Hepatobiliary complications of total parenteral nutrition

Quigley, Eamonn Martin; Marsh, Michael N.; Shaffer, Jon; Markin, Rodney S.

doi:10.1016/0016-5085(93)90864-9

Cited by 319 publications

(149 citation statements)

References 153 publications

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“…When the rate of glucose infusion is increased, there is a higher oxidation of the glucose to CO 2 , with progressively higher respiratory quotients, and increased work of breathing (Askanazi et al, 1982). Excessive administration of carbohydrates leads to net lipogenesis in liver and adipose tissue, which replaces net fat oxidation (Quigley et al, 1993;Elwyn, 1987). It is associated with an increase in dietinduced thermogenesis from 6 to 33% (Schutz et al, 1983).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of nonglucose carbohydrates in parenteral nutrition for diabetic patients

et al. 2001

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Objective: There is little information on the advantages of nonglucose carbohydrates in total parenteral nutrition (TPN) for diabetic patients. The aim of this study is to evaluate glycemic control and insulin requirements in diabetic patients who received TPN with different sources of carbohydrates, and to determine whether insulin requirements are different when septic and non-septic diabetic patients are studied. Materials and Methods: One-hundred and thirty-eight patients were randomly divided into two groups receiving either glucose (G), n ¼ 71, or glucose-fructose-xylitol 2 : 1 : 1 (GFX), n ¼ 67. There were no differences between the demographic or anthropometric characteristics of the groups, nor between the patients with diabetes mellitus type 1 and type 2, nor the initial TPN composition. Acceptable glycemic control was considered when glycemia reached < 200 mg=dl. Results: Glycemic control was attained in 79.7% of patients (74.6 vs 85.1%), in the same period of treatment. At the end of treatment, insulin requirements were not different (45 AE 19 vs 45 AE 26 UI=day) in both groups, while similar amounts of carbohydrates (191 AE 36 vs 187 AE 45 g=day) were infused. The ratio insulin=body weight and insulin=carbohydrates were equal in both groups. In the GFX group nonseptic and septic patients needed less and more insulin, respectively, than their counterparts in the G group. No major adverse events related to carbohydrate infusions were observed. Conclusions: Either G or GFX could be used in TPN for diabetic patients, providing glycemic control in most cases with similar insulin requirements. GFX mixtures were slightly more beneficial to attain glycemic control in nonseptic patients, but septic diabetic patients had higher insulin needs in this group.

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Section: Discussionmentioning

confidence: 99%

Evaluation of nonglucose carbohydrates in parenteral nutrition for diabetic patients

et al. 2001

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“…Three well-recognized clinical syndromes include fatty liver, cholestasis, and gallbladder disease related to sludge formation. 5,95,96 Fatty liver usually occurs in adults receiving TPN, whereas cholestasis is more commonly seen in children. Gallbladder disease, however, appears to be common in both groups.…”

Section: Tpnmentioning

confidence: 99%

“…5,95,96,[103][104][105] Numerous studies indicate that increasing the dextrose concentration correlates with increasing hepatic lipid accumulation. The work of Li et al [106][107][108] has also shown that this increase in dextrose concentration results in elevated portal insulin/glucagon ratios in rat models.…”

Section: Tpnmentioning

confidence: 99%

“…1 Although macrovesicular fatty liver is perhaps best recognized from the chronic ingestion of alcohol, it is also seen in other conditions including total parenteral nutrition (TPN), nonalcoholic steatohepatitis (NASH), jejunoileal bypass, kwashiorkor/protein-calorie malnutrition, type II diabetes mellitus, obesity, and syndrome X. [5][6][7][8][9][10][11][12] Most patients with uncomplicated macrovesicular steatosis are generally asymptomatic but may report malaise and vague abdominal discomfort. 6 Physical examination is often unrevealing except, perhaps, for the palpation of an enlarged liver.…”

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confidence: 99%

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Metabolic and nutritional considerations in nonalcoholic fatty liver

et al. 2000

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“…However, a long period of TPN can lead to severe complications. Among them, chronic abnormalities in liver biochemistries are frequent in adult and children, ranging from 15 to 85% (Clarke et al, 1991;Colomb et al, 1992;Messing et al, 1992;Quigley et al, 1993;Angelico and Della Guardia, 2000;Knafelz et al, 2003;Kelly, 2006;Colomb et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of liver complications in children receiving long-term parenteral nutrition

et al. 2011

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Background/Objectives: The hepatic prognosis of long-term home total parenteral nutrition (TPN)-dependent children is poorly documented. The objective was to study outcome data in home TPN-dependent children and to describe precisely their liver biopsies in the attempt to analyze risk factors for biochemical and histological hepatic abnormalities. Subjects/Methods: Medical records of 42 children receiving home TPN for more than 2 years between January 1998 and December 2007 in a single approved home total parenteral center were reviewed. Hepatic biochemical abnormalities were analyzed. Hepatic biopsies were classified by two independent pathologists. Results: Duration of TPN was 7.9 ± 0.8 years (mean ± s.e.m.), with an average age at onset of 1.5 ± 0.5 years. A total of 24 patients (57%) developed biochemical liver abnormalities in an average of 2.9±0.4 years after starting TPN. Risk factors for biochemical abnormalities were younger age at TPN commencement, longer duration of TPN, higher rate of catheter-related infections and higher volume and energy content of TPN. Liver biopsies were carried out in 43% of patients (mean age 3.2±0.9 years). Almost all patients had fibrosis (94%). Risk factors were dependent on each histological abnormality: fibrosis was significantly associated with a shorter length of bowel and a longer duration of TPN; cholestasis correlated with a lower percentage of total parenteral energy intake due to lipids; and steatosis had no risk factor identified. Conclusion: Our study reports a high rate of histological liver abnormalities and analyzes risk factors in children who underwent very long-term home TPN.

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Hepatobiliary complications of total parenteral nutrition

Cited by 319 publications

References 153 publications

Evaluation of nonglucose carbohydrates in parenteral nutrition for diabetic patients

Evaluation of nonglucose carbohydrates in parenteral nutrition for diabetic patients

Metabolic and nutritional considerations in nonalcoholic fatty liver

Prevalence of liver complications in children receiving long-term parenteral nutrition

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