Mj. Gil et al., RESPONSE OF SEVERELY MALNOURISHED PATIENTS TO PREOPERATIVE PARENTERAL-NUTRITION - A RANDOMIZED CLINICAL-TRIAL OF WATER AND SODIUM RESTRICTION, Nutrition, 13(1), 1997, pp. 26-31
Preoperative parenteral nutrition (PPN) may be beneficial for severely
malnourished patients who are candidates For a major elective surgica
l procedure. The response to PPN, however, has not been thoroughly inv
estigated. Expansion of the extracellular water compartment may occur
in some patients, producing a further decrease in the serum albumin co
ncentration and increasing the postoperative complications. Our aims w
ere to investigate the occurrence of and factors associated with water
and sodium retention during PPN and its impact on postoperative respi
ratory complications. Forty-one patients with gastrointestinal cancer
and severe malnutrition (weight loss >15% and/or serum albumin <35 g/L
) were randomly allocated to two groups receiving isocaloric isonitrog
enous PPN for IO d. The Standard PPN Group (SG, n = 19) received 70% o
f nonprotein calories as glucose, 45 cc of water . kg(-1). d(-1), and
140 mEq/d of sodium chloride; and the Modified Group (MG, n = 22) rece
ived 70% of calories as fat, 30 cc of water . kg(-1). d(-1), and no so
dium. Weight and albumin changes, diuresis, sodium and water balances,
and postoperative complications were recorded. Ar, the end of PPN, th
e SG showed a higher wright gain (0.8 versus -1.5 kg, P = 0.0001) and
albumin decrease (-0.7 versus 2.3 g/L, P = 0.006), Diuresis and sodium
balance were greater in the SG (1,230 versus 959 mL/d, P = 0.003 and
40 versus -27 mEq/d, P = 0.001). Weight changes correlated with water
(r(2) = 0.46, P = 0.001) and sodium (r(2) = 0.62, P = 0.0001) balances
. Inappropriate responses to PPN in both groups (expansion or depletio
n of the extracellular water compartment) were associated with a signi
ficant increase in pulmonary postoperative complications. During PPN,
extracellular water expansion-as determined by increasing weight and l
owering of the serum albumin concentration-and aggressive fluid therap
y to treat water and sodium depletion seem crucial to the development
of postoperative respiratory complications. (C) Elsevier Science Inc.
1997.