Hemodynamic changes with high infusion rates of lipid emulsion. Experimental study in swine

To evaluate hemodynamic changes caused by sole intravenous infusion of lipid emulsion with doses recommended for treatment of drug-related toxicity. METHODS: Large White pigs underwent general anesthesia, tracheal intubation was performed, and mechanical ventilation was instituted. Hemodynamic variables were recorded using invasive blood pressure and pulmonary artery catheterization. Baseline hemodynamic measurements were obtained after a 30-minute stabilization period. An intravenous bolus injection of 20% lipid emulsion at 1.5 ml/kg was administered. Additional hemodynamic measurements were made after 1 minute, followed by a continuous intravenous lipid infusion of 0.25 ml/kg/min. Further measurements were carried out at 10, 20 and 30 minutes, when the infusion was doubled to 0.5 ml/kg/min. Assessment of hemodynamic changes were then made at 40, 50 and 60 minutes. RESULTS: Lipid infusion did not influence cardiac output or heart rate, but caused an increase in arterial blood pressure, mainly pulmonary blood pressure due to increased vascular resistance. Ventricular systolic stroke work consequently increased with greater repercussions on the right ventricle. CONCLUSION: In doses used for drug-related toxicity, lipid emulsion cause significant hemodynamic changes with hypertension, particularly in the pulmonary circulation and increase in vascular resistance, which is a factor to consider prior to use of these solutions.(AU)

Efeito do captrol no metabolismo de quilomícrons / Effect of captopril upon the chylomicrons metabolism

Avaliamos em 10 pacientes (8 mulheres) com hipertensão arterial leve ou moderada, 60,7  2,2 anos, o efeito do captopril: 1)na cinética plasmática dos quilomícrons (Qm) e seus remanescentes; 2)nas concentrações das lipoproteínas plasmáticas. Os resultados foram comparados a 20 indivíduos (15 mulheres) normotensos e normolipidêmicos, 60,5  1,5 anos (grupo controle). Concluímos que a remoção plasmática dos remanescentes de Qm, avaliada pelo teste da emulsão lipídica artificial, não se alterou com o uso de captopril. O emprego deste fármaco resultou em melhora significativa nas cocentrações plasmáticas de colesterol total e de LDL-c / The objective of this study was to verify in patients under captopril treatment: 1) the status of chylomicrons metabolism, using the chylomicron-like emulsion approach; 2) to evaluate plasma lipoprotein concentrations. The emulsion was injected intravenously into 10 mild or moderated hipertensive patients (8 women), 60.7 + 2.2 years. The results were compared to 20 normotensive and normolipidemic subjects (15 women), 60.5 + 1.5 years. Our study shows that captopril treatment does not disturb the removal from the plasma of chylomicron remnants and the plasma lipid and apolipoprotein profile. Captopril treatment may even bear an antiatherogenic effect, by decreasing LDL cholesterol...

Iodine supplementation in children receiving long-term parenteral nutrition.

In 18 children receiving long-term total parenteral nutrition (TPN) without iodide supplements, thyroid function test results were normal but serum iodide levels were greater than in control subjects (p less than 0.01). Iodine contamination of TPN solutions and fat emulsions accounted for only half of the recommended parenteral intake. Skin absorption of topical iodinated disinfectant may explain the adequate, if not excessive, iodine intake. We conclude that iodine is an unnecessary supplement in TPN solutions.

Plasma carnitine levels during intravenous feeding of the neonate.

The premature infant has a limited capacity for fatty acid oxidation. This study shows that solutions commonly used for intravenous feedings in the newborn infant contain no carnitine. Infants maintained on this solution have significantly lower total, free, and acylcarnitine levels as compared to when they are fed orally with expressed human milk or a proprietary formula, which is known to contain carnitine. The exogenous supply of carnitine to the premature infant may have a significant influence on the ability to stimulate optimal fatty acid oxidation.