Clinical and Biological Changes in Liver Function during Intravenous Hyperalimentation

Abstract

The use of intravenous hyperalimentation (IVH) with 30% dextrose‐amino acid solution produces prolonged positive nitrogen (N) balance, weight gain, and normal growth and development, with minimal metabolic complications. Several investigators have recently reported liver fatty metamorphosis with an associated increase in serum liver enzymes during IVH, particularly noticeable in premature infants. However, this effect has not been clearly defined in adult patients, especially in regard to the composition of the solution, the kcs:N ratio of the infused solution, and caloric requirements of the patient. A series of 42 patients were given a standard IVH formula (25% dextrose—4.5% crystalline amino acids) administered continuously through a central venous catheter whose tip was positioned in the superior vena cava. These patients were divided into 3 groups: Group I (27) who had no documented liver pathology. Group II (15) who had liver disease documented by liver biopsy or liver scan, and Group III (9) who were infused with IVH for simple malnutrition alone. All patients received IVH for 3 weeks or longer; the average dose in Groups I and II was 34.9 ± 1.70 (S.E.x) kcal/kg/day and 41.0 ± 3.9 (S.E.x) in Group III. Liver function studies were analyzed once each week during therapy and included serum glutamic oxaloacetic transaminase (SGOT), serum alkaline phosphatase, and serum total bilirubin. There was no statistical change in any of these levels between Groups I, II, and III; however, patients with known liver disease showed a progressive increase in serum liver enzyme levels during IVH therapy. On the other hand, patients in Group III showed an increase in serum liver enzyme levels by the second week, which decreased to preinfusion levels by the third week of IVH therapy. It is concluded from this study that IVH does not statistically alter liver function studies. Serum liver enzyme changes may be due to an abnormally high kcal: N ratio in the solution, excessive infusion of calories, intrinsic liver disease, or infection. Therefore, IVH therapy for patients should be individualized to maximize nutrient utilization with minimal complications.