Liver function values in adults receiving total parenteral nutrition
K. D. Lindor, C. R. Fleming, A. Abrams and M. A. Hirschkorn
A retrospective review was made of results of conventional liver function
tests in adult patients who received fat-free total parenteral nutrition
(TPN) for two weeks or longer and who did not have other obvious causes for
liver function abnormalities. A "meaningful" increase (greater than or
equal 50% increase above baseline pre-TPN value) in SGOT levels was noted
in 68% of patients, in alkaline phosphatase levels in 54%, and in serum
bilirubin levels in 21% of patients. The median peak values for SGOT,
alkaline phosphatase, and bilirubin were 3-, 1.9-, and 0.25-fold above the
upper limit of normal, respectively. The median time interval of peak
increase for each of the three tests was between 9 and 12 days after TPN
was started. Liver biopsy specimens from four patients, taken when liver
function values were abnormal, showed pronounced steatosis in three
patients and mild periportal cholestasis in the fourth patient. The
cause(s) of the elevated liver values is unknown, but possibilities include
cellular damage, such as steatosis, and an "overshoot" of enzymes when
starved patients are refed.
