Metabolic Complications Liver Disease

Although PN may be life sustaining, long-term use may be detrimental to the liver. The severity of injury ranges from reversible transaminase elevations to severe cholestasis and cirrhosis, especially in infants with short bowel syndrome. It is not clear whether this is due mainly to a nutrient deficiency, toxicity, or some physiological process missing because of the lack of enteral feeding. Prevention and treatment strategies continue to include minimizing or preventing episodes of sepsis, providing enteral feedings, moderating energy intake to provide for adequate growth but not to overfeed, cycling parenteral nutrition infusion, reduction of copper and manganese, use of an amino acid solution developed for infants, treatment/prophylaxis for bacterial overgrowth, and the use of ursodeoxy-cholic acid. Another drug that has been studied but is not available for clinical use is cholecystokinin, which promotes gallbladder contraction. A recent and controversial recommendation is the adjustment of the dose of intravenous lipid emulsion to <1 g/kg/ day. Intravenous lipid emulsions are a rich source of linoleic acid, an omega-6 polyunsaturated fatty acid, and may enhance production of the proinflamma-tory cytokines. Increased leukotriene B4 synthesis by the hepatic macrophages will draw additional poly-morphonuclear leukocytes that intensify the inflammatory response to endotoxin by release of reactive oxygen species.

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