Growth hormone and pulmonary disease: metabolic effects in patients receiving parenteral nutrition

Article Abstract:

Chronic obstructive pulmonary disease often results in malnutrition due both to a decrease in food intake and an increase in energy expenditure at rest. Patients with chronic obstructive pulmonary disease can benefit from parenteral nutrition, in which calories, protein, carbohydrates, fat, vitamins and minerals are delivered intravenously. But metabolism of these nutrients requires that the respiratory system work harder, which may complicate the management of the pulmonary disease; for example it may be more difficult to remove a patient from the ventilator, the machine that provides artificial respiration. The availability of recombinant growth hormone now makes it possible to add this substance to the parenteral nutrition mixture infused into the patient. Growth hormone is a potent stimulator of protein retention and synthesis. The value of growth hormone was tested in the treatment of six patients with severe malnutrition and chronic obstructive pulmonary disease. For the first three days, the patients received only intravenous glucose, followed by 12 days of total parenteral nutrition (TPN). On days 8 through 11, growth hormone was added to the mixture. Body weights decreased during the glucose infusion and the first three days of TPN; weight increased during the infusion of growth hormone, but the increase did not reach statistical significance. An improvement in the nitrogen balance (which indicates retention of protein and growth of tissues) was observed, indicating that the growth hormone permitted the patient to maintain a positive balance at a level of caloric intake which otherwise would have been too high for a patient with poor respiratory function. Despite the positive nitrogen balance, no improvement in muscle function was observed during this study. Further studies should address whether muscle improvement occurs over longer periods of treatment, as well as other issues such as the optimal dose of growth hormone and the long-term effectiveness of its use in patients with chronic obstructive pulmonary disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Methods, Lung diseases, Obstructive, Chronic obstructive lung disease, Somatotropin, Respiratory tract diseases, Respiratory insufficiency

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Flavimonas oryzihabitans (Pseudomonas oryzihabitans; CDC group Ve-2) bacteremia in the immunocompromised host

Article Abstract:

Flavimonas (formerly Pseudomonas) oryzihabitans is a bacterium that normally occurs in soil, and is seldom a cause of disease in humans. There have been only seven cases of infection by this organism reported in the literature. Three of these were in patients who were undergoing chronic ambulatory peritoneal dialysis for the treatment of chronic kidney failure, and four occurred as bacteria in the blood. Three new cases are reported in patients whose immune systems were weakened, and who had catheters placed (into a vein) for the delivery of drugs. One woman had leukemia and was admitted to the hospital with fever, muscle pain, and headache five weeks after receiving chemotherapy. A woman with sickle cell disease and a history of catheter-associated infections was admitted for sickle cell crisis. A man with AIDS and a history of lung infections was admitted with fever, chills, headache, and vomiting. Flavimonas oryzihabitans was isolated from the blood of all three patients. They all responded to antibiotic treatment. Although the bacterium has been isolated from wounds and abscesses, as well as from inhalation therapy equipment and hospital sinks, there have been few reports of serious infection. However, with the increasing numbers of immunocompromised patients, and the increased use of venous catheters to deliver drugs, Flavimonas oryzihabitans should be considered a possible cause of infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Immunodeficiency, Pseudomonas infections

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Oerskovia infection caused by contaminated home parenteral nutrition solution

Article Abstract:

Three cases of human infection by the bacterium Oerskovia have been reported. The case is discussed of a woman who was receiving total parenteral nutrition (TPN, in which all nutritional needs are provided intravenously) at home and was diagnosed with an Oerskovia infection at the site of her intravenous tube insertion. She was started on antibiotic medication in the hospital and returned home, continuing the TPN there, but again she developed an infection. Oerskovia bacteria was found in her blood and in the TPN solution. After additional antibiotic therapy the patient recovered. Home TPN solutions provide an excellent environment for the growth of bacteria. Quality control measures appropriate for hospital TPN solutions may not be appropriate for home TPN solutions, and no standards currently exist for manufacturers of home TPN solutions. It is advised that physicians inquire about quality control when choosing a company for home intravenous therapy.

Standards, Complications and side effects, Home nursing

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