Severe hypophosphatemia following the institution of enteral feedings.

Although severe hypophosphatemia has been recognized in refeeding syndromes, it is not a commonly reported complication of enteral nutrition. The present study was designed to identify cases of severe hypophosphatemia (less than 0.32 mmol/L [less than 1.0 mg/dL]) related to the administration of carbohydrates via the enteral route. Serum phosphorus levels were evaluated at the time of admission of 25 patients to two midwestern teaching hospitals and during their postoperative enteral support in the surgical intensive care unit. The initial serum phosphorus levels ranged from 0.77 to 1.55 mmol/L (2.4 to 4.8 mg/dL), serum calcium levels ranged from 1.80 to 2.44 mmol/L (7.2 to 9.8 mg/dL). From two to five days following the initiation of isotonic enteral feedings, the serum phosphorus level decreased to 0.16 to 0.39 mmol/L (0.5 to 1.2 mg/dL). Serum phosphorus levels were corrected within two to ten days with oral supplementation only. Patients with high metabolic demand may have a higher daily requirement for phosphorus than that available in routine isotonic enteral formulas.

Initial results of a program in liver transplantation.

St. Louis University established a liver transplant program in early 1988. The authors report on the program's first 10 months in operation, emphasizing the careful planning and cooperation the medical center must undertake to ensure the program's success.

The use of scintiangiography with technetium 99m in the diagnosis of traumatic pseudoaneurysm.

Pseudoaneurysm formation is a known complication of peripheral arterial access procedures. Although standard contrast angiography has been considered the diagnostic study of choice to identify pseudoaneurysms, isotope angiography has been described as an alternative method. In this study, we examined the role of 99mTc-tagged red blood cell scans in the diagnosis of traumatic pseudoaneurysm. Forty patients underwent scans; 25 scans were reported as abnormal and 15 as normal. There were no false-negative results; one scan had false-positive results (2.5%). The presence of pseudoaneurysm among the patients with abnormal scans was verified at operation in 23 of 25 patients. The one false-positive test was verified by ultrasound. All patients with normal scans were followed up for verification. Follow-up time ranged from 2 to 28 months. Radionuclide vascular flow study appears to give information similar to that of conventional angiography. With a series false-positive rate of 2.5%, the examination has a high specificity. The 99mTc-tagged red blood cell scan is a viable alternative to conventional angiography for the diagnosis of traumatic pseudoaneurysms and is associated with less radiation and morbidity.