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Serial liver enzyme and bilirubin concentrations were measured in 100 patients undergoing total parenteral nutrition. Between the eighth and tenth days, serum glutamic-pyruvic transaminase levels rose to 5.4 times pretotal parenteral nutrition levels; serum glutamic-oxalacetic transaminase, 2.8 times; bilirubin, 2.3 times, and lactic dehydrogenase, 1.5 times. These elevations were transient, lasting four to ten days. Biopsies of the liver taken during maximal elevations demonstrated marked periportal fatty change. A second elevation of serum glutamic-pyruvic transaminase, serum glutamic-oxalacetic transaminase, alkaline phosphatase and lactic dehydrogenase occurred in one-third to one-half of those patients receiving total parenteral nutrition for longer than a 20 day period. These elevations were more prolonged, and no biopsies were taken. Amino acid solutions contain conversion products of tryptophan, an amino acid that is unstable in the presence of the preservative sodium bisulfite which is added to all commercially available protein solutions. Infusion of these products into rats, either alone or as part of total parenteral nutrition solutions, resulted in periportal fatty change of the livers identical to that seen in our patients receiving total parenteral nutrition. A toxic effect of tryptophan conversion products in total parenteral nutrition solutions is proposed.
J P Grant, and
C E Cox, and
L M Kleinman, and
M M Maher, and
M A Pittman, and
J A Tangrea, and
J H Brown, and
E Gross, and
R M Beazley, and
R S Jones
January 1979,
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J P Grant, and
C E Cox, and
L M Kleinman, and
M M Maher, and
M A Pittman, and
J A Tangrea, and
J H Brown, and
E Gross, and
R M Beazley, and
R S Jones
September 1979,
British medical journal,
J P Grant, and
C E Cox, and
L M Kleinman, and
M M Maher, and
M A Pittman, and
J A Tangrea, and
J H Brown, and
E Gross, and
R M Beazley, and
R S Jones
October 1979,
British medical journal,
J P Grant, and
C E Cox, and
L M Kleinman, and
M M Maher, and
M A Pittman, and
J A Tangrea, and
J H Brown, and
E Gross, and
R M Beazley, and
R S Jones
August 1979,
British medical journal,
J P Grant, and
C E Cox, and
L M Kleinman, and
M M Maher, and
M A Pittman, and
J A Tangrea, and
J H Brown, and
E Gross, and
R M Beazley, and
R S Jones
June 1980,
The Journal of surgical research,
J P Grant, and
C E Cox, and
L M Kleinman, and
M M Maher, and
M A Pittman, and
J A Tangrea, and
J H Brown, and
E Gross, and
R M Beazley, and
R S Jones
January 1985,
JPEN. Journal of parenteral and enteral nutrition,
J P Grant, and
C E Cox, and
L M Kleinman, and
M M Maher, and
M A Pittman, and
J A Tangrea, and
J H Brown, and
E Gross, and
R M Beazley, and
R S Jones
March 1984,
Revue medicale de la Suisse romande,
J P Grant, and
C E Cox, and
L M Kleinman, and
M M Maher, and
M A Pittman, and
J A Tangrea, and
J H Brown, and
E Gross, and
R M Beazley, and
R S Jones
March 1986,
Changgeng yi xue za zhi,
J P Grant, and
C E Cox, and
L M Kleinman, and
M M Maher, and
M A Pittman, and
J A Tangrea, and
J H Brown, and
E Gross, and
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R S Jones
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J P Grant, and
C E Cox, and
L M Kleinman, and
M M Maher, and
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J A Tangrea, and
J H Brown, and
E Gross, and
R M Beazley, and
R S Jones
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Surgery annual,
