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The hepatotoxicity of parenteral protein hydrolysate-containing solutions
Insights
Parenteral nutrition with protein hydrolysates may cause liver damage in infants. This study found abnormal liver enzymes and amino acid imbalances in infants receiving these solutions, indicating potential hepatotoxicity.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Clinical Nutrition
Background:
- Parenteral nutrition is crucial for infant growth but can pose risks.
- Protein hydrolysates are used in parenteral solutions.
- Previous reports suggest hepatotoxicity associated with these solutions.
Purpose of the Study:
- To investigate the potential hepatotoxicity of protein hydrolysate-containing parenteral solutions in infants.
- To assess liver function and amino acid profiles in infants receiving these solutions.
Main Methods:
- Retrospective review of ten infants (30-40 weeks gestational age, 1000-3500g birth weight).
- Serial measurement of liver enzymes (GOT, GPT, LAP) and bilirubin.
- Analysis of serum amino acid levels.
- Review of liver biopsy findings in three patients.
Main Results:
- Eight infants showed elevated transaminases (GOT, GPT).
- Six patients had increased bilirubin levels, and four had elevated LAP.
- Consistent amino acid imbalances were observed, including decreased isoleucine and increased other amino acids.
- Liver biopsies revealed minimal to moderate hepatic parenchymal disease with cholestasis.
Conclusions:
- Protein hydrolysate-containing parenteral solutions may be associated with infant liver injury.
- Observed amino acid imbalances correlate with elevated liver enzymes.
- Further research is needed to confirm causality and explore alternative nutritional strategies.
Abstract:
Protein hydrolysate-containing parenteral solutions have been reported to be hepatotoxic. Ten infants who were treated with a 20 percent glucose solution containing either 2.5 percent or 3.25 percent protein hydrolysate are reviewed. Their gestational ages were 30 to 40 weeks and births weights 1000 to 35000 g. Serum glutamate-oxaloacetate transaminase (GOT), glutamate-pyruvate transaminase (GPT), leucine amino peptidase (LAP) and bilirubin were measured serially. Serum amino acids were measured and consistently demonstrated decreased levels of isoleucine and increased aspartic acid, glutamic acid, serine, proline, glycine, alanine, threonine and lysine. The amino acid imbalances were associated with transaminase elevations in eight infants. Serum bilirubin levels increased in six patients and LAP in four. Liver biopsies from three patients showed minimal to moderate hepatic parenchymal disease with cholestasis.