BHBA levels in the B+C3 group were significantly lower than those in the other groups. In conclusion, intravenous administration of butaphosphan and cyanocobalamin to the late-pregnant dairy cows may reduce their insulin resistance after calving.

Effects of Parenteral Supplementation with Minerals and Vitamins on Oxidative Stress and Humoral Immune Response of Weaning Calves.

We aimed to evaluate the effects of injectable mineral and vitamin supplementation on weaning calves subjected to a low-stress (fence-line) weaning system. Seven-month-old Aberdeen Angus female calves (n = 40, 152 ± 11 kg body weight) from a selenium-deficient area of extensive cattle production on natural grass were randomly assigned to two groups (n = 20 each). One group received subcutaneous supplementation with copper, zinc, selenium, manganese and vitamins A and E (SG), and the other was given sterile saline solution (CG). The animals were supplemented twice, seven days before weaning (day -7) and on the day of weaning (day 0), and they were evaluated 30 (+30) and 60 (+60) days after weaning. Total antioxidant status (TAS), selenium-dependent glutathione peroxidase (GPx) activity, body weight, and average daily gain (ADG) were evaluated. Additionally, antibody titers were assessed prior to and after each immunization with a vaccine containing bovine herpes virus type 1 (BoHV-1). On day +30, body weight (p = 0.03) was higher in SG, whereas TAS (p = 0.02) and GPx (p = 0.0038) activity were lower in CG and remained constant in SG. Antibody titers increased in SG and CG following immunization, being higher in SG on days +30 and +60 (p < 0.05). In conclusion, parenteral supplementation of minerals and vitamins with antioxidant effects in a low-stress weaning system prevented the decrease in TAS and GPx activity, improved antibody response and had positive effects on body weight.