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Serum hepatic enzyme and bilirubin elevations during parenteral nutrition.

Publication ,  Journal Article
Grant, JP; Cox, CE; Kleinman, LM; Maher, MM; Pittman, MA; Tangrea, JA; Brown, JH; Gross, E; Beazley, RM; Jones, RS
Published in: Surg Gynecol Obstet
October 1977

Serial liver enzyme and bilirubin concentrations were measured in 100 patients undergoing total parenteral nutrition. Between the eighth and tenth days, serum glutamic-pyruvic transaminase levels rose to 5.4 times pretotal parenteral nutrition levels; serum glutamic-oxalacetic transaminase, 2.8 times; bilirubin, 2.3 times, and lactic dehydrogenase, 1.5 times. These elevations were transient, lasting four to ten days. Biopsies of the liver taken during maximal elevations demonstrated marked periportal fatty change. A second elevation of serum glutamic-pyruvic transaminase, serum glutamic-oxalacetic transaminase, alkaline phosphatase and lactic dehydrogenase occurred in one-third to one-half of those patients receiving total parenteral nutrition for longer than a 20 day period. These elevations were more prolonged, and no biopsies were taken. Amino acid solutions contain conversion products of tryptophan, an amino acid that is unstable in the presence of the preservative sodium bisulfite which is added to all commercially available protein solutions. Infusion of these products into rats, either alone or as part of total parenteral nutrition solutions, resulted in periportal fatty change of the livers identical to that seen in our patients receiving total parenteral nutrition. A toxic effect of tryptophan conversion products in total parenteral nutrition solutions is proposed.

Duke Scholars

Published In

Surg Gynecol Obstet

ISSN

0039-6087

Publication Date

October 1977

Volume

145

Issue

4

Start / End Page

573 / 580

Location

United States

Related Subject Headings

  • Tryptophan
  • Rats, Inbred F344
  • Rats
  • Parenteral Nutrition, Total
  • Parenteral Nutrition
  • Liver
  • L-Lactate Dehydrogenase
  • Humans
  • Female
  • Fatty Liver
 

Citation

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Grant, J. P., Cox, C. E., Kleinman, L. M., Maher, M. M., Pittman, M. A., Tangrea, J. A., … Jones, R. S. (1977). Serum hepatic enzyme and bilirubin elevations during parenteral nutrition. Surg Gynecol Obstet, 145(4), 573–580.
Grant, J. P., C. E. Cox, L. M. Kleinman, M. M. Maher, M. A. Pittman, J. A. Tangrea, J. H. Brown, E. Gross, R. M. Beazley, and R. S. Jones. “Serum hepatic enzyme and bilirubin elevations during parenteral nutrition.Surg Gynecol Obstet 145, no. 4 (October 1977): 573–80.
Grant JP, Cox CE, Kleinman LM, Maher MM, Pittman MA, Tangrea JA, et al. Serum hepatic enzyme and bilirubin elevations during parenteral nutrition. Surg Gynecol Obstet. 1977 Oct;145(4):573–80.
Grant, J. P., et al. “Serum hepatic enzyme and bilirubin elevations during parenteral nutrition.Surg Gynecol Obstet, vol. 145, no. 4, Oct. 1977, pp. 573–80.
Grant JP, Cox CE, Kleinman LM, Maher MM, Pittman MA, Tangrea JA, Brown JH, Gross E, Beazley RM, Jones RS. Serum hepatic enzyme and bilirubin elevations during parenteral nutrition. Surg Gynecol Obstet. 1977 Oct;145(4):573–580.

Published In

Surg Gynecol Obstet

ISSN

0039-6087

Publication Date

October 1977

Volume

145

Issue

4

Start / End Page

573 / 580

Location

United States

Related Subject Headings

  • Tryptophan
  • Rats, Inbred F344
  • Rats
  • Parenteral Nutrition, Total
  • Parenteral Nutrition
  • Liver
  • L-Lactate Dehydrogenase
  • Humans
  • Female
  • Fatty Liver