Elizabeth M. Ross

Renal and Electrolyte Effects of Total Parenteral Nutrition

Effects of short-term (4-14 days) total parenteral nutrition on renal handling of water and electrolytes were studied retrospectively in 24 patients and prospectively in eight patients. There was 33% incidence of hyponatremia and significant reductions in serum creatinine (from 1.03 +/- 0.06 to 0.88 +/- 0.06 mg/dl, p less than 0.001), phosphorus (from 3.2 +/- 0.14 to 2.5 +/- 0.17 mg/dl, p less than 0.005) and uric acid (from 6.09 +/- 0.38 to 3.66 +/- 0.24 mg/dl, p less than 0.001) were observed. Hypouricemia correlated with increased fractional excretion of urate (r = 0.81, p less than 0.05). Hypophosphatemia was associated with increased tubular reabsorption of phosphate. Clearance studies in eight patients showed high urine flow rate (1.7 +/- 0.2 ml/min), osmolar clearance (3.2 +/- 0.7 ml/min), urinary nonelectrolyte, nonurea solute excretion (0.23 +/- 0.14 mmol/min), and negative free water clearance (TcH2O = 1.5 +/- 0.6 ml/min). These data suggest presence of compartmental shifts, expanded extracellular fluid volume, and possible direct effects on renal tubular transport functions during total parenteral nutrition.

A Prospective Survey for Central Line Skin-Site Colonization by the Pathogen Malassezia furfur Among Hospitalized Adults Receiving Total Parenteral Nutrition

BACKGROUND Over 50 case reports suggest that Malassezia furfur is an emerging systemic pathogen in neonates who receive IV lipid emulsions. Because isolation of this fungus requires special culture techniques, which are not routinely used, the authors of many case reports of M. furfur infections in adults question whether infections caused by this organism are being underdiagnosed in older patients. METHODS Catheter insertion site colonization rates in adults receiving total parenteral nutrition (TPN) were prospectively evaluated in 149 hospitalized patients with 928 cultures handled specifically for M. furfur detection. Positive control samples consisted of M. furfur cultures in neonates and in adults, who had not been enrolled in the study, and of a separate positive culture obtained from a skin site inoculated with M. furfur. RESULTS M. furfur was not cultured from any of the 928 study samples (95% confidence interval [CI] -0.4% to +0.4%). CONCLUSIONS These results suggest that M. furfur is less of a threat to hospitalized adults receiving TPN than has been otherwise postulated. These data do not support the inclusion of special cultures for M. furfur in routine skin-site surveillance programs among hospitalized adults receiving TPN.