Background: Hypophosphatemia is a common metabolic
complication in patients receiving specialized nutrition support. We changed our
previously reported dosing algorithm because the low dose no longer ...appeared to be
effective at increasing serum phosphorus concentrations. The purpose of this study
was to evaluate the safety and efficacy of a revised weight-based phosphorus-dosing
algorithm in critically ill trauma patients receiving specialized nutrition support.
Methods: Seventy-nine adult trauma patients with
hypophosphatemia (serum phosphorus concentration ≤0.96 mmol/L) receiving nutrition
support received an IV dose of phosphorus on day 1 according to the serum
concentration of phosphorus: 0.73–0.96 mmol/L (0.32 mmol/kg, low dose), 0.51–0.72
mmol/L (0.64 mmol/kg, moderate dose), and ≤0.5 mmol/L (1 mmol/kg, high dose). The IV
phosphorus bolus dose was administered at 7.5 mmol/hour. Generally, patients with a
serum potassium concentration <4 mmol/L received potassium phosphate and patients
with a serum potassium concentration ≥4 mmol/L received sodium phosphate. Patients
who still had hypophosphatemia on day 2 were dosed using the new dosing algorithm by
the nutrition support service according to that day's serum concentration of
phosphorus, or empirically by the trauma service. Results: Of the 79 patients studied, 57 were male and 22 were female
with a mean age of 44.8 ± 20.6 years. Mean Injury Severity Scores and APACHE-II
scores were 27.1 ± 11.6 and 15.2 ± 6.8, respectively. There was no difference in
baseline characteristics among the 3 dosing groups. Of the 79 patients, 34 received
the low dose, 30 received the moderate dose, and 15 received the high dose of
phosphorous. Mean serum phosphorous concentrations on day 2 were significantly
increased in the moderate-dosed group (0.64 ± 0.06 to 0.77 ± 0.22 mmol/L, p < .05) and high-dosed group (0.38 ± 0.06 to 0.93 ± 0.32
mmol/L, p < .01), respectively, when compared with
day 1. Mean serum phosphorus concentrations were normal in all 3 groups on day 3.
Serum concentrations of magnesium, sodium, and potassium, as well as arterial pH,
were stable across the study. Mean concentrations of ionized calcium were not
significantly different in any of the 3 dosing groups across the study period.
Conclusions: This weight-based phosphorus-dosing
algorithm is safe for use in critically ill patients receiving nutrition support. The
moderateand severe-dose regimens effectively increase serum phosphorus
concentrations.
Hypophosphatemia is a common metabolic complication associated with the
administration of specialized nutrition support. We report the safety and efficacy of
a revised phosphorus dosing algorithm based on serum phosphorus concentrations.
Abstract Objective The purpose of this investigation was to evaluate the dose-dependent characteristics of intravenous calcium gluconate therapy for hypocalcemic critically ill patients. Methods The ...dose-dependent characteristics of 2 g versus 4 g of intravenous calcium gluconate therapy were evaluated in 25 critically ill, adult multiple trauma patients with hypocalcemia. The calcium gluconate was infused at a rate of 1 g/h for both groups. Patients weighed within 90% to 120% of ideal body weight, had normal renal function, did not receive diuretic therapy, and did not have anasarca. Results Fifteen patients with mild hypocalcemia (serum ionized calcium concentration iCa 1–1.12 mmol/L) were given 2 g of calcium gluconate. Ten patients with moderate to severe hypocalcemia (iCa <1 mmol/L) were given 4 g. Each dosage group had a significant ( P ≤ 0.001) increase in iCa (from 1.07 ± 0.05 to 1.17 ± 0.05 mmol/L and from 0.92 ± 0.08 to 1.16 ± 0.11 mmol/L, respectively). Each dosage group retained about half of the dose in the exchangeable calcium space ( P = NS between groups), but the higher dosage group retained significantly more elemental calcium overall (81 ± 38 versus 201 ± 50 mg, respectively, P ≤ 001). Serum ionized calcium concentrations achieved a plateau without a further decline in iCa by 10 h after completion of the infusion for each dosage. Conclusion About half of the administered elemental calcium dose was retained for each dosage group, with the higher dose (4 g) resulting in significantly more elemental calcium retention in the exchangeable calcium space. An iCa determination performed about ≥10 h after the completion of the calcium gluconate infusion should be sufficient time to ensure equilibration of iCa to assess the efficacy of the therapy. This mode of calcium therapy serves as an effective means for providing calcium to the acutely hypocalcemic, critically ill, multiple trauma patient.
Valentine Telegdi was an outstandingly original experimental physicist who contributed greatly to our understanding of the
weak and electromagnetic interactions of elementary particles. Outspoken and ...colourful in expression, Telegdi (usually called
‘Val’) had the reputation of being a ‘conscience of physics’, known for his incisive and sometimes acerbic wit. In this respect
he was reminiscent of Wolfgang Pauli, one of his teachers, whom he greatly admired. However, Val could be warm and caring
to friends, professional associates and students. After receiving his doctorate from the Swiss Federal Institute of Technology
(ETH) in Zurich in 1950, he began his academic career at the University of Chicago in 1951, and his reputation grew rapidly.
In 1968 he was elected to the National Academy of Sciences. In 1972 the University of Chicago appointed him as the first Enrico
Fermi Distinguished Service Professor of Physics.
These scientific papers of Richard Feynman are renowned for their brilliant content and the author's striking original style. They are grouped by topic: path integral approach to the foundations of ...quantum mechanics and quantum field theory, renormalized quantum electrodynamics, theory of superfluid liquid helium, theory of the Fermi interaction, polarons, gravitation, partons, computer theory, etc. Comments on Feynman's topics are provided by the editor, together with biographical notes and a complete bibliography of Feynman's publications.
Background: The intent of this study was to ascertain
the adequacy of delivery of enteral nutrition (EN) to critically ill adult multiple
trauma patients and to identify potential detrimental factors ...that affect EN
delivery. Methods: Retrospective observational study.
Trauma intensive care unit (TICU) in a university-affiliated hospital. Adult patients
(≥18 years of age) admitted to the TICU who received enteral feeding. Results: Fifty-six adult patients were enrolled for study.
Patients received, on average, 67% ± 19% of what was prescribed for 5.7 ± 2.0 days. A
total of 222 occurrences for temporary discontinuation of tube feeding were
identified. Gastrointestinal intolerance, as defined by a gastric residual volume of
>150 mL, abdominal pain, or >3 liquid stools per day, accounted for only 11% of
the occurrences for discontinuation of feeding. Surgery (27%) and diagnostic
procedures (15%) represented the majority of reasons for inadequate nutrient
delivery. Minor factors for EN interruptions were mechanical feeding tube problems
(8%), pharmacy delivery delay (4%), and miscellaneous factors (3%). Multiple and
unknown reasons contributed to 14% and 18% of the occurrences, respectively. Conclusions: Surgery and diagnostic procedures accounted for
the largest factor in enteral feeding discontinuations in our critically ill trauma
patients. Gastrointestinal intolerance contributed a minor role in the temporary
discontinuation of enteral feeding.
This study aims to determine the prevalence of neurodevelopmental impairments at age ten years among children born extremely preterm (less than 28 weeks gestational age) and to offer a framework for ...categorizing neurological limitations.
A multicenter, prospective cohort follow-up study recruited 889 ten-year-old children born from 2002 to 2004. We assessed prevalence of cognitive impairment, measured by intelligent quotient and tests of executive function, cerebral palsy (CP), autism spectrum disorder (ASD), and epilepsy singly and in combination. The three levels of impairment severity were: category I—no major neurodevelopmental impairment; category II—normal cognitive ability with CP, ASD, and/or epilepsy; and category III—children with cognitive impairment.
A total 214 of 873 children (25%) had cognitive impairment, 93 of 849 children (11%) had CP, 61 of 857 children (7%) had ASD, and 66 of 888 children (7%) had epilepsy. Further, 19% of all children had one diagnosis, 10% had two diagnoses, and 3% had three diagnoses. Decreasing gestational age was associated with increasing number of impairments (P < 0.001). Half the children with cognitive impairment and one third of children with CP, ASD, or epilepsy had a single impairment. Six hundred one (68% 95% CI, 64.5%-70.7%) children were in category I, 74 (8% 95% CI, 6.6%-10.3%) were in category II, and 214 (24% 95% CI 21.7%-27.4%) were in category III.
Three quarters of children had normal intellect at age ten years; nearly 70% were free of neurodevelopmental impairment. Forty percent of children with impairments had multiple diagnoses.
To examine elevated neonatal inflammatory and neurotrophic proteins from children born extremely preterm in relation to later childhood brain Magnetic Resonance Imaging volumes and cognition.
We ...measured circulating inflammation-related proteins and neurotrophic proteins on postnatal days 1, 7, and 14 in 166 children at 10 years of age (73 males; 93 females). Top quartile levels on ≥2 days for ≥3 inflammation-related proteins and for ≥4 neurotrophic proteins defined exposure. We examined associations among protein levels, brain Magnetic Resonance Imaging volumes, and cognition with multiple linear and logistic regressions.
Analyses were adjusted for gestational age at birth and sex. Children with ≥3 elevated inflammation-related proteins had smaller grey matter, brain stem/cerebellar, and total brain volumes than those without elevated inflammation-related proteins, adjusted for neurotrophic proteins. When adjusted for inflammation-related proteins, children with ≥4 neurotrophic proteins, compared with children with no neurotrophic proteins, had larger grey matter and total brain volumes. Higher grey matter, white matter, and cerebellum and brainstem volumes were significantly correlated with higher IQ. Grey and white matter volumes were correlated with each other (r = −0.18; P = .021), and cerebellum and brainstem was highly correlated with grey matter (r = 0.55; P < .001) and white matter (r = 0.29; P < .001). Adjusting for other brain compartments, cerebellum and brainstem was associated with IQ (P = .016), but the association with white matter was marginally significant (P = .051). Grey matter was not associated with IQ. After adjusting for brain volumes, elevated inflammation-related proteins remained significantly associated with a lower IQ, and elevated neurotrophic proteins remained associated with a higher IQ.
Newborn inflammatory and neurotrophin protein levels are associated with later brain volumes and cognition, but their effects on cognition are not entirely explained by altered brain volumes.
Objectives To compare the prevalence of cognitive, neurologic, and behavioral outcomes at 10 years of age in 428 girls and 446 boys who were born extremely preterm. Study design A total of 889 of 966 ...eligible children previously enrolled in the multicenter Extremely Low Gestational Age Newborns Study from 2002-2004 were evaluated at 10 years of age. Children underwent a neuropsychological battery and testing for autism spectrum disorder (ASD), and parents reported on their child's behavior, development, and seizures. Results Of the children, 28% of boys and 21% of girls exhibited moderate to severe impairment on summary measures of cognitive abilities. Boys had a higher prevalence of impairment than girls in nearly all measures of cognition, were more than twice as likely to have microcephaly (15% in boys, 8% in girls), and require more often assistive devices to ambulate (6% in boys, 4% in girls). In contrast, boys and girls had comparable risk for a history of seizure (identified in 10% of the cohort) or epilepsy (identified in 7% of the cohort). The boy-to-girl ratio of ASD (9% in boys, 5% in girls) was lower than expected compared with the overall US autism population. Conclusions In this contemporary cohort of children born extremely premature and evaluated at school age, boys had higher prevalence of cognitive, neurologic, and behavioral deficits than girls. The ratio of boys to girls among those with ASD deserves further study as does the perinatal environmental-genetic interactions that might contribute to male preponderance of deficits in this high-risk sample.
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