Effects of Long‐Chain Triglyceride Emulsions on Reticuloendothelial System Function in Humans

Abstract

Parenteral administration of long-chain triglyceride emulsions has been shown to have deleterious effects on reticuloendothelial system function in animal models. It is unknown whether this interference occurs in humans with clinically relevant doses of intravenous fat. Two studies were done. Eighteen patients were prospectively enrolled for study. Patients received full feeding by continuous total parenteral nutrition (amino acids 1.5 g/kg/day and dextrose 4.5 g/kg/day) with 33.1 kcal/kg/day. Forty-three % of the nonprotein calories were provided as soybean oil emulsion (Travamulsion 20%) and was administered intravenously over 10 hr (0.130 g/kg/hr). Reticuloendothelial system function was determined by measuring the change in the clearance rate of intravenously injected 99mTc-sulfur colloid (TSC) in each patient. In study 1 (n = 10), one day of lipid (10 hr) was infused, with the clearance of 99mTc-sulfur colloid measured before the lipid was infused and then during the last hour of the 10-hr infusion. In study 2 (n = 8), the clearance rates were measured before the lipid emulsion was begun, and then during the last hour of the infusion on the 3rd day. Clearance rates for TSC after 10 hr of lipid infusion in study 1 did not differ (0.27 +/- 1/min to 0.26 +/- 0.1/min, p greater than 0.10). However, after 3 days of lipid infusion (10 hr/day), a statistically significant reduction in TSC was seen (0.46 +/- 0.08/min-0.27 +/- 0.03/min, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Parenteral nutrition in the critically-ill patient: more harm than good?

“…Further studies are needed to clarify the optimal timing and composition of PN in patients who do not tolerate sufficient energy enterally. Consistent with findings of the present review, there are some experimental and clinical data that suggest that intravenously-administered lipid emulsions may have an adverse effect on immune function and clinical outcomes (Seidner et al 1989;Basttistella et al 1997).…”

No, the glycaemic target in the critically ill should not be ≤6.1 mmol/l

“…The results of the Leuven I trial suggest that the link between infectious risk and exogenous lipid administration depends on the degree of hypertriacylglycerolaemia that results from feeding. The mechanism responsible for increased infectious risk in patients receiving lipid emulsions is not entirely clear, but may involve impairment of reticuloendothelial function [21].…”

Hepatic reticuloendothelial function during parenteral nutrition including an MCT/LCT or LCT emulsion after liver transplantation - a double-blind study

“…Opsonins appear not to be involved in HSA-MM clearance, but it is still unclear which receptor may indeed be involved [ 171. Seidner et al [29] and Jensen et al [12] used TSCs in their studies, but these appear unsuitable for macrophage function assessment. In studies by Hirschberg et al [14], TSCs were cleared from the bloodstream with nonsaturable kinetics.…”