Clonidine Reduces Diarrhea and Sodium Loss in Patients With Proximal Jejunostomy: A Controlled Study
Background: Patients with short bowel syndrome have significant fluid losses. This represents a significant management problem, especially in patients with minimal residual intestine. We determined whether clonidine, anα 2-adrenergic agonist, is effective in decreasing fecal water and sodium (Na) lo...
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| creator | Buchman, Alan L. Fryer, Jon Wallin, Anita Ahn, Chul W. Polensky, Sharon Zaremba, Karen |
| description | Background: Patients with short bowel syndrome have significant
fluid losses. This represents a significant management problem, especially in
patients with minimal residual intestine. We determined whether clonidine, anα
2-adrenergic agonist, is effective in decreasing fecal water
and sodium (Na) losses in patients with proximal jejunostomy. Eight parenteral
nutrition (PN)–dependent subjects (3 men, 5 women), aged 49.9 ±
10.2 years, with a residual small bowel length of 71.8 ± 152.0 cm that
ended in a jejunostomy, were studied. Methods: Subjects were admitted
to the North-western General Clinical Research Center (GCRC) for a 2-day
equilibrium period while receiving a self-selected 100 g fat diet with protein
1.5 g/kg/d and 30 kcal/kg/d and 1 L/d of oral rehydration solution. A
d-xylose test was performed after an overnight fast. On days
3–5, all stool and urine were collected for volume, weight, fat,
nitrogen, energy, sodium, magnesium, potassium, and calcium. Meals were
provided in duplicate and the equivalent portions consumed by each patient
were analyzed for fluid volume, fat, nitrogen, energy, sodium, magnesium,
calcium, and potassium in order to calculate nutrient balances. At the
conclusion of the stool and urine collections (day 6), a clonidine (0.3 mg)
patch was applied to the shoulder. Subjects were restudied after 1 week.
Results: Daily fecal volume and weight were 4.514 ± 1.769 L/d
and 4394 ± 1727 g/d, respectively, at baseline. Five subjects were net“
secretors” in that excreted fecal volume exceeded oral intake.
Fecal volume decreased by 427 ± 562 mL/d (8.9%, p = .07).
Fecal weight decreased by 438 ± 527 g/d (9.4%, p = .05). Urine
volume correspondingly increased by 747 ± 1934 mL (18.9%, p =
not significant [NS]). The increase in urine output was weakly and negatively
correlated with the decrease in fecal volume and weight (r
=–0.37 and –0.41, respectively, p = NS). Oral fluid
intake decreased slightly from 3.328 ± 1.246 L/d baseline to 3.203±
1.119 L/d with clonidine therapy (–3.8%, p = NS).
Fecal Na loss was significantly decreased from baseline (887 ± 996
mg/d, 11.2 ± 12.3%; p = .036). This was not related to
decreased oral Na intake, which actually increased from baseline (3.799±
2.271 g/d) to 3.933 ± 1.314 g/d after clonidine therapy
(p = NS). No patient developed hypotension. Conclusions: Our
results show the transdermal administration of clonidine is associated with a
modest but clinically significant decrease in fecal output in patien |
| doi_str_mv | 10.1177/0148607106030006487 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_68970866</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0148607106030006487</sage_id><sourcerecordid>1166850581</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4517-9eb31576dfd6617073e900fe7850e91c4671af31b5774d92779ef97b72d29b4e3</originalsourceid><addsrcrecordid>eNqN0V2L1DAUBuAgiju7-gsECYJ7Vz1pMzmNd8u4fiyDDn7gZUmbUzdDJ1mTFp1_b4YODIiIV7l53pP3JIw9EfBCCMSXIGStAAUoqABAyRrvsYXQUhSllPI-WxxEcSBn7DylbUaVAnjIzgSCRIHlgtnVELyzzhP_RHbqKPHXzsR4S4Ybb_nnYN204-uQEneeb8zoyI-Jf3PjLd_E8MvtzMBvaDv5kMaw27_iV3wV_BjDMFDOj5PdP2IPejMkenw8L9jXN9dfVu-K9ce371dX66KTS4GFprYSS1S2t0rliliRBugJ6yWQFp1UKExfiXaJKK0uETX1GlssbalbSdUFu5zn3sXwY6I0NjuXOhoG4ylMqVG1RqiVyvDZH3Abpuhzt6asoATIwzOqZtTFvH2kvrmLedu4bwQ0hx9o_vIDOfX0OHpqd2RPmeOTZ_D8CEzqzNBH4zuXTq4uRSWwzk7P7qcbaP8_dzc3m-sPMJeAOZvMdzrt9q_evwG0v6lv</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>230200927</pqid></control><display><type>article</type><title>Clonidine Reduces Diarrhea and Sodium Loss in Patients With Proximal Jejunostomy: A Controlled Study</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Alma/SFX Local Collection</source><creator>Buchman, Alan L. ; Fryer, Jon ; Wallin, Anita ; Ahn, Chul W. ; Polensky, Sharon ; Zaremba, Karen</creator><creatorcontrib>Buchman, Alan L. ; Fryer, Jon ; Wallin, Anita ; Ahn, Chul W. ; Polensky, Sharon ; Zaremba, Karen</creatorcontrib><description>Background: Patients with short bowel syndrome have significant
fluid losses. This represents a significant management problem, especially in
patients with minimal residual intestine. We determined whether clonidine, anα
2-adrenergic agonist, is effective in decreasing fecal water
and sodium (Na) losses in patients with proximal jejunostomy. Eight parenteral
nutrition (PN)–dependent subjects (3 men, 5 women), aged 49.9 ±
10.2 years, with a residual small bowel length of 71.8 ± 152.0 cm that
ended in a jejunostomy, were studied. Methods: Subjects were admitted
to the North-western General Clinical Research Center (GCRC) for a 2-day
equilibrium period while receiving a self-selected 100 g fat diet with protein
1.5 g/kg/d and 30 kcal/kg/d and 1 L/d of oral rehydration solution. A
d-xylose test was performed after an overnight fast. On days
3–5, all stool and urine were collected for volume, weight, fat,
nitrogen, energy, sodium, magnesium, potassium, and calcium. Meals were
provided in duplicate and the equivalent portions consumed by each patient
were analyzed for fluid volume, fat, nitrogen, energy, sodium, magnesium,
calcium, and potassium in order to calculate nutrient balances. At the
conclusion of the stool and urine collections (day 6), a clonidine (0.3 mg)
patch was applied to the shoulder. Subjects were restudied after 1 week.
Results: Daily fecal volume and weight were 4.514 ± 1.769 L/d
and 4394 ± 1727 g/d, respectively, at baseline. Five subjects were net“
secretors” in that excreted fecal volume exceeded oral intake.
Fecal volume decreased by 427 ± 562 mL/d (8.9%, p = .07).
Fecal weight decreased by 438 ± 527 g/d (9.4%, p = .05). Urine
volume correspondingly increased by 747 ± 1934 mL (18.9%, p =
not significant [NS]). The increase in urine output was weakly and negatively
correlated with the decrease in fecal volume and weight (r
=–0.37 and –0.41, respectively, p = NS). Oral fluid
intake decreased slightly from 3.328 ± 1.246 L/d baseline to 3.203±
1.119 L/d with clonidine therapy (–3.8%, p = NS).
Fecal Na loss was significantly decreased from baseline (887 ± 996
mg/d, 11.2 ± 12.3%; p = .036). This was not related to
decreased oral Na intake, which actually increased from baseline (3.799±
2.271 g/d) to 3.933 ± 1.314 g/d after clonidine therapy
(p = NS). No patient developed hypotension. Conclusions: Our
results show the transdermal administration of clonidine is associated with a
modest but clinically significant decrease in fecal output in patients with
short bowel syndrome and high-output proximal jejunostomy that require chronic
parenteral fluid infusion. This is accompanied by decreased fecal Na loss.
Transdermal clonidine results in a modest decrease in fluid and sodium losses in jejunostomy patients.</description><identifier>ISSN: 0148-6071</identifier><identifier>EISSN: 1941-2444</identifier><identifier>DOI: 10.1177/0148607106030006487</identifier><identifier>PMID: 17047172</identifier><identifier>CODEN: JPENDU</identifier><language>eng</language><publisher>Silver Spring, MD: SAGE Publications</publisher><subject>Administration, Cutaneous ; Adrenergic alpha-Agonists - therapeutic use ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis ; Clinical death. Palliative care. Organ gift and preservation ; Clonidine - therapeutic use ; Diarrhea - drug therapy ; Diarrhea - metabolism ; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition ; Feces - chemistry ; Female ; Fluid Therapy ; Humans ; Intensive care medicine ; Intestinal Absorption - drug effects ; Jejunostomy - adverse effects ; Male ; Medical sciences ; Middle Aged ; Short Bowel Syndrome - metabolism ; Short Bowel Syndrome - pathology ; Short Bowel Syndrome - physiopathology ; Short Bowel Syndrome - therapy ; Sodium - metabolism ; Sodium - urine ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy ; Treatment Outcome ; Urinalysis</subject><ispartof>JPEN. Journal of parenteral and enteral nutrition, 2006-11, Vol.30 (6), p.487-491</ispartof><rights>American Society for Parenteral and Enteral Nutrition</rights><rights>2006 by The American Society for Parenteral and Enteral Nutrition</rights><rights>2007 INIST-CNRS</rights><rights>Copyright American Society for Parenteral and Enteral Nutrition Nov/Dec 2006</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4517-9eb31576dfd6617073e900fe7850e91c4671af31b5774d92779ef97b72d29b4e3</citedby><cites>FETCH-LOGICAL-c4517-9eb31576dfd6617073e900fe7850e91c4671af31b5774d92779ef97b72d29b4e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1177%2F0148607106030006487$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1177%2F0148607106030006487$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,778,782,1414,27907,27908,45557,45558</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18213178$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17047172$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Buchman, Alan L.</creatorcontrib><creatorcontrib>Fryer, Jon</creatorcontrib><creatorcontrib>Wallin, Anita</creatorcontrib><creatorcontrib>Ahn, Chul W.</creatorcontrib><creatorcontrib>Polensky, Sharon</creatorcontrib><creatorcontrib>Zaremba, Karen</creatorcontrib><title>Clonidine Reduces Diarrhea and Sodium Loss in Patients With Proximal Jejunostomy: A Controlled Study</title><title>JPEN. Journal of parenteral and enteral nutrition</title><addtitle>JPEN J Parenter Enteral Nutr</addtitle><description>Background: Patients with short bowel syndrome have significant
fluid losses. This represents a significant management problem, especially in
patients with minimal residual intestine. We determined whether clonidine, anα
2-adrenergic agonist, is effective in decreasing fecal water
and sodium (Na) losses in patients with proximal jejunostomy. Eight parenteral
nutrition (PN)–dependent subjects (3 men, 5 women), aged 49.9 ±
10.2 years, with a residual small bowel length of 71.8 ± 152.0 cm that
ended in a jejunostomy, were studied. Methods: Subjects were admitted
to the North-western General Clinical Research Center (GCRC) for a 2-day
equilibrium period while receiving a self-selected 100 g fat diet with protein
1.5 g/kg/d and 30 kcal/kg/d and 1 L/d of oral rehydration solution. A
d-xylose test was performed after an overnight fast. On days
3–5, all stool and urine were collected for volume, weight, fat,
nitrogen, energy, sodium, magnesium, potassium, and calcium. Meals were
provided in duplicate and the equivalent portions consumed by each patient
were analyzed for fluid volume, fat, nitrogen, energy, sodium, magnesium,
calcium, and potassium in order to calculate nutrient balances. At the
conclusion of the stool and urine collections (day 6), a clonidine (0.3 mg)
patch was applied to the shoulder. Subjects were restudied after 1 week.
Results: Daily fecal volume and weight were 4.514 ± 1.769 L/d
and 4394 ± 1727 g/d, respectively, at baseline. Five subjects were net“
secretors” in that excreted fecal volume exceeded oral intake.
Fecal volume decreased by 427 ± 562 mL/d (8.9%, p = .07).
Fecal weight decreased by 438 ± 527 g/d (9.4%, p = .05). Urine
volume correspondingly increased by 747 ± 1934 mL (18.9%, p =
not significant [NS]). The increase in urine output was weakly and negatively
correlated with the decrease in fecal volume and weight (r
=–0.37 and –0.41, respectively, p = NS). Oral fluid
intake decreased slightly from 3.328 ± 1.246 L/d baseline to 3.203±
1.119 L/d with clonidine therapy (–3.8%, p = NS).
Fecal Na loss was significantly decreased from baseline (887 ± 996
mg/d, 11.2 ± 12.3%; p = .036). This was not related to
decreased oral Na intake, which actually increased from baseline (3.799±
2.271 g/d) to 3.933 ± 1.314 g/d after clonidine therapy
(p = NS). No patient developed hypotension. Conclusions: Our
results show the transdermal administration of clonidine is associated with a
modest but clinically significant decrease in fecal output in patients with
short bowel syndrome and high-output proximal jejunostomy that require chronic
parenteral fluid infusion. This is accompanied by decreased fecal Na loss.
Transdermal clonidine results in a modest decrease in fluid and sodium losses in jejunostomy patients.</description><subject>Administration, Cutaneous</subject><subject>Adrenergic alpha-Agonists - therapeutic use</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis</subject><subject>Clinical death. Palliative care. Organ gift and preservation</subject><subject>Clonidine - therapeutic use</subject><subject>Diarrhea - drug therapy</subject><subject>Diarrhea - metabolism</subject><subject>Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition</subject><subject>Feces - chemistry</subject><subject>Female</subject><subject>Fluid Therapy</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Intestinal Absorption - drug effects</subject><subject>Jejunostomy - adverse effects</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Short Bowel Syndrome - metabolism</subject><subject>Short Bowel Syndrome - pathology</subject><subject>Short Bowel Syndrome - physiopathology</subject><subject>Short Bowel Syndrome - therapy</subject><subject>Sodium - metabolism</subject><subject>Sodium - urine</subject><subject>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><subject>Treatment Outcome</subject><subject>Urinalysis</subject><issn>0148-6071</issn><issn>1941-2444</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqN0V2L1DAUBuAgiju7-gsECYJ7Vz1pMzmNd8u4fiyDDn7gZUmbUzdDJ1mTFp1_b4YODIiIV7l53pP3JIw9EfBCCMSXIGStAAUoqABAyRrvsYXQUhSllPI-WxxEcSBn7DylbUaVAnjIzgSCRIHlgtnVELyzzhP_RHbqKPHXzsR4S4Ybb_nnYN204-uQEneeb8zoyI-Jf3PjLd_E8MvtzMBvaDv5kMaw27_iV3wV_BjDMFDOj5PdP2IPejMkenw8L9jXN9dfVu-K9ce371dX66KTS4GFprYSS1S2t0rliliRBugJ6yWQFp1UKExfiXaJKK0uETX1GlssbalbSdUFu5zn3sXwY6I0NjuXOhoG4ylMqVG1RqiVyvDZH3Abpuhzt6asoATIwzOqZtTFvH2kvrmLedu4bwQ0hx9o_vIDOfX0OHpqd2RPmeOTZ_D8CEzqzNBH4zuXTq4uRSWwzk7P7qcbaP8_dzc3m-sPMJeAOZvMdzrt9q_evwG0v6lv</recordid><startdate>200611</startdate><enddate>200611</enddate><creator>Buchman, Alan L.</creator><creator>Fryer, Jon</creator><creator>Wallin, Anita</creator><creator>Ahn, Chul W.</creator><creator>Polensky, Sharon</creator><creator>Zaremba, Karen</creator><general>SAGE Publications</general><general>ASPEN</general><general>American Society for Parenteral and Enteral Nutrition</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>200611</creationdate><title>Clonidine Reduces Diarrhea and Sodium Loss in Patients With Proximal Jejunostomy: A Controlled Study</title><author>Buchman, Alan L. ; Fryer, Jon ; Wallin, Anita ; Ahn, Chul W. ; Polensky, Sharon ; Zaremba, Karen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4517-9eb31576dfd6617073e900fe7850e91c4671af31b5774d92779ef97b72d29b4e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Administration, Cutaneous</topic><topic>Adrenergic alpha-Agonists - therapeutic use</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis</topic><topic>Clinical death. Palliative care. Organ gift and preservation</topic><topic>Clonidine - therapeutic use</topic><topic>Diarrhea - drug therapy</topic><topic>Diarrhea - metabolism</topic><topic>Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition</topic><topic>Feces - chemistry</topic><topic>Female</topic><topic>Fluid Therapy</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Intestinal Absorption - drug effects</topic><topic>Jejunostomy - adverse effects</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Short Bowel Syndrome - metabolism</topic><topic>Short Bowel Syndrome - pathology</topic><topic>Short Bowel Syndrome - physiopathology</topic><topic>Short Bowel Syndrome - therapy</topic><topic>Sodium - metabolism</topic><topic>Sodium - urine</topic><topic>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</topic><topic>Treatment Outcome</topic><topic>Urinalysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Buchman, Alan L.</creatorcontrib><creatorcontrib>Fryer, Jon</creatorcontrib><creatorcontrib>Wallin, Anita</creatorcontrib><creatorcontrib>Ahn, Chul W.</creatorcontrib><creatorcontrib>Polensky, Sharon</creatorcontrib><creatorcontrib>Zaremba, Karen</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>JPEN. Journal of parenteral and enteral nutrition</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Buchman, Alan L.</au><au>Fryer, Jon</au><au>Wallin, Anita</au><au>Ahn, Chul W.</au><au>Polensky, Sharon</au><au>Zaremba, Karen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clonidine Reduces Diarrhea and Sodium Loss in Patients With Proximal Jejunostomy: A Controlled Study</atitle><jtitle>JPEN. Journal of parenteral and enteral nutrition</jtitle><addtitle>JPEN J Parenter Enteral Nutr</addtitle><date>2006-11</date><risdate>2006</risdate><volume>30</volume><issue>6</issue><spage>487</spage><epage>491</epage><pages>487-491</pages><issn>0148-6071</issn><eissn>1941-2444</eissn><coden>JPENDU</coden><abstract>Background: Patients with short bowel syndrome have significant
fluid losses. This represents a significant management problem, especially in
patients with minimal residual intestine. We determined whether clonidine, anα
2-adrenergic agonist, is effective in decreasing fecal water
and sodium (Na) losses in patients with proximal jejunostomy. Eight parenteral
nutrition (PN)–dependent subjects (3 men, 5 women), aged 49.9 ±
10.2 years, with a residual small bowel length of 71.8 ± 152.0 cm that
ended in a jejunostomy, were studied. Methods: Subjects were admitted
to the North-western General Clinical Research Center (GCRC) for a 2-day
equilibrium period while receiving a self-selected 100 g fat diet with protein
1.5 g/kg/d and 30 kcal/kg/d and 1 L/d of oral rehydration solution. A
d-xylose test was performed after an overnight fast. On days
3–5, all stool and urine were collected for volume, weight, fat,
nitrogen, energy, sodium, magnesium, potassium, and calcium. Meals were
provided in duplicate and the equivalent portions consumed by each patient
were analyzed for fluid volume, fat, nitrogen, energy, sodium, magnesium,
calcium, and potassium in order to calculate nutrient balances. At the
conclusion of the stool and urine collections (day 6), a clonidine (0.3 mg)
patch was applied to the shoulder. Subjects were restudied after 1 week.
Results: Daily fecal volume and weight were 4.514 ± 1.769 L/d
and 4394 ± 1727 g/d, respectively, at baseline. Five subjects were net“
secretors” in that excreted fecal volume exceeded oral intake.
Fecal volume decreased by 427 ± 562 mL/d (8.9%, p = .07).
Fecal weight decreased by 438 ± 527 g/d (9.4%, p = .05). Urine
volume correspondingly increased by 747 ± 1934 mL (18.9%, p =
not significant [NS]). The increase in urine output was weakly and negatively
correlated with the decrease in fecal volume and weight (r
=–0.37 and –0.41, respectively, p = NS). Oral fluid
intake decreased slightly from 3.328 ± 1.246 L/d baseline to 3.203±
1.119 L/d with clonidine therapy (–3.8%, p = NS).
Fecal Na loss was significantly decreased from baseline (887 ± 996
mg/d, 11.2 ± 12.3%; p = .036). This was not related to
decreased oral Na intake, which actually increased from baseline (3.799±
2.271 g/d) to 3.933 ± 1.314 g/d after clonidine therapy
(p = NS). No patient developed hypotension. Conclusions: Our
results show the transdermal administration of clonidine is associated with a
modest but clinically significant decrease in fecal output in patients with
short bowel syndrome and high-output proximal jejunostomy that require chronic
parenteral fluid infusion. This is accompanied by decreased fecal Na loss.
Transdermal clonidine results in a modest decrease in fluid and sodium losses in jejunostomy patients.</abstract><cop>Silver Spring, MD</cop><pub>SAGE Publications</pub><pmid>17047172</pmid><doi>10.1177/0148607106030006487</doi><tpages>5</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0148-6071 |
| ispartof | JPEN. Journal of parenteral and enteral nutrition, 2006-11, Vol.30 (6), p.487-491 |
| issn | 0148-6071 1941-2444 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_68970866 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Alma/SFX Local Collection |
| subjects | Administration, Cutaneous Adrenergic alpha-Agonists - therapeutic use Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis Clinical death. Palliative care. Organ gift and preservation Clonidine - therapeutic use Diarrhea - drug therapy Diarrhea - metabolism Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition Feces - chemistry Female Fluid Therapy Humans Intensive care medicine Intestinal Absorption - drug effects Jejunostomy - adverse effects Male Medical sciences Middle Aged Short Bowel Syndrome - metabolism Short Bowel Syndrome - pathology Short Bowel Syndrome - physiopathology Short Bowel Syndrome - therapy Sodium - metabolism Sodium - urine Transfusions. Complications. Transfusion reactions. Cell and gene therapy Treatment Outcome Urinalysis |
| title | Clonidine Reduces Diarrhea and Sodium Loss in Patients With Proximal Jejunostomy: A Controlled Study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-16T23%3A41%3A13IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Clonidine%20Reduces%20Diarrhea%20and%20Sodium%20Loss%20in%20Patients%20With%20Proximal%20Jejunostomy:%20A%20Controlled%20Study&rft.jtitle=JPEN.%20Journal%20of%20parenteral%20and%20enteral%20nutrition&rft.au=Buchman,%20Alan%20L.&rft.date=2006-11&rft.volume=30&rft.issue=6&rft.spage=487&rft.epage=491&rft.pages=487-491&rft.issn=0148-6071&rft.eissn=1941-2444&rft.coden=JPENDU&rft_id=info:doi/10.1177/0148607106030006487&rft_dat=%3Cproquest_cross%3E1166850581%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=230200927&rft_id=info:pmid/17047172&rft_sage_id=10.1177_0148607106030006487&rfr_iscdi=true |