Parenteral nutrition at home for 5 years via arteriovenous fistulae. Supplemental intravenous feedings for a patient with severe short bowel syndrome. 1977

W D Heizer, and E P Orringer

On March 26, 1970, a 33-year-old male suffered intestinal infarction which required total enterectomy and duodeno-transverse colostomy. Nutrition was maintained in the hospital by daily parenteral feeding for 2 months postoperatively, after which parenteral feedings were decreased and stopped for long periods. Various oral dietary regimens failed to provide adequate nutrition, and the patient lost 40 kg and became severely malnourished during the next 13 months. In June 1971, supplemental home parenteral nutrition (PN) via an arteriovenous fistula was instituted on a 3 or 4 nights per week basis. The patient's weight and strength increased markedly after institution of the home supplemental PN program. The first fistula became occluded after 9.5 months of home PN use and subsequent successive fistulae have remained patent for 31.3, 8.8, and 5.5 months of use. The patient prepares his own PN fluids at home, using a commercial device for filling plastic intravenous fluid bags. Although several different types of fluid have been used, the current mixture of 25% glucose and 2.75% amino acids with added vitamins, potassium, calcium, magnesium, and insulin plus simultaneously administered lipid emulsion has proven most effective. Only when the patient's low fat, low oxalate diet is supplemented with this parenteral mixture 4 nights each week is he in positive nitrogen, phosphorus, and magnesium balance. However, his negative calcium balance is only partially corrected. There has been no sepsis, embolism, or fistula infection during 5 years of home PN.

UI MeSH Term Description Entries
D007421 Intestine, Small The portion of the GASTROINTESTINAL TRACT between the PYLORUS of the STOMACH and the ILEOCECAL VALVE of the LARGE INTESTINE. It is divisible into three portions: the DUODENUM, the JEJUNUM, and the ILEUM. Small Intestine,Intestines, Small,Small Intestines
D008286 Malabsorption Syndromes General term for a group of MALNUTRITION syndromes caused by failure of normal INTESTINAL ABSORPTION of nutrients. Malabsorption Syndrome,Syndrome, Malabsorption,Syndromes, Malabsorption
D008297 Male Males
D008903 Minerals Native, inorganic or fossilized organic substances having a definite chemical composition and formed by inorganic reactions. They may occur as individual crystals or may be disseminated in some other mineral or rock. (Grant & Hackh's Chemical Dictionary, 5th ed; McGraw-Hill Dictionary of Scientific and Technical Terms, 4th ed) Mineral
D009584 Nitrogen An element with the atomic symbol N, atomic number 7, and atomic weight [14.00643; 14.00728]. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells.
D010288 Parenteral Nutrition The administering of nutrients for assimilation and utilization by a patient who cannot maintain adequate nutrition by enteral feeding alone. Nutrients are administered by a route other than the alimentary canal (e.g., intravenously, subcutaneously). Intravenous Feeding,Nutrition, Parenteral,Parenteral Feeding,Feeding, Intravenous,Feeding, Parenteral,Feedings, Intravenous,Feedings, Parenteral,Intravenous Feedings,Parenteral Feedings
D010289 Parenteral Nutrition, Total The delivery of nutrients for assimilation and utilization by a patient whose sole source of nutrients is via solutions administered intravenously, subcutaneously, or by some other non-alimentary route. The basic components of TPN solutions are protein hydrolysates or free amino acid mixtures, monosaccharides, and electrolytes. Components are selected for their ability to reverse catabolism, promote anabolism, and build structural proteins. Hyperalimentation, Parenteral,Intravenous Hyperalimentation,Nutrition, Total Parenteral,Parenteral Hyperalimentation,Total Parenteral Nutrition,Hyperalimentation, Intravenous
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D001842 Bone and Bones A specialized CONNECTIVE TISSUE that is the main constituent of the SKELETON. The principal cellular component of bone is comprised of OSTEOBLASTS; OSTEOCYTES; and OSTEOCLASTS, while FIBRILLAR COLLAGENS and hydroxyapatite crystals form the BONE MATRIX. Bone Tissue,Bone and Bone,Bone,Bones,Bones and Bone,Bones and Bone Tissue,Bony Apophyses,Bony Apophysis,Condyle,Apophyses, Bony,Apophysis, Bony,Bone Tissues,Condyles,Tissue, Bone,Tissues, Bone
D006701 Home Nursing Nursing care given to an individual in the home. The care may be provided by a family member or a friend. Home nursing as care by a non-professional is differentiated from HOME CARE SERVICES provided by professionals: visiting nurse, home health agencies, hospital, or other organized community group. Home Care, Non-Professional,Nursing, Home,Home Care, Nonprofessional,Care, Non-Professional Home,Care, Nonprofessional Home,Home Care, Non Professional,Non-Professional Home Care,Nonprofessional Home Care

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