Intravenous fish oil emulsion attenuates total parenteral nutrition-induced cholestasis in newborn piglets.

Total parenteral nutrition (TPN) causes intrahepatic cholestasis and membrane phospholipid changes. Fatty acid (FA) composition of bile and hepatocyte phospholipid is influenced by dietary FA composition. We hypothesized that altering FA composition of i.v. lipid emulsions modifies 1) severity of TPN-induced cholestasis; 2) hepatocyte membrane composition and function; 3) bile flow and composition. Newborn piglets received either sow's milk, TPN with i.v. soybean oil or TPN with i.v. fish oil (FO). After 3 wk, basal and stimulated bile flow were measured after bolus injections of 20, 50, and 100 micromol/kg of taurocholate (TCA). Bile was analyzed for bile acids, cholesterol, phospholipids, and phospholipid-FA. Sinusoidal and canalicular membrane PL-FA, fluidity, and Na+/K+-ATPase were measured. Although the soybean oil-fed animals developed cholestasis, the FO and milk group had similar liver and serum bilirubin. Basal and stimulated bile flow rates were impaired in the soybean oil but not in the FO group. Hepatocyte membrane FA composition reflected dietary FA. Changes in sinusoidal and canalicular membrane fluidity and sinusoidal Na+/K+-ATPase activity did not explain the effect of FO on TPN-induced cholestasis. Intravenous FO reduces TPN-induced cholestasis by unknown mechanisms.

Electrolyte abnormalities in patients with chronic renal failure receiving parenteral nutrition.

BACKGROUND AND METHODS: Chronic renal failure frequently is complicated by elevations in serum potassium, phosphate, and magnesium. Consequently, parenteral nutrition (PN) solutions used to treat malnourished patients with chronic renal failure usually are prepared with little supplementation of these cations. Four malnourished patients with chronic renal failure and electrolyte abnormalities are reported. RESULTS: Four patients developed significant hypophosphatemia 3 to 5 days after starting PN. Although carbohydrate infused via PN initially was not excessive (1.4 to 2.0 mg/kg/min), two patients received additional dextrose through continuous ambulatory peritoneal dialysis (CAPD). Two of the four patients received insulin during PN. Other electrolyte abnormalities included hypomagnesemia (1 patient) and hypokalemia (3 patients). CONCLUSIONS: Malnourished patients with chronic renal failure receiving PN are at risk of developing electrolyte abnormalities, particularly hypophosphatemia. The electrolytes of these patients should be monitored closely when nutrition support is begun, and supplementation should be started as levels begin to fall within a normal range.

Risk of symptomatic central venous thrombotic complications in AIDS patients receiving home parenteral nutrition.

BACKGROUND: The acquired immunodeficiency syndrome (AIDS) is frequently complicated by malnutrition that may require parenteral nutritional support. In a non-AIDS population with long-term indwelling central venous catheters, low-dose warfarin therapy has been shown to prevent venous thrombosis. The purpose of this study was to determine the incidence of symptomatic central venous thrombosis in AIDS patients receiving home parenteral nutrition. The incidence of thrombosis on low-dose warfarin was compared with no prophylactic therapy. METHODS: A retrospective review of 47 malnourished AIDS patients started on home parental nutrition was performed. None of the patients had a prior history of venous thrombosis. During this period, 9 of 47 patients were treated with low-dose warfarin therapy. The incidence of clinical and radiologic venous thrombosis was compared in these two groups. RESULTS: Forty-seven patients were treated with parenteral nutrition for 296 patients-months. The rate of central venous thrombosis in patients receiving warfarin (0.016 thromboses per patient-month) was no different from those patients on no prophylactic therapy (0.009 thromboses per patient-month). The most common abnormality in coagulation observed in the entire group during follow-up was thrombocytopenia occurring in 66% of patients. Sixty percent of patients received medications that could interfere with platelet function. CONCLUSIONS: We conclude that routine thrombosis prophylaxis with low-dose warfarin may not be justified in malnourished AIDS patients receiving home parenteral nutrition. Prospective clinical trials are needed to determine the risks and benefits of prophylactic warfarin therapy in this group of patients.