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Cholestasis in late metabolic acidosis of prematurely born infants
H Senger1, G Boehm, K Beyreiss
1Department of Pediatrics, Karl-Marx University Leipzig, GDR.
Insights
Metabolic acidosis in premature infants disrupts bile acid and tyrosine levels, leading to impaired fat digestion. Treatment normalized these levels, improving infant health.
Area of Science:
- Biochemistry
- Pediatric Gastroenterology
- Neonatology
Background:
- Premature infants are susceptible to metabolic acidosis.
- Metabolic acidosis can affect various physiological processes, including digestion and nutrient absorption.
Purpose of the Study:
- To investigate the impact of late metabolic acidosis on bile acid and tyrosine metabolism in premature infants.
- To assess the effects of metabolic acidosis on digestive enzyme activity and fat excretion.
- To evaluate the recovery of these parameters after acidosis resolution.
Main Methods:
- Serum bile acids and tyrosine were measured in infants with and without metabolic acidosis.
- Duodenal juice analysis included bile acid concentration and lipase/trypsin activity.
- Fecal fat excretion was quantified.
- Duodenal studies were repeated in a subset of patients after acidosis correction.
Main Results:
- Infants with metabolic acidosis exhibited significantly higher serum bile acids and tyrosine.
- Decreased duodenal bile acids, lipase, and trypsin activity were observed during acidosis.
- Increased fecal fat excretion was associated with metabolic acidosis.
- Duodenal parameters normalized within a week after acidosis resolution.
Conclusions:
- Late metabolic acidosis in premature infants is linked to cholestasis and altered amino acid transport.
- Digestive enzyme deficiencies and impaired fat absorption are consequences of metabolic acidosis.
- Correction of metabolic acidosis leads to the recovery of gastrointestinal function.
Abstract:
Serum concentrations of bile acids and tyrosine were determined in 14 premature infants with late metabolic acidosis and in 13 comparable controls without acidosis (protein intake 2 g/kg X d). At the same time the bile acids and the catalytic activity concentrations of lipase and trypsin were estimated in the duodenal juice. The daily faecal excretion and the percentage of fat eliminated were measured. In 8 patients with late metabolic acidosis the duodenal studies were repeated one week after late metabolic acidosis. Infants with late metabolic acidosis showed significantly higher concentrations of bile acids and tyrosine in the serum than the controls (p less than 0.0005). In the duodenal juice the activities of lipase and trypsin and the concentration of bile acids--especially of dihydroxy bile acids--were decreased (p less than 0.001). The faecal excretion during late metabolic acidosis was significantly increased, with high percentage of fat. Eight days after late metabolic acidosis all duodenal parameters equalled the range of the control group. The relations between acidosis, cholestasis, and amino acid transport to the liver are discussed.