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Hepatic Cytolytic and Cholestatic Changes Related to a Change of Lipid Emulsions in Four Long‐Term Parenteral Nutrition Patients With Short Bowel
Author(s) -
GerardBoncompain M.,
Claudel J.P.,
Gaussorgues P.,
Salord F.,
Sirodot M.,
Chevallier M.,
Robert D.
Publication year - 1992
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/014860719201600178
Subject(s) - parenteral nutrition , gastroenterology , cholestasis , medicine , short bowel syndrome , lecithin , lipid emulsion , endocrinology , biochemistry , chemistry
Long‐term parenteral nutrition hepatic‐related impairment is commonly reported and diversely explained. However, with a low cyclic caloric intake (100% to 130% of basal metabolism calculated with the Harris‐Benedict formula) consisting of two‐thirds glucose, one‐third lipid, and 0.20 to 0.25 g of nitrogen per kilogram per day, these complications were infrequent in a clinical practice of home long‐term parenteral nutrition. Retrospectively, it was noticed that the switch from Intralipid 20% to Ivelip 20% at the same amount was followed within 2 months by four cases of jaundice in a population of four home long‐term parenteral nutrition patients with short bowel disease. Hepatic disturbances were characterized by cytolysis and cholestasis and were reversible after switching from Ivelip 20% back to Intralipid 20%. Neither viral, nor biliary, nor septic etiologies were detected. The exact pathological mechanism remains unknown. The basal composition of both lipid emulsions seems to be identical: soy oil emulsion emulsified by egg phospholipids. However, some differences exist such as the size of particles, the presence of sodium oleate in Ivelip 20%, and the purification process of lecithin. These may explain the difference in hepatic tolerance during long‐term parenteral nutrition. ( Journal of Parenteral and Enteral Nutrition 16:78–83, 1992)