Increased Incidence of Cholestasis during Total Parenteral Nutrition in Children. Factors Affecting Stone Formation.

Abstract

Cholelithiasis is extremely unusual in infants and children. Recently, some cases of cholelithiasis associated with total parenteral nutrition (TPN) have been reported. A group of 400 children receiving TPN were evaluated prospectively for the presence of gallstones and sludge in this report. Eight children (2%) were determined by ultrasonography to have developed cholelithiasis. All of these patients had received large amounts of amino acids (> or = 1.8g/kg/day) and relatively low amounts of fat (< or = 1.7g/kg/day) with a high ratio of non-protein: kcal/ml (> 0.8). It was concluded that the administration of large amounts of amino acids and a high ratio of non-protein: kcal/ml enhanced the risk for formation of gallstones and sludge. Conversely, these are prevented by the administration of appropriate amounts of fat.