Liver Enzyme Elevation associated with Total Parenteral Nutrition

Abstract

A number of complications associated with total parenteral nutrition (TPN) have been identified, and methods of prevention or treatment have been developed. However, abnormal liver function continues to occur with the use of TPN, and little is known about its incidence and etiology. Twenty-three patients, receiving TPN through the TPN program at Holy Cross Hospital from January, 1978 to May, 1978, were studied. All patients received a basic parenteral amino acid solution (Travasol®), with varying amounts of nitrogen per day, depending on nitrogen balance studies. Dextrose was supplied in quantities necessary to provide 120 percent or more of the patient's calculated basal energy expenditure (BEE). Of the 23 patients studied, elevated liver function test values were detected in two patients (8.6 percent). In both cases, the complication developed within six to eight days, and both had received calories in excess of 213 percent of their calculated BEE and had a calorie to nitrogen (kcal: N) ratio greater than 150: 1. Mean calories as a percent of calculated BEE and kcal: N ratio were significantly higher in the patients with elevated liver function test (LFT) values than in those with normal LFT values (p < 0.05 and p < 0.005, respectively). Following identification of the elevated LFT values, both patients were immediately placed on cyclic TPN (CyTPN). In the one patient, liver enzymes reverted toward normal after seven days of CyTPN, while the second patient required only five days. Cyclic TPN was deemed effective in the reversal of abnormal liver function in these two patients. It is speculated that the abnormal liver function was a result of fatty liver infiltration. The mechanism by which this infiltration occurs and its treatment are discussed.