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Query: UMLS:C0008370 (cholestasis)
 9,378 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hypermetabolism with negative nitrogen balance and immune deficiencies characterize the systemic response to major thermal injury. Patients with burns greater than 50% of the total body surface area (TBSA) initially have poor gastrointestinal function, making it difficult to deliver sufficient enteral calories to meet nutritional requirements. Controversy has developed over whether to supplement oral alimentation with total parenteral nutrition (TPN) early in their treatment. This study randomly assigned 28 patients with burns greater than 50% TBSA to receive TPN supplementation or no TPN supplementation in the first 10 days postburn. Patients receiving TPN supplementation had significantly lower T-cell helper-to-suppressor cell ratios than the unsupplemented group. However, there was no difference in mortality between the groups (eight in each). All patients who died developed hepatomegaly associated with fatty infiltration cholestasis and antemortem liver function abnormalities, indicating that this syndrome is the result of burn injury itself, not TPN.
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PMID:Failure of TPN supplementation to improve liver function, immunity, and mortality in thermally injured patients. 310 54

It has been suggested that the quantity of amino acids perfused is a pathogenetic factor in total parenteral nutrition (TPN)-associated hepatotoxicity. However, the effect of the qualitative pattern of amino acid solutions has not been studied. Rats on parenteral nutrition for 5 days received 10.2 g of dextrose and 3.4 g of amino acids daily. Bile flow (microliter/min/g liver protein) after administration of Vamin was 16.2 +/- 0.8, which was similar to that in controls given chow and dextrose iv, but it was significantly higher (p less than 0.001) than those on Travasol (12.3 +/- 0.8). The decrease in bile flow was not related to the large concentrations of alanine and glycine present in Travasol. However, the addition to Travasol of serine present only in Vamin increased bile flow significantly. Bile acid secretion rate, biliary lipid constituents, calcium, sodium, and glucose showed little change. In contrast, alpha-amino nitrogen was increased (p less than 0.05) in Vamin-perfused animals. Steatosis was noted in only a few animals in the Travasol group, and was not associated with an increase in the triglycerides content of the liver. Glycogen and protein content of the livers did not differ. The data show that the composition of amino acid solutions may be a determinant of TPN-induced cholestasis and suggest that the presence of methyl donor amino acids may have a protective effect.
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PMID:Total parenteral nutrition-associated cholestasis in rats: comparison of different amino acid mixtures. 310 84

A mixture of amino acids designed to maintain normal plasma amino acid concentrations of infants and children requiring parenteral nutrition was evaluated in 40 infants and children receiving only parenteral nutrients (2.39 +/- 0.26 g/kg/d of amino acids and 110.3 +/- 10.4 kcal/kg/d) for five to 21 days. The children ranged in weight from 2.0 to 12.6 kg (median weight, 3.83 kg; fifth to 95th percentile, 2.06 to 11.1 kg) and in age from 1 week to 43.6 months (median age, 2.7 months; fifth to 95th percentile, 0.2 to 25.3 months). Mean weight gain was 11.0 +/- 5.0 g/kg/d; mean nitrogen balance was 242 +/- 70 mg/kg/d. Plasma concentrations of all amino acids except tyrosine were within the normal range (ie, within the 95% confidence limits of the two-hour postprandial plasma concentrations observed in 30-day-old, healthy, normally growing, breast-fed, term infants) throughout the period of study. Mean prestudy and poststudy serum total protein, albumin, and transthyretin (prealbumin) concentrations were not significantly different. However, plasma transthyretin concentration increased in all children with low prestudy concentrations. Mean poststudy serum total bilirubin concentration of the total population was not different from the mean prestudy concentration. This was true also for the 31 children who received the parenteral amino acid mixture for more than ten days. In contrast to the expected 30% to 50% incidence of cholestasis, only one of these 31 experienced an unexplained increase in serum total bilirubin concentration during study, suggesting that normalizing plasma amino acid concentrations and/or providing taurine during parenteral nutrition may decrease the incidence of cholestasis associated with this therapy.
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PMID:Amino acid mixture designed to maintain normal plasma amino acid patterns in infants and children requiring parenteral nutrition. 311 9

Cholestasis and fatty infiltration of the liver are common complications of total parenteral nutrition (TPN). Following a recent suggestion that TPN-associated liver function derangements may be related to intestinal overgrowth of anaerobic bacteria, the effect of metronidazole on hepatic dysfunction during TPN in rats was investigated. After 5 days of TPN with either amino acids and glucose or amino acids with glucose and fat, all groups exhibited a mild weight gain, positive nitrogen balance, increased liver weight, increased liver:body weight ratio, increased levels of liver enzymes, and increased hepatic lipid content. The administration of metronidazole at 15 mg/kg/day significantly decreased the hepatic lipid content from 0.077 g fat/g liver for controls to 0.053 g fat/g liver. The efficacy of metronidazole in reducing hepatic fat accumulation during nutritionally effective and adequate TPN in rats suggests the possible involvement of anaerobic bacterial flora of the intestinal tract, at least in part, in the pathogenesis of TPN-associated liver function derangements. However, the various biochemical and morphological expressions of these changes and the discrepancy between unchanged liver weight, liver:body weight ratio, liver enzymes, and the improved hepatic fat content suggest multifactorial mechanisms for TPN-related liver damage.
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PMID:A possible beneficial effect of metronidazole in reducing TPN-associated liver function derangements. 392 67

In patients with inflammatory bowel disease treated by total parenteral nutrition (TPN), the incidence of TPN-induced cholestasis may be reduced by discontinuous (cyclic) TPN. In order to test this statement, a prospective trial was carried out in which 21 selected adults requiring at least 12 day postoperative nutrition were randomly allocated to two groups: continuous vs cyclic TPN. The efficiency, evaluated on nitrogen balance and prealbumin levels, was no different. Those patients undergoing cyclic-TPN needed more insulin in the first four postoperative days. The incidence of biological cholestasis was the same in the two groups. This prospective study gave strong evidence against the potential benefit of cyclic rather than continuous TPN in postoperative patients. Nonetheless, additional prospective trials using larger patient populations and greater lengths of TPN are needed to confirm these findings.
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PMID:[Postoperative continuous or cyclic total parenteral nutrition]. 642 17

An abnormal lipoprotein (LP), detected in plasma during total parenteral nutrition, has been shown to be similar to LPX observed in cholestasis and in familial lecithin-cholesterol-acyl-transferase (LCAT) deficiency. However, the conditions which facilitate the appearance of LPX during total parenteral nutrition are unclear; potential determining factors could be lipid input, plasma lipid levels, and/or inhibition of LCAT activity. An investigation was conducted on 12 patients receiving total parenteral nutrition for 3 wk by simultaneously evaluating plasma LPX (via a quantitative method) as well as total cholesterol, phospholipids (PL), triglycerides (TG), apolipoprotein B, and LCAT activity. Daily total nonprotein calories (40 kcal/kg body weight) and nitrogen input (250 mg/kg body weight) were fixed in this study. Three 7-day periods were defined: during periods 1 and 3, lipid emulsion (10 or 20% Intralipid) and glucose were given as nonprotein calories (glucose-lipid periods); in period 2, glucose was administered alone as the sole source of nonprotein energy (glucose period) so that the total energy input was not modified. During periods 1 and 3, the patients were randomly assigned to receive either 9 g (period 1) and 12 g (period 3) of PL/day for 7 days, or 12 and 9 g of PL/day. By infusing either 10 or 20% Intralipid, TG input was varied concomitantly so that the subjects received 75, 100, or 150 g/day in periods 1 and 3. During the glucose-lipid periods, plasma LPX was measurable from the 2nd day and increased progressively. Its increment was closely related to a rise in unesterified cholesterol and PL (r = 0.7; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Quantification of lipoprotein X and its relationship to plasma lipid profile during different types of parenteral nutrition. 643 26

Results on haemoglobin, PCV, serum proteins, blood urea nitrogen, creatinine, cholesterol, bilirubin and some serum enzymes in bitches with clinical pyometra were compared with the degree of polydipsia, anorexia and dehydration in the same patients, and with their plasma progesterone levels. The findings indicate that the pyometra syndrome includes a liver derangement--i.e. cholestasis--in addition to changes in bone marrow activity and renal function as shown previously. Autopsic results also indicate the presence of an endotoxic influence upon the lung function.
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PMID:Pyometra in the dog--a pathophysiological investigation. IV. Functional derangement of extra-genital organs. 743 12

Quantitative and qualitative nutritional requirements depend on the level of energetic expenses. Various formulas, especially the tables by Harris and Benedict allow the estimation of the level of energetic expenses with an approximation of 14%. Corrective factors permit an adjustment of the figures, according to the level of body aggression. In complex cases, indirect calorimetry allows a more accurate appraisal of energetic expenses. This technique provides also indications on the utilisation of each substrate and allows therefore to determine the optimal carbohydrate-lipid ratio for each patient. The assessment of the direct benefit of artificial nutritional support relies on anthropometric techniques and at present on body composition appraisal by determination of its impedance. The changes in muscular strength are difficult to assess. Moreover the time course of body weight is not specific for nutritional status. Therefore other biological indicators such as the nitrogen balance, the concentration of plasma proteins and albumin are more often assessed; proteins with a short half-life depend on the body aggression level. The potassium balance, which is easy to obtain in clinical practice, is a relevant indicator for nitrogen balance and protein synthesis. Clinical monitoring includes the checking of hydratation and its impact on the circulatory, respiratory and renal functions. The tolerance of enteral nutrition is appraised by the quality of gastrointestinal function. Biological monitoring includes the electrolyte balance and various variables of carbohydrate, lipidic and proteic metabolisms. It allows to check the absence of hyperglycaemia, hyperlipidaemia and cholestasis. The daily checking of catheters is part of the monitoring of nutritional support.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[How to assess and monitor postoperative artificial nutrition?]. 748 31

Cholestasis often occurs in infants on total parenteral nutrition (TPN) for long periods. Amino acid formulations developed specifically for infants, namely Aminosyn PF and Trophamine, may protect against cholestasis associated with total parenteral nutrition (CATPN). The development of cholestasis may also be caused by other risk factors such as prematurity, surgery, sepsis, and extracorporeal membrane oxygenation (ECMO). To evaluate the relative effectiveness of the pediatric amino acid formulations in reducing CATPN, the courses of 70 infants < 1 year of age who received TPN for at least 14 days were reviewed. Cholestasis was defined as a conjugated serum bilirubin > or = 2 mg/dl subsequent to the initiation of TPN; CATPN was considered present when other factors related to cholestasis were ruled out. Liver function tests were recorded 24 h before starting TPN and at day 7, 15, and 21 during TPN infusion. Thirty infants (42.8%) developed cholestasis. CATPN was judged to have occurred in 15 (21.4%) of 70 infants, while 15 (21.4%) developed cholestasis secondary to other factors. Of the 15 CATPN patients, 7 had received Trophamine, 6 had received Aminosyn PF, and 2 had received both solutions. Aminosyn PF and Trophamine, along with other potential risk factors for CATPN such as antecedent surgery, sepsis, ECMO, prematurity, and nitrogen/calorie intake were analyzed by regression-analysis methods. None was statistically significant except the length of TPN (p = 0.0063). In conclusion, we cannot support the view that Trophamine is more effective than Aminosyn PF in the prevention of CATPN.
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PMID:Aminosyn PF or trophamine: which provides more protection from cholestasis associated with total parenteral nutrition? 858 87

The relative sensitivities of eight commonly used clinical chemistry end points and histopathology to detect potential toxic effects in liver and kidney were evaluated for a series of 61 13-week rat toxicity studies conducted for the National Toxicology Program. The data consisted of 1-,2- to 3-, and 13 week clinical chemistry measurements and 13-week histopathological assessments of liver and kidney. Except for serum alkaline phosphatase, treatment-related alterations of individual clinical chemistry variables occurred in 20-48% of the studies, depending on the analyte, sampling time, and sex. Liver and kidney lesions were reported for 31% and 41% of the studies respectively. There was an association between treatment-related increases in alanine aminotransferase (ALT) and sorbitol dehydrogenase (SDH) activities and histopathological changes in the liver. SDH activity had greater positive and negative predictive values than similar changes in ALT; by week 1 in females and weeks 2-3 in both sexes. SDH predicted morphological hepatic change at study termination with 75% or better accuracy. If increases in activities of both enzymes occurred simultaneously, however, terminal histopathological changes could be predicted, in both sexes, with 75% accuracy by week 1, increasing to 100% by weeks 2-3. There also was an association between treatment-related increases in urea nitrogen (UN) and creatinine (Cre) concentrations and morphological kidney change. Cre concentration had greater positive predictive values than similar changes in UN; by weeks 2-3 in males and week 13 in both sexes. Cre predicted morphological renal change at study termination with 56% or better accuracy. UN concentration was associated and predictive of morphological kidney change only in females at week 13. Depending on time point and sex, serum alkaline phosphatase activity increased in 5-22% of the studies. Increases in total bile acid concentration occurred in 33-48% of the studies. Because both tests are used as markers of cholestasis, this marked discrepancy was unexpected. Treatment-related decreases in alkaline phosphatase activity occurred, however, in 39-56% of the studies; serum alkaline phosphatase may be more useful as an indicator of decreased food intake (decreased activity) than of cholestasis (increased activity). In summary, treatment-related alterations of clinical chemistry and histopathology occurred frequently in this series of toxicity studies in rats. Changes in the chemistry end points also occurred frequently at interim time points, indicating that clinical chemistry evaluations can be useful for detecting potential treatment effects throughout a study. This observation is important, since histopathological evaluations are limited to animal termination and not useful for detecting transient responses or the onset of treatment-related effects.
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PMID:Frequency and relationships of clinical chemistry and liver and kidney histopathology findings in 13-week toxicity studies in rats. 859 28


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