Determination of serum bile acids routinely may prevent delay in diagnosisof total parenteral nutrition-induced cholestasis

Background/Porpose: Early diagnosis of development of cholestasis is a curr ent major problem for patients receiving total parenteral nutrition (TPN). Conventional tests for hepatic function such as serum transaminases and alk aline phosphatase do not often reflect simultaneously histopathologic chang es of the liver. The aim of this study is to find out the relationships bet ween conventional hepatic function tests, total serum bile acid concentrati ons (TSBA), and the histopathologic changes in the liver during TPN adminis tration in rats. Methods: Forty Albino rats were divided into four experimental groups, each consisting of 10 rats, as follows: control group (C), 0.9% saline for 14 d ays; T-7 group, TPN for 7 days; T-14 group, TPN for 14 days; T7O7 group, TP N for 7 days and then 0.9% saline for the next 7 days. All solutions were a dministered by infusion through intraperitoneal catheter in two equal doses . During the experiment, rats also maintained on rat chow and water ad libi tum. Levels of serum glutamic oxaloacetic transaminase, glutamic pyruvic tr ansaminase, alkaline phosphatase, and TSBA were measured. Liver was evaluat ed histopathologically by light microscope and then Morphological Cholestas is Index (MCI) was calculated. Results: Cholestasis was present in all experimental groups except control. Levels of transaminases and alkaline phosphatase were not correlated with the histopathologic changes (P > .05), but TSBA concentrations were correla ted with MCI in all groups (P < .01). TSBA concentrations and MCI in all gr oups also were correlated with the duration of exposure with TPN (P < .01). Conclusions: Measurement of TSBA seems to be more sensitive in early diagno sis of TPN-induced cholestasis. Therefore, periodical determination of TSBA during TPN administration can be done routinely. Copyright (C) 1999 by W.B . Saunders Company.