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Total parenteral nutrition-associated cholestasis: acute studies in infant and adult rabbits
Insights
Total parenteral nutrition (TPN) can cause cholestasis. This study found that nutrient solutions containing amino acids and glucose significantly reduce bile flow and secretion, suggesting these components are responsible for TPN-associated cholestasis.
Area of Science:
- Hepatology
- Gastroenterology
- Pediatric Gastroenterology
Background:
- Cholestasis is a known complication of total parenteral nutrition (TPN).
- The specific components of TPN responsible for inducing cholestasis remain unclear.
- Understanding the impact of individual TPN components on bile physiology is crucial for managing TPN-associated liver dysfunction.
Purpose of the Study:
- To investigate the short-term effects of individual and combined TPN components on bile flow and bile salt secretion.
- To compare the effects in infant and adult rabbits to assess age-related differences.
- To identify which TPN constituents contribute to cholestasis.
Main Methods:
- Adult and infant rabbits were intravenously administered solutions of NaCl, amino acids, glucose, or fat emulsion, alone or in combination.
- Bile was collected from the common bile duct for 3 hours post-infusion.
- Bile flow rate and bile salt secretion were measured to assess hepatic excretory function.
Main Results:
- Solutions containing both amino acids and glucose significantly reduced bile flow and bile salt secretion in both infant and adult rabbits.
- Glucose alone decreased bile flow and bile salt secretion, while amino acids alone primarily decreased bile flow.
- The suppressive effect on bile flow was more pronounced in infant rabbits compared to adults. Fat emulsion had no significant effect.
- The combination of amino acids and glucose demonstrated a significant (p < 0.05) impact on bile secretion.
Conclusions:
- Short-term intravenous administration of amino acids and glucose solutions significantly impairs bile flow and bile salt secretion.
- These findings suggest that amino acids and glucose are key contributors to the development of cholestasis associated with total parenteral nutrition.
- Infants may be more susceptible to TPN-induced cholestasis due to a more pronounced suppressive effect of these nutrient components.
Abstract:
To assess the basis of cholestasis associated with total parenteral nutrition (TPN), we studied the short-term effect of the component solutions on bile flow and bile salt secretion in infant and adult rabbits. Groups of four to six adult and infant rabbits received intravenously 154 mM NaCl (control), 2.5% amino acid, 10% glucose, or 10% fat emulsion alone or in combination. Bile was collected directly from the common bile duct for 3 h. Solutions containing both amino acids and glucose significantly (p less than 0.05) reduced bile flow and bile salt secretion in both age groups. Glucose alone also decreased bile flow and bile salt secretion, whereas amino acids as the sole infusate significantly (p less than 0.05) decreased bile flow only. The suppressive effect of the amino acid-glucose solutions on bile flow was more pronounced in infants than in adults. Fat emulsion alone had no effect on bile formation. Our findings demonstrate that short-term intravenous administration of nutrient solutions containing amino acids and glucose reduces bile flow and bile salt secretion, suggesting that these components are responsible for TPN-associated cholestasis.