Recollections of pioneers in nutrition: landmarks in the development of parenteral nutrition

Abstract

Total parenteral nutrition (TPN) has been available for only 30 years. The successful development of this therapy, in a modern sense, was initiated in the late 30s. However, history in this field goes back more than 350 years, with the first landmark being the description of general blood circulation by William Harvey in 1628. His discovery is the anatomical basis for intravenous infusions. Many investigations were performed during the following centuries showing that solutions containing electrolytes and glucose could be given intravenously in man. The accumulated knowledge of protein metabolism formed the basis for studies on intravenous nutrition with protein hydrolysates, peptides and amino acids. The observation in the late 30s by Robert Elman that amino acids in the form of protein hydrolysate could be administered safely in man was the first major step toward TPN. During the following years, major efforts were made to find methods to prepare infusion solutions with a high energy content and low osmotic pressure. The most realistic alternative seemed to be fat in the form of an emulsion. Many studies of a large number of various fat emulsions were made from the 20s until the end of the 50s. However, all of these emulsions caused severe adverse reactions in man. The first safe fat emulsion, Intralipid, was made available in the early 60s. This was the second major step toward TPN. It was then no problem to include vitamins, electrolytes and trace elements in the fat emulsions and the solutions of amino acids and glucose.(ABSTRACT TRUNCATED AT 250 WORDS)