By J. E. Fischer M.D. (auth.), J. M. Greep, Peter B. Soeters, R. I. C. Wesdorp, C. W. R. Phaf, Josef E. Fischer M.D. (eds.)

J. E. Fischer, M.D. Professor Greep, girls and gents. it's a nice excitement for me and the contributors to be current at this overseas assembly of Parenteral Nutri­ tion. This assembly do not need been attainable 5 years in the past. at the moment we have been nonetheless arguing approximately critical vs. peripheral routes, efficacy of the tech­ nique, and nonetheless getting familiar with our skill to aid sufferers nutri­ tionally. in the final 5 years those discussions, which look nearly futile looking back, were set aside. either recommendations, we all know how, paintings rather good and feature their very own symptoms. Having turn into pleased with the process, it really is now time to go into the second one part of parenteral foodstuff, and that's the differentiation of the approach for the advantage of diverse sufferers. Over the following days we are going to be discussing numerous difficulties which this present day are principal to the complete topic of parenteral food. Is a fats calorie kind of like a carbo­ hydrate calorie? what's the impression on protein metabolism of the fats calorie rather than the carbohydrate calorie? Are they identical? Are'there occasions within which one is stronger to the opposite? possibly we are going to discover the next day to come within the panel.

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Correction ofenergy deficit: energy sources Table 9 contains a list of energy sources used for this purpose. Table 9 Energy sources, used for correction of nitrogen balance for correction of energy deficit Pats Ethanol Carbohydrates Glucose Pructose Polyalcohols Sorbitol Xylitol Mixtures of carbohydrates and/or polyalcohols Amino acids Fats as an energy source Fats contain a lot of energy (100 g = 1000-1100 Kcal) which might become available after total metabolism; however in early post-traumatic states, fats are not useful because up to 70-80% is lost in the first stages (2,28).

Are but a few examples. REMARK Special therapeutic problems may also result from initial metabolic differences of a physiological nature. This refers to the differences between infants, children, adolescents, adults, the aged, males and females. They deserve to be studied with the same approach as suggested here. Stage three In general, parenteral nutrition should be able to perform the following functions: a) help control the release of endogenous energetic substrates as well as the mechanisms which induce this process; b) improve the utilization of their excess when present, either by stimulating their catabolic utilization or inducing their storage or both (if this is not achieved, intolerance phenom- 48 P.

R. Phaf and E. L. M. Hardy Table 5. T. T. Wound healing and other conditions of the patient Urea excretion Nitrogen balance Plasma levels of single amino acids to detect and correct limiting factors This brings us to the question: are the amino acid patterns of mixtures for oral feeding useful as criteria for the composition of preparations for parenteral nutrition? We want to point out some reasons why they are not. 1. Absorption of amino acids is often an intricate matter because of carriers and combinations of molecules, mutual stimulation or antagonism and dipeptides that are involved in absorption processes.

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