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June 1, 1979, Vol 241, No. 22 >
ARTICLE | June 1, 1979

Liver Function Values in Adults Receiving Total Parenteral Nutrition FREE

Keith D. Lindor, BChem; C. Richard Fleming, MD; Alan Abrams, MD; Mark A. Hirschkorn, MD
[+] Author Affiliations

Reprint requests to Mayo Clinic, 200 First St SW, Rochester, MN 55901 (Dr Fleming).


JAMA. 1979;241(22):2398-2400. doi:10.1001/jama.1979.03290480032019
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References

A retrospective review was made of results of conventional liver function tests in adult patients who received fat-free total parenteral nutrition (TPN) for two weeks or longer and who did not have other obvious causes for liver function abnormalities. A "meaningful" increase (≥50% increase above baseline pre-TPN value) in SGOT levels was noted in 68% of patients, in alkaline phosphatase levels in 54%, and in serum bilirubin levels in 21% of patients. The median peak values for SGOT, alkaline phosphatase, and bilirubin were 3-, 1.9-, and 0.25-fold above the upper limit of normal, respectively. The median time interval of peak increase for each of the three tests was between 9 and 12 days after TPN was started. Liver biopsy specimens from four patients, taken when liver function values were abnormal, showed pronounced steatosis in three patients and mild periportal cholestasis in the fourth patient. The cause(s) of the elevated liver values is unknown, but possibilities include cellular damage, such as steatosis, and an "overshoot" of enzymes when starved patients are refed.

(JAMA 241:2398-2400, 1979)

REFERENCES

1 +
Dudrick SJ, Wilmore DW, Vars HM, et al:  Long-term total parenteral nutrition with growth, development, and positive nitrogen balance . Surgery 64:134-141, 1968;.
2 +
Fleming CR, McGill DB, Hoffman HN II, et al:  Total parenteral nutrition . Mayo Clinic Proc 51:187-199, 1976;.
3 +
Ryan JA Jr, Abel RM, Abbott WM, et al:  Catheter complications in total parenteral nutrition: A prospective study of 200 consecutive patients . N Engl J Med 290:757-761, 1974;.
4 +
Dudrick SJ, Macfadyen BV Jr, Van Buren CT, et al:  Parenteral hyperalimentation: Metabolic problems and solutions . Ann Surg 176:259-264, 1972;.
5 +
Chang S, Silvis SE:  Fatty liver produced by hyperalimentation of rats . Am J Gastroenterol 62:410-418, 1974;.
6 +
Pulito AR, Santulli TV, Wigger HJ, et al:  Effects of total parenteral nutrition and semistarvation on the liver of beagle puppies . J Pediatr Surg 11:655-662, 1976;.
7 +
Grant JP, Cox CE, Kleinman LM, et al:  Serum hepatic enzyme and bilirubin elevations during parenteral nutrition . Surg Gynecol Obstet 145:573-580, 1977;.
8 +
Dudrick SJ, Long JM, Steiger E, et al:  Intravenous hyperalimentation . Med Clin North Am 54:577-589, 1970;.
9 +
Fleming CR, Smith LM, Hodges RE:  Essential fatty acid deficiency in adults receiving total parenteral nutrition . Am J Clin Nutr 29:976-983, 1976;.
10 +
Host WR, Serlin O, Rush BF Jr:  Hyperalimentation in cirrhotic patients . Am J Surg 123:57-61, 1972;.
11 +
Eade MN:  Liver disease in ulcerative colitis: I. Analysis of operative liver biopsy in 138 consecutive patients having colectomy . Ann Intern Med 72:475-487, 1970;.
12 +
Derr RF, Zieve L:  Effect of carbohydrate load by intravenous infusion in fasted rats on liver glucose-6-phosphate dehydrogenase and malic enzyme . J Nutr 104:65-68, 1974;.
13 +
Steiger E, Daly JM, Allen TR, et al:  Postoperative intravenous nutrition: Effects on body weight, protein regeneration, wound healing, and liver morphology . Surgery 73:686-691, 1973;.
14 +
Maini B, Blackburn GL, Bistrian BR, et al:  Cyclic hyperalimentation: An optimal technique for preservation of visceral protein . J Surg Res 20:515-525, 1976;.
15 +
Jeejeebhoy KN, Zohrab WJ, Langer B, et al:  Total parenteral nutrition at home for 23 months, without complication, and with good rehabilitation . Gastroenterology 65:811-820, 1973;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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1 +
Dudrick SJ, Wilmore DW, Vars HM, et al:  Long-term total parenteral nutrition with growth, development, and positive nitrogen balance . Surgery 64:134-141, 1968;.
2 +
Fleming CR, McGill DB, Hoffman HN II, et al:  Total parenteral nutrition . Mayo Clinic Proc 51:187-199, 1976;.
3 +
Ryan JA Jr, Abel RM, Abbott WM, et al:  Catheter complications in total parenteral nutrition: A prospective study of 200 consecutive patients . N Engl J Med 290:757-761, 1974;.
4 +
Dudrick SJ, Macfadyen BV Jr, Van Buren CT, et al:  Parenteral hyperalimentation: Metabolic problems and solutions . Ann Surg 176:259-264, 1972;.
5 +
Chang S, Silvis SE:  Fatty liver produced by hyperalimentation of rats . Am J Gastroenterol 62:410-418, 1974;.
6 +
Pulito AR, Santulli TV, Wigger HJ, et al:  Effects of total parenteral nutrition and semistarvation on the liver of beagle puppies . J Pediatr Surg 11:655-662, 1976;.
7 +
Grant JP, Cox CE, Kleinman LM, et al:  Serum hepatic enzyme and bilirubin elevations during parenteral nutrition . Surg Gynecol Obstet 145:573-580, 1977;.
8 +
Dudrick SJ, Long JM, Steiger E, et al:  Intravenous hyperalimentation . Med Clin North Am 54:577-589, 1970;.
9 +
Fleming CR, Smith LM, Hodges RE:  Essential fatty acid deficiency in adults receiving total parenteral nutrition . Am J Clin Nutr 29:976-983, 1976;.
10 +
Host WR, Serlin O, Rush BF Jr:  Hyperalimentation in cirrhotic patients . Am J Surg 123:57-61, 1972;.
11 +
Eade MN:  Liver disease in ulcerative colitis: I. Analysis of operative liver biopsy in 138 consecutive patients having colectomy . Ann Intern Med 72:475-487, 1970;.
12 +
Derr RF, Zieve L:  Effect of carbohydrate load by intravenous infusion in fasted rats on liver glucose-6-phosphate dehydrogenase and malic enzyme . J Nutr 104:65-68, 1974;.
13 +
Steiger E, Daly JM, Allen TR, et al:  Postoperative intravenous nutrition: Effects on body weight, protein regeneration, wound healing, and liver morphology . Surgery 73:686-691, 1973;.
14 +
Maini B, Blackburn GL, Bistrian BR, et al:  Cyclic hyperalimentation: An optimal technique for preservation of visceral protein . J Surg Res 20:515-525, 1976;.
15 +
Jeejeebhoy KN, Zohrab WJ, Langer B, et al:  Total parenteral nutrition at home for 23 months, without complication, and with good rehabilitation . Gastroenterology 65:811-820, 1973;.

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