Response of severely malnourished patients to preoperative parenteral nutrition: A randomized clinical trial of water and sodium restriction

Gil, María José; Franch, G.; Guirao, Xavier; Oliva, A; Herms, R.; Salas, E.; Girvent, Meritxell; Sitges‐Serra, Antonio

doi:10.1016/s0899-9007(97)90875-3

Cited by 41 publications

(9 citation statements)

References 21 publications

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“…These patients had a 50% post-operative complication rate compared with a 4 % rate in the remaining patients who were able to excrete a salt and water load with resulting weight loss and increase in serum albumin concentration. Again, in a randomised study in severelymalnourished patients receiving preoperative parenteral nutrition, Gil et al (1997) have compared a group of patients receiving a standard feed containing 70% of the non-protein energy as glucose, 140 mmol Na/d and 45 ml water/kg per d with a group receiving a modified feed containing 70 % non-protein energy as fat, no Na and 30 ml water/kg per d. Weight gain with positive Na and water balance and lowering of serum albumin concentration were noted in the standard group while a negative Na and water balance, reduction in overall complications and decreased post-operative stay were noted in the modified group. Mitchell et al (1992) randomised 101 patients with pulmonary oedema to management based on pulmonary artery wedge pressure (n 49) or extravascular lung water (n 52).…”

Section: Consequences Of Salt and Water Imbalancementioning

confidence: 99%

Fluid, electrolytes and nutrition: physiological and clinical aspects

Lobo

2004

Proc. Nutr. Soc.

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Fluid and electrolyte balance is often poorly understood and inappropriate prescribing can cause increased post-operative morbidity and mortality. The efficiency of the physiological response to a salt or water deficit, developed through evolution, contrasts with the relatively inefficient mechanism for dealing with salt excess. Saline has a Na + :Cl -of 1 :1 and can produce hyperchloraemic acidosis, renal vasoconstriction and reduced glomerular filtration rate. In contrast, the more physiological Hartmann's solution with a Na + :Cl -of 1 . 18 :1 does not cause hyperchloraemia and Na excretion following infusion is more rapid. Salt and water overload causes not only peripheral and pulmonary oedema, but may also produce splanchnic oedema, resulting in ileus or acute intestinal failure. This overload may sometimes be an inevitable consequence of resuscitation, yet it may take 3 weeks to excrete this excess. It is important to avoid unnecessary additional overload by not prescribing excessive maintenance fluids after the need for resuscitation has passed. Most patients require 2-2 . 5 litres water and 60-100 mmol Na/d for maintenance in order to prevent a positive fluid balance. This requirement must not be confused with those for resuscitation of the hypovolaemic patient in whom the main aim of fluid therapy is repletion of the intravascular volume. Fluid and electrolyte balance is a vital component of the metabolic care of surgical and critically-ill patients, with important consequences for gastrointestinal function and hence nutrition. It is also of importance when prescribing artificial nutrition and should be given the same careful consideration as other nutritional and pharmacological needs.

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Section: Consequences Of Salt and Water Imbalancementioning

confidence: 99%

Fluid, electrolytes and nutrition: physiological and clinical aspects

Lobo

2004

Proc. Nutr. Soc.

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“…In a randomized trial we compared a 10-day course of two different preoperative TPN regimens in depleted cancer patients [46]. One group received a water and salt-poor diet while the other group was refed with a standard protocol.…”

Section: Water and Sodium Retention And Hypoalbuminemiamentioning

confidence: 99%

“…It is interesting to note that the 3 human studies investigating water and sodium metabolism during preoperative TPN [42,43,46] have shown that only between 50 and 60% of patients refed with large glucose loads did in fact exhibit an inappropriate expansive response. The same was true for the only animal study [9].…”

Section: Water and Sodium Retention And Hypoalbuminemiamentioning

confidence: 99%

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Water and Sodium Balance: A Nutritional Goal

Sitges‐Serra

2004

Metabolic Issues of Clinical Nutrition

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“…The restricted group also ate earlier, had fewer complications and were discharged 3 days earlier than the high fluid intake group. Salt and water excess is not therefore harmless and may also be associated with other complications (11,12).…”

Section: Fluid Overload and Gastrointestinal Functionmentioning

confidence: 99%

Fluid, electolytes and nutrition

Allison¹

2003

Food & Nutrition Research

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There is a close relationship between nutrition, metabolism, and water and electrolyte balance during ingestion, digestion, absorption and metabolism of nutrients. It is clinically important to consider not only external balance, but also internal balances between the intravascular and extravascular portions of the extracellular fluid (ECF), between the ECF and the gut during daily flux, and between the ECF and intracellular fluid, since all these balances may be affected by disease, treatment and nutrition. Doctors' knowledge of fluid and electrolyte pathophysiology is often as poor as their knowledge of nutrition. Both subjects require a major educational effort.

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Response of severely malnourished patients to preoperative parenteral nutrition: A randomized clinical trial of water and sodium restriction

Cited by 41 publications

References 21 publications

Fluid, electrolytes and nutrition: physiological and clinical aspects

Fluid, electrolytes and nutrition: physiological and clinical aspects

Water and Sodium Balance: A Nutritional Goal

Fluid, electolytes and nutrition

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