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Formation of oxalate during postoperative xylitol infusion
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FORMATION OF OXALATE DURING POSTOPERATIVE XYLITOL INFUSION. D. Lohlein, A. Bar (Centrum Surgery, Medizinische Hochschule Hannover, FRG; Xyrofin Ltd., Basel, CH) Induction of reno-cerebral oxalosis is discussed as a possible and most serious side However data mostly based on retroeffect of xylitol application in some patients. spective case reports and patho-morphological findings. So to calculate the risk for surgical patients, we therefore measured the oxalate production in patients after major abdominal surgery receiving postoperative parenteral nutrition )PPN) with and without xylitol. Until now 11 patients after total gastrectomy were studied. All received a standardized PPN from 1. - 6. p-0. day consisting of I,5 g AA + 3,0 g CH + 1,5 g lipids/kg b. wt. per day. Prospectively and randomized the CH-supply was done either with xylitol (X-group, n = 5) or glucose only (G-group, n = 6). Preoperative and until the 6th p.o. day oxalate in plasma was measured by HPLC, as well as oxalate- (chromotropic acid method) and glycollate excretion (enzymatic method) determined in 24h
urine daily, Postoperatively
significant differences in both plasma oxalate decreased+without groups (av: X = 0,64 - 0,ll vs G = 0,69 - 0,13 mg/l). At the same time oxalate TXcretion w$s slightly elevated in the X-group compared to G-group (av: X = 93,3 - 50 vs G = 50,2 - 14). Despite great deviations glycollate excretion, however, Showed a 50 fold incr$ase during xylitol G = 59,9 - 42 mg/d).
infusion
compared to glycose
(av: X = 3089 - 1832 vs
So our results indicate, that there is no relevant increase in oxalate formation during postoperative xylitol infusions at a dosage of 3,0 g/kg b. wt. per day. Although the glycollate production is strongly increased, the endogenous transformation to oxalate seems to be clearly limited in this situation.
p-53
~N~~G,~inV,ERILO~~maDnURING LONG TERM TOTAL. PARENTERAL NUTRITION TO THE RAT. L Bjelton, K Lundholm and L Landmark (Vltrum Institute of Human Nutrition, Stockholm, and Cepi.of Surgery I, Gothenburg, Sweden) Energy overload is a potential clinical problem associated with TPN. The aim of this study was to evaluate different levels of energy supply on whole body and organ development in a rat model during TPN for 40 days. Methods -.Study.1. Twelve weanling rats were fed a standard lab diet for 5 months. Body weight, food intake and energy expenditure were assessed throughout the study period. The energy intake was used as a guideline for the design of the TPN experiment. Study II. TPN was given at 4 different energy levels in relation to either body weight or metabolic body mass (kg0.75) or at a constant rate per animal. One liter TPN solution contained 410 ml Vaminm9, 140 ml Intralipid@, 205 g glucose and all the other essential nutrients. Body weight, organ development and fat deposition were assessed. Results Study I. Energy intake per kg body weight decreased with age, which was most pronounced during the first weeks of the experiment. Energy intake when related to the metabolic body weight (kg0.75) showed less variation. At the age of 7-13 weeks it decreased from 220 to 190 kcal/kg0.75. Energy expenditure was always lower than the intake. Study I_I Energy level 330 kcal/kg 22G kcal/kg0'75 200 kcal/kg0'75 77 kcal/rat Survival 316 * 5/b * 717 b/7 Liver wt (g) 23.3 21.0 * 14.8 +1.2 * 11.4 ~0.6 11.7 21.1 Spleen wt (g) 2.6 +0.7 * 2.2 to.7 * 1.1 to.2 1.1 +0.1 ttt * Sit + Fat deposition t tt Mean *SE, * sign.diff. from the group given 2G0 kcal/kg0'75 Conclusion. Energy overload is deleterious during long term TPN leading to organ derange&nts and heavy fat deposition or even death. The metabolic weight of the body (kg0.75) is suggested as a guideline for energy supply during long term TPN.
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FORMATION OF OXALATE DURING POSTOPERATIVE XYLITOL INFUSION. D. Lohlein, A. Bar (Centrum Surgery, Medizinische Hochschule Hannover, FRG; Xyrofin Ltd., Basel, CH) Induction of reno-cerebral oxalosis is discussed as a possible and most serious side However data mostly based on retroeffect of xylitol application in some patients. spective case reports and patho-morphological findings. So to calculate the risk for surgical patients, we therefore measured the oxalate production in patients after major abdominal surgery receiving postoperative parenteral nutrition )PPN) with and without xylitol. Until now 11 patients after total gastrectomy were studied. All received a standardized PPN from 1. - 6. p-0. day consisting of I,5 g AA + 3,0 g CH + 1,5 g lipids/kg b. wt. per day. Prospectively and randomized the CH-supply was done either with xylitol (X-group, n = 5) or glucose only (G-group, n = 6). Preoperative and until the 6th p.o. day oxalate in plasma was measured by HPLC, as well as oxalate- (chromotropic acid method) and glycollate excretion (enzymatic method) determined in 24h
urine daily, Postoperatively
significant differences in both plasma oxalate decreased+without groups (av: X = 0,64 - 0,ll vs G = 0,69 - 0,13 mg/l). At the same time oxalate TXcretion w$s slightly elevated in the X-group compared to G-group (av: X = 93,3 - 50 vs G = 50,2 - 14). Despite great deviations glycollate excretion, however, Showed a 50 fold incr$ase during xylitol G = 59,9 - 42 mg/d).
infusion
compared to glycose
(av: X = 3089 - 1832 vs
So our results indicate, that there is no relevant increase in oxalate formation during postoperative xylitol infusions at a dosage of 3,0 g/kg b. wt. per day. Although the glycollate production is strongly increased, the endogenous transformation to oxalate seems to be clearly limited in this situation.
p-53
~N~~G,~inV,ERILO~~maDnURING LONG TERM TOTAL. PARENTERAL NUTRITION TO THE RAT. L Bjelton, K Lundholm and L Landmark (Vltrum Institute of Human Nutrition, Stockholm, and Cepi.of Surgery I, Gothenburg, Sweden) Energy overload is a potential clinical problem associated with TPN. The aim of this study was to evaluate different levels of energy supply on whole body and organ development in a rat model during TPN for 40 days. Methods -.Study.1. Twelve weanling rats were fed a standard lab diet for 5 months. Body weight, food intake and energy expenditure were assessed throughout the study period. The energy intake was used as a guideline for the design of the TPN experiment. Study II. TPN was given at 4 different energy levels in relation to either body weight or metabolic body mass (kg0.75) or at a constant rate per animal. One liter TPN solution contained 410 ml Vaminm9, 140 ml Intralipid@, 205 g glucose and all the other essential nutrients. Body weight, organ development and fat deposition were assessed. Results Study I. Energy intake per kg body weight decreased with age, which was most pronounced during the first weeks of the experiment. Energy intake when related to the metabolic body weight (kg0.75) showed less variation. At the age of 7-13 weeks it decreased from 220 to 190 kcal/kg0.75. Energy expenditure was always lower than the intake. Study I_I Energy level 330 kcal/kg 22G kcal/kg0'75 200 kcal/kg0'75 77 kcal/rat Survival 316 * 5/b * 717 b/7 Liver wt (g) 23.3 21.0 * 14.8 +1.2 * 11.4 ~0.6 11.7 21.1 Spleen wt (g) 2.6 +0.7 * 2.2 to.7 * 1.1 to.2 1.1 +0.1 ttt * Sit + Fat deposition t tt Mean *SE, * sign.diff. from the group given 2G0 kcal/kg0'75 Conclusion. Energy overload is deleterious during long term TPN leading to organ derange&nts and heavy fat deposition or even death. The metabolic weight of the body (kg0.75) is suggested as a guideline for energy supply during long term TPN.
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