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Clinical Experiences with Total Nutrient Admixture in 26 Cases

Journal of the Korean Pediatric Society 1992;35(7):921-932.
Published online July 15, 1992.
Clinical Experiences with Total Nutrient Admixture in 26 Cases
Yong Soon Kwon1, Eun Jin Choi1, Soon Ok Byun1, Ji Sub Oh1, Hwan Seon Ryu2, Charles D. Sands2
1Department of Pediatrics, Wallace Memorial Baptist Hospital, Pusan, Korea
2Department of Pharmaceutical Services, Wallace Memorial Baptist Hospital, Pusan, Korea
Total Nutrient Admixture에 관한 26례의 임상 경험
권용순1, 최은진1, 변순옥1, 오지섭1, 유환선2, Charles D. Sands2
1왈레스 기념 침례회 병원 소아과
2왈레스 기념 침례회 병원 약제부
Total Nutrient Admixture(TNA) is an intravenous nutrient system composed of dextrose, amino acid, fat, electrolytes, vitamins and trace elements in a single container which is administered over 24 hours. Twenty six seriously ill or premature neonatal patients reciving parenteral nutrition with TNA were studied by analyzing anthropometric parameters, laboratory values, and complications. The objective of the study was to test the efficacy and safety of a parenteral lipid emulsion, Intralipid, when given as part of a TNA system. 1) Four of the 26 cases died and the remainder improved. The cause of the four death was not related to TNA. 2) Anthropometric parameters including weight, height, head circumference, triceps, subscapular skinfold thickness and midarm circumference were significantly increased. 3) Mean serum albumin increased from 3.0 to 3.2gm/dl, mean transferrin incrteased from 146 to 204mg/dl. 4) Mean total cholesterol increased from 102 to 126mg/dl and mean triglyceride from 77 to 108mg/dl. Mild hypertriglyceridemia was observed in 2 cases. 5) Liver function sudies were normal with the exception of increased alkaline phosphatase in 4 patients(mean 40.9KAU/L) that later normalized. 6) Arterial blood gas analysis in 11 patient with respiratory insufficiency showed improved pH and PaO2 despite diminished oxygen requirement 7) Hyperglycemia with glucosuria was observed in eight patients, glucosuria without hyperglycemia in four and hypoglycemia in three. 8) In all cases blood culture during TNA showed no organism growth. 9) Visual examination of the TNA solution throughout this study period revealed no evidence of instability of the fat emulsion. 10) Two cases developed phlebitis. Although this study was not compared to a control group, the data suggest that parenteral nutrition with TNA may be convenient and safe during the neonatal period.
Key Words: Total Nutrient Admixture, Total parenteral nutrition

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