Hyperalimentation-associated jaundice: an example of a serum factor inducing cholestasis in rats

A patient receiving total parenteral nutrition (TPN) at home following emergency resection of the small intestine was studied over a two year interval. Cholestatic jaundice developed after 6 months. A factor in serum was found to produce cholestatic changes in the bile flow of rats on intravenous infusion. Normal human serum and saline infusion did not produce this cholestasis. Endotoxin infusion in the rat produced a similar impairment in bile flow. The hypothesis was proposed that endotoxin might be an occult factor contributing to cholestasis in this case. An antiserum prepared to an endotoxin isolated from a sequestered E. coli infection in this patient, ameliorated the cholestatic effects of the patients' serum in rats. The possible role of endotoxin in the cholestasis of the TPN-induced jaundice in this patient is presented and discussed.