Alcohol in intravenous feeding.

Some degree of starvation is a common and accepted sequel to severe injury, and for several days after major operations patients usually lose their appetite and do not eat. In the past attempts have been made to avoid this period of starvation by means of intravenous feeding with protein hydrolysates and various sources of energy. Close examination of the normal response to injury shows, however, that the well-nourished patient has an inherent capacity to survive injury and starvation and to heal his wounds, that after injury the organism so orders its economy that it provides from its own substance the raw materials for the repair of injured tissues as well as the daily energy requirements. The present tendency is thus once more to leave the body as much as possible to its own rather inscrutable devices during the postoperative period. This attitude means that the potential field for intravenous feeding, including the administration of alcohol, has again contracted to the few states in which a patient is unable to ingest or digest food by the alimentary tract. The value of parenteral nutrition is rather uncertain but there may be some place for it in the treatment of patients with fistulas of the small intestine, ulcerative colitis, advanced malnutrition and some forms of hepatic disease. Originally a 5 or 6% solution of amino-acids derived from the acid or enzymic hydrolysis of milk protein was combined with a source of energy such as glucose. The success of intravenous feeding with protein depends, however, on the provision of an adequate accompaniment of calories, which has given rise to most practical difficulties. An uninjured healthy person lying in bed probably requires about 2100 Cal./day, but this basal requirement is increased after injury and by other forms of inflammation (Cuthbertson, 1945). T o supply 2100 Cal. would entail the daily infusion of over 11 1. of 5%) or 5.6 1. of 10%) glucose solution. Even normal subjects have only a limited tolerance for repeated large intravenous infusions; after injury and in inflammation of all kinds this tolerance is greatly reduced and, apart from the replacement of losses of body fluids, not more than 2.5 l./day can be safely administered. Emulsions containing up to 30% of fat have been developed and administered intravenously and are safe and satisfactory sources of calories but have a limited stability or ‘shelf-life’. A 15% fat emulsion would provide 1200 Cal. /l. but, unfortunately, is still not commercially available. These various difficulties in providing adequate supplies of energy to accompany or ‘cover’ infusions of protein