REDUCING PARENTERAL ENERGY AND PROTEIN-INTAKE IMPROVES METABOLIC HOMEOSTASIS AFTER BONE-MARROW TRANSPLANTATION

The purpose of this prospective study was to compare the metabolic effects of reducing parenteral energy and protein intake in bone-marrow-transplant (BMT) patients from 150% (hi-TPN group) to 100% (lo-TPN group) basal energy expenditure. Cytotoxic therapy was given on days 1-5, BMT on day 6, and TPN beginning on days 6 or 7. The lo-TPN group exhibited higher serum albumin (38 +/- 0.4 vs 32 +/- 0.4 g/L, P < 0.01) but similar nitrogen balance (-83 +/- 8 vs -86 +/- 8 mg . kg-1 . d-1, P > 0.05). Serum Na+ remained > 134 +/- 1 mmol/L in the lo-TPN group but fell to 127 +/- 1 mmol/L in the hi-TPN group (P < 0.001) despite similar Na+ intakes and balances. Serum K+ remained < 4.4 +/- 0.2 mmol/L in the lo-TPN group but rose to 5.1 +/- 0.1 mmol/L in the hi-TPN group (P < 0.01) despite similar K+ intakes and balances. Delivering TPN at lower-than-normal rates after BMT appears to minimize Na+ and K+ disturbances and improve serum albumin concentrations without having any adverse effect on nitrogen balance.