The effect of intravenous feeding on the balances of nitrogen, sodium, and potassium after operation

Abstract

The value of intravenous nutrients in reducing the postoperative negative balance of nitrogen and associated loss of body-weight is uncertain. Metabolic balance studies of amino acids, nitrogen, sodium, and potassium were carried out on 30 men, aged 25 to 60 years, for 5 days after vagotomy and drainage for duodenal ulcer.The patients were divided into 5 groups: a control group had fluids only and no calories; amino acids (0.15 g. nitrogen/kg./day) and few calories had no effect on the nitrogen balance in a second group; the addition of calories as fat emulsion (35 cals/kg./day) reduced, but did not abolish, the negative balance of nitrogen (0.05 > F;.0.02); anabolic steroids had no effect on the utilization of intravenous nutrients after operation; intravenous feeding was more efficient than comparable amounts of nutrients given intrajejunally.Intravenous nutrients contain large amounts of sodium and negligible quantities of potassium. Sodium balances remained strongly positive after operation. Potassium losses were considerable and serum levels fell after 4 or 5 days.When the daily postoperative intake of amino acids was constant, the mean proportion retained was least on the third day (70 per cent) and greatest on the fifth day (90 per cent).Intravenous nutrients appear to be of more value towards the end of the catabolic response to injury, and their use should be considered at that time if normal feeding cannot be resumed. Numerous physical and histological studies on woun? healing have led to the idea of a metabolically inert 'lag phase (Slome, 1961) which lasts for 3-5 days after injury. The earliest changes escape observation when examined by routine histological techniques. Enzyme histochemistry gives a better picture of the functional state of cells and tissues and is thus more suitable for detection of the first reactions in wounded tissue. Studies of alkaline phosphatase, acid phosphatase, cytochrome oxidase, and succinate dehydrogenase activities were undertaken on wounds in albino rats and guinea-pigs. Enzyme activity was studied at intervals from half an hour to one week after wounding. Comparative histological changes and an estimation of cell glycogen were also made.In the immediate vicinity of the wound there is a central zone of decreased enzyme activity: surrounding this a peripheral zone exhibited increased enzyme activity which appears 1-8 hours after wounding. This initial increase seemed to indicate an adaptive defence mechanism by local connective-tissue cells in response to injury i: Raekallio, 1964). The enzymes in the outer zone of the wound may play a part in more specific regenerative processes. It seems probable that the production of the enzymes studied is the earliest step in the process of repair which begins in the so-called 'lag' phase of wound healing. RAEKALLIO The exact method of placentation in the higher primates is unknown. It has been suggested that the chorionic villi act like malignant cells, burrowing their way into the endometrium which tends to resist their invasion...

The Effect of an Anabolic Steroid on Postoperative Nitrogen Balance

“…The similar results obtained during the catabolic phase by the use of parenteral nutrients or an anabolic steroid agree with the results of an earlier study in which anabolic steroids did not further enhance nitrogen retention with parenteral nutrition immediately after surgery (Johnston et al , 1966). However, in this study, the optimal effect was achieved in the later anabolic phase by the combined use of parenteral nutrients and an anabolic steroid.…”

Parenteral nutrition in carcinoma of the oesophagus treated by surgery: Nitrogen balance and clinical studies

“…The reports of Abbott and Albertsen (1963), Johnston et al (1966), Irving and Rushman (1971), Walker and Johnston (1971) and Johnston et al (1972) have suggested that parenteral nutrition with a high calorie and nitrogen content can reduce, or even reverse, the negative nitrogen balance during the postoperative catabolic phase.…”

“…SINCE the original work of Cuthbertson (1930Cuthbertson ( , 1932, Moore and Ball (1952) and Moore (1959), it has been well established that following trauma, including surgery, there is a 'catabolic phase' during which there is a temporary alteration in the metabolism as a whole, with an increase in the urinary output of nitrogen, resulting in a negative nitrogen balance. The reports of Abbott and Albertsen (1963), Johnston et al (1966), Irving and Rushman (1971), Walker and Johnston (1971) and Johnston et al (1972) have suggested that parenteral nutrition with a high calorie and nitrogen content can reduce, or even reverse, the negative nitrogen balance during the postoperative catabolic phase.…”

A comparison of hydrolyzed L‐ and synthesized DL‐amino acids for complete parenteral nutrition

“…Diets with lower nitrogen content than those used here do not secure nitrogen balance in total parenteral nutrition. 10,19,25 Potassium requirements must be met by the prior injection of these solutions with potassium chloride, with the attendant dangers of error and infection. It would be preferable, therefore, if the sodium hydroxide used at the hydrolysis stage were partly replaced by potassium hydroxide, because this would reduce the sodium content and add the necessary potassium during manufacture.…”