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From: B. Harris)
Subject: Re: Vitamins and Liver Damage
Date: Mon, 10 Nov 1997

In <> James Oliver
<> writes:

>It is my understanding, and please correct me if I am wrong, that many
>hospitals have established protocols for their enteral and TPN

   For TPN the formulas are more or less custom, though here again the
vitamin content is not going to be much over RDA, if for no other
reason than the present severe shortage of IV vitamins (caused by one
large company leaving the market, and the others not yet quite having
taken up the slack).

   For enteral formulas, most places pretty much use what's in the
formulas.  In some cases this is more than the RDA (though not much
more) and in some it isn't.  A lot of sick people get Ensure, which has
basically RDA and nothing more.

   >>Wouldn't the "MD and RD collaborate to add nutrient supplements as

     Ideally.   Though it's tough to tell how much are "needed."  Often
the answers aren't known, except that requirements are up.  For the
individual patient, it's just about impossible to tell vitamin
requirements exactly in metabolic stress.   Nobody measures vitamin
levels, for instance, for most vitamins other than B12 (or almost
never).  One would think that, this being the case, hospital medical
caregivers would be especially careful to give at least several times
the RDA for all nontoxic vitamins, to make absolutely SURE that enough
is being given.  Too often, it's not done, however.    As the patient
continues with his $2000 a day hospital care, everybody is really
careful to make sure that the vitamins in his 20 cent supplement aren't
being wasted in giving him "expensive urine."  Admirable economic
restraint, there.   Soon, with such complete all-levels attention, the
nation's trillion dollar a year medical care bill will be whittled down
to size.  No doubt.

  >>Therapeutic doses of vitamins/minerals certainly seem within the
discretion of the attending physician.<<

    They are.  But too often the attending has better things to do.
"Isn't that the job of the formula company, anyway?" is the attitude.
And as for RDs, they are overworked, and may not even be involved in
many cases.

                                  Steve Harris, M.D.

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