Korean J Community Nutr.  2006 Apr;11(2):289-297.

The Outcome of Nutrition Support of Surgery Patients with Hypermetabolic Severity by Total Parenteral Nutrition and Enteral Nutrition and Biochemical Data

• Rha M
• Kim E
• Cho YY
• Seo JM
• Choi H

Abstract

This study evaluated the nutrition intake and changes in laboratory data of surgery patients with hypermetabolic severity on nutrition support. From January 2002 to September 2002, 66 hospitalized surgery patients who had received enteral nutrition (EN, n=19) and total parenteral nutrition (TPN, n=47) for more than 7 days were prospectively and retrospectively recruited. The laboratory data was examined pre-operatively, and on the post-operative 1, 3, 7 day and at the time of discharge. The characteristics of the patients were examined for the hypermetabolic severity, The hypermetabolic scores were determined by high fever (> 38 degrees C), rapid breathing (> 30 breaths/min), rapid pulse rate (> 100 beats/min), leukocytosis (WBC>12,000/microliter), leukocytopenia (WBC<3,000/microliter), status of infection, inflammatory bowel disease, surgery and trauma. The scores for the hypermetabolic status were divided into three groups (mild 0-10, moderate 11-40, severe>41). According to the results of the study, 38.3% (n=23), 45.4% (n=30) and 19.6% (n=13) were in the mild, moderate, and severe groups, respectively. There was a decrease in the serum albumin level and weight loss according to the hypermetabolic severity. However, the white blood cells (WBC), fasting blood sugar (FBS), c-reactive protein (CRP), total bilirubin, GOT, and GPT increased. The nutritional intake was TPN (32.5 kcal/kg, protein 1.2 g/kg, fat 0.25 g/kg), EN (28.1 kcal/kg, protein 1.0 g/kg, fat 1.01 g/kg). The serum albumin, hemoglobin and cholesterol were higher in the EN group than in the TPN group. But the FBS, total bilirubin, GOT and GPT were higher in the TPN group than the EN group. In conclusion, there was a negative correlation between the changes in the laboratory data and the hypermetabolic severity. There was an increase in the number of metabolic complications in the TPN group.

Keyword

malnutrition; nutrition support; total perenteral nutrition (TPN); enteral nutrition (EN); hypermetabolism; hypermetabolic score

MeSH Terms

Bilirubin
Blood Glucose
C-Reactive Protein
Cholesterol
Enteral Nutrition*
Fasting
Fever
Heart Rate
Humans
Inflammatory Bowel Diseases
Leukocytes
Leukocytosis
Leukopenia
Malnutrition
Parenteral Nutrition, Total*
Prospective Studies
Respiration
Retrospective Studies
Serum Albumin
Weight Loss
Bilirubin
Blood Glucose
C-Reactive Protein
Cholesterol
Serum Albumin