Free Communications TRANSITION FROM TOTAL PARENTERAL NUTRITION TO ENTERAL NUTRITION. L.Fuller, A.J.Rich and I.D.A.Johnston. Dept.of Surg., Univ.of Newcastle upon Tyne, UK.

Total parenteral nutrition (TPN) can be very successfully used, but the ultimate aim is a return to enteral nutrition (EN) and the transition re- quires careful management for continued patient progress. A retrospective study was made from the records of 24 patients admitted to this teaching hospital, to assess the adequacy of energy intake during the change-over period. There were 14 males and 10 females, average age 46 years + 17, diagnoses varied. Adequacy of energy provision was measured by comparison with calculated energy expenditure (EE). Basal EE was derived using the Harris-Benedict equations, increments of 20, 54 or 76% being applied, de- pending upon patient state, to obtain an estimate of total EE (Rutten et al, 1975). Results are shown in the table below. Energy supplied met> 95% of calculated EE in all weeks except 0. Week 0 was the first week on EN only. Although energy from EN (mainly voluntary food consumption) doubled at least from week -1 to 0, total energy intake fell to only 86% of EE. Perhaps TPN was halted prematurely, but intake improved, all patients re- covered and were finally discharged. In conclusion, whilst TPN must not be discontinued too abruptly, so long as EN is increasing before TPN is hal- ted it does not appear necessary for EN to provide the main proportion of calories before doing so.

Week -3 -2 -1 1 No. of patients with data 9 15 24 2: 5 22 EN kcal as % total intake 26 25 42 100 100 100 Total kcal intake as % EE 98 97 91 86 97 139 EN kcal as % EE 26 29 40 86 97 139

Rutten,P., Blackburn,GL., Flatt,JP., Hallowel,E., Cochran,E. (1975). J. Surg.Res. 18: 477.

F02 A STUDY OF DIJODENALENTERALNUTRITION CARRIED OUT OVER A PERIOD OF SEVEN DAYS ON YOUNG HEALTHY MALE VOLUNTEERS: H.Wiedeck, F.W. Ahnefeld, A.GrUnert. Center of Anaesthesiology, University of

m, UU Ulm, Steinhtivelstr.9, FRG. In general treatment, and especially in the field of post-

traumatic intensive care, the importance of nutrition has be- come increasingly apparent over the past few years. The following study was designed to assess a new method of nutriton which, even in the case of intensive care patients, avoids the not insignifi- cant risks of a central venous line by the use of an enteral route. Prerequisites to being able to carry out this method were the de- velopment of soft, filiform tubes which could with certainty be placed in the duodenum, and of an adapted nutrient mixture which could be completely absorbed in the duodenum. The acceptability and efficacy of the technique with respect to energy and protein carriage and the maintenance of body homeostasis was studied in a group of ten men of age between 17 and 44, and average body weight of 82 kg, over a period of 7 days. Using an infusion pump the solution was applied via the new filiform duodenal tube con- tinuously during three seven hour periods per day in between which there was a one hourbr-enkduring which the volunteers were physi- cally active. Each person received 2000 mls per day, an amount which had a total energy content of 2000 Kcals. Stool frequency and consistency, substrate input - output, body weight, and the following biochemical parameters: glucose, electrolytes, osmolali- ty, lactate, urea and creatinine, were measured. Patient tolerance, tube location (controlled by pH measurement) and bowel activity (stool frequency decreased and in no case did diarrhoea occur) were all very satisfactory. The study shows that the biochemical and biological parameters used to define body homeostasis remain within the normal range, further, that this method of nutrition, and the nutrient mixtures used, are suitable for the maintenance of normal physiologicalprocressover a number of days.

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