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Hepatic dysfunction during hyperalimentation.

G F Sheldon, S R Peterson, R Sanders

    Archives of Surgery (Chicago, Ill. : 1960)
    |April 1, 1978
    PubMed
    Summary
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    Intravenous hyperalimentation (IVH) can cause liver problems like fatty liver and cholestasis. Adjusting IVH composition may treat these hepatic changes.

    Area of Science:

    • Hepatology
    • Gastroenterology
    • Clinical Nutrition

    Background:

    • Intravenous hyperalimentation (IVH) is crucial for nutritional support in critically ill patients.
    • Liver function abnormalities are a recognized complication of IVH.
    • Understanding the spectrum of hepatic changes is vital for patient management.

    Purpose of the Study:

    • To investigate the liver biopsy findings in patients developing liver dysfunction during IVH.
    • To correlate clinical manifestations and duration of IVH with observed liver morphology.
    • To identify potential causative factors and therapeutic strategies for IVH-induced liver injury.

    Main Methods:

    • Analysis of liver biopsy specimens from 26 patients receiving IVH.
    • Evaluation of clinical data, including duration and composition of IVH.

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  • Histopathological examination to identify hepatic changes.

    • Main Results:

    • Early hepatic changes included fatty metamorphosis (steatosis).
    • Progressive intrahepatic cholestasis was observed with continued IVH.
    • Potential causative factors identified: essential fatty acid deficiency, amino acid imbalance, caloric excess, and amino acid toxicity.

    Conclusions:

    • Hepatic steatosis secondary to IVH can be managed by adjusting dextrose concentration or using dextrose-free amino acid solutions.
    • Distinguishing IVH-induced cholestasis from other causes in critically ill patients presents a clinical challenge.
    • Early recognition and management of IVH-related liver complications are essential.