The effects of administering hyperalimentation solutions into the atrium and pulmonary artery

Pulmonary hypertension, edema, and congestion have been found in three infants who died after infusion of chronic TPN solutions through catheters placed into the right atrium (RA) or pulmonary artery (PA). In 24 anesthetized dogs receiving varying concentrations of dextrose and water through catheters placed into the RA, the endothelium of the RA evidenced injury only when concentrations of 20% DW or greater were infused. Both the main PA and distal PA endothelium showed evidence of injury only when concentrations higher than 40% DW were infused. When solutions were infused directly into the main PA, the main PA endothelium revealed injury if more than 15% DW was infused, and the distal PA showed moderate endothelial injury when 10% DW or greater was infused. The distal PA evidenced more severe endothelial injury after concentrated dextrose solution infusion than either the RA or main PA. Pulmonary congestion, edema, and hypertension became increasingly prominent when 24-hour infusions of 10% DW or more were placed into the main PA, or concentrations higher than 40% were infused into the RA. Distal PA endothelial injury appears to correlate directly with the severity of pulmonary congestion, suggesting endothelial cell emboli.