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Hepatic Cytolytic and Cholestatic Changes Related to a Change of Lipid Emulsions in Four Long-Term Parenteral Nutrition Patients With Short Bowel

Service de Réanimation Médicale et Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon, France

J.P. Claudel

Service de Réanimation Médicale et Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon, France

P. Gaussorgues

Service de Réanimation Médicale et Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon, France

F. Salord

Service de Réanimation Médicale et Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon, France

M. Sirodot

Service de Réanimation Médicale et Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon, France

M. Chevallier

Laboratoire d'Anatomie et de Cytologie Pathologique, Institut Pasteur de Lyon

D. Robert

Service de Réanimation Médicale et Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon, France

Long-term parenteral nutrition hepatic-related impairment is commonly reported and diversely explained. However, with a low cyclic caloric intake (100% to 130% of basal metabolism calculated with the Harris-Benedict formula) consisting of two-thirds glucose, one-third lipid, and 0.20 to 0.25 g of nitrogen per kilogram per day, these complications were infrequent in a clinical practice of home long-term parenteral nutrition. Retrospectively, it was noticed that the switch from Intralipid 20% to Ivelip 20% at the same amount was followed within 2 months by four cases of jaundice in a population of four home long-term parenteral nutrition patients with short bowel disease. Hepatic disturbances were characterized by cytolysis and cholestasis and were reversible after switching from Ivelip 20% back to Intralipid 20%. Neither viral, nor biliary, nor septic etiologies were detected. The exact pathological mechanism remains unknown. The basal composition of both lipid emulsions seems to be identical: soy oil emulsion emulsified by egg phospholipids. However, some differences exist such as the size of particles, the presence of sodium oleate in Ivelip 20%, and the purification process of lecithin. These may explain the difference in hepatic tolerance during long-term parenteral nutrition. (Journal of Parenteral and Enteral Nutrition 16:78-83, 1992)

Journal of Parenteral and Enteral Nutrition, Vol. 16, No. 1, 78-83 (1992)
DOI: 10.1177/014860719201600178


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