Measuring bile-salt concentrations lacks clinical value for detecting hepatic dysfunction in infants receiving parenteral nutrition.

Abstract

Concentrations of conjugated cholate, chenodeoxycholate, direct bilirubin, and alanine aminotransferase (ALT, EC 2.6.1.2) were measured in plasma of 122 low-birthweight infants receiving parenteral nutrition. Eighteen (15%) of them developed hepatic dysfunction. We observed two distinct biochemical patterns in these infants. In the Type A pattern (12 infants), concentrations of direct-reading bilirubin and bile salts increased with no change in ALT activity. In the Type B pattern (six infants), increases in the concentrations of bile salt and direct bilirubin were followed by increases in ALT activity. Hepatic dysfunction persisted significantly longer in infants who developed the Type B pattern. The two patterns did not differ significantly in the times at which values for bile salts or direct bilirubin in plasma became abnormal or became normal at resolution, nor did maximal concentrations of bile salts in plasma differ significantly. Maximal concentrations of direct bilirubin were higher in the Type B infants. We conclude that, in such infants, measurement of bile-salt concentrations in plasma offers no advantages for detecting hepatic dysfunction over the more conventional measurement of direct bilirubin in plasma.

Parenteral Nutrition‐Associated Liver Complications in Children

“…[23][24][25][26] Elevations in these concentrations may be either the result of regurgitation of bile acids from the hepatocytes into the blood, 23,26,27 or a reflection of immaturity of hepatic excretory functions in premature infants. 28 Because a reference range for these concentrations in infants is difficult to establish due to changes in bile synthesis and transport, 29 and since other sensitive biochemical values are simpler to measure, monitoring serum bile acid in patients with PNAC is not a routine practice.…”

Gauging Reactive Metabolites in Drug-Induced Toxicity

“…Bilirubin is not released from the liver, but is from the breakdown of heme containing proteins, particularly hemoglobin and myoglobin. In the liver, bilirubin is conjugated by glucuronidation and sulfation and then exported into the bile [304][305][306][307][308][309]. This creates an important caveat in the evaluation of liver damage: increases in total bilirubin levels are not necessarily indicative of liver dysfunction and can be due to increased hemolysis.…”

Κινητικη Μελετη Και Αναλυτικες Εφαρμογες Ενζυμικων Συστηματων Για Τον Προσδιορισμο Χολικων Οξεων Σε Βιολογικα Υγρα

“…Ενώ όμως η διαγνωστική αξία του προσδιορισμού των χολικών οξέων στον ορό υποστηρίζεται βιβλιογραφικό: από πολλούς (50-67), αν και αμφισβητείται από άλλους για ειδικές περιπτώσεις (68)(69)(70)(71)(72), εν τούτοις η πολυπλοκότητα των υπαρχουσών μέχρι στιγμής αναλυτικών μεθοδολογιών περιορίζει την ευρεία χρήση τους σε Εργαστήρια Κλινικής Χημείας (73). Αυτός είναι και ο κύριος λόγος που καθυστέρησε η αναγνώριση της διαγνωστικής αξίας του προσδιορισμού των χολικών οξέων στα ούρα.…”