The effect of parenteral nutrition on biliary calcium and bilirubin

Elvira L. Muller, Pierce A. Grace, Henry A. Pitt

Research output: Contribution to journalArticle

Abstract

Recent studies have suggested that patients maintained on prolonged total parenteral nutrition (TPN) are at increased risk for gallstone formation. Animal and human data suggest that TPN causes calcium bilirubinate sludge and pigment gallstones. However, the effect of TPN on bile bilirubin and calcium concentrations has not previously been investigated. We, therefore, tested the hypothesis that TPN alters biliary bilirubin and calcium. Eight adult male prairie dogs received TPN (dextrose 15%, FreAmine III 4.25%, Intralipid 10%, insulin 25 U, electrolytes, and vitamins) at a rate of 80 cc/kg/day for 10 days. Eight additional animals maintained on a trace cholesterol diet served as controls. Gallbladder and hepatic bile samples were assayed for bilirubin and calcium. Cholesterol saturation index (CSI) and Rsa, a measure of gallbladder stasis, were also calculated. Calcium bilirubinate crystals were seen in gallbladder bile or wall scrapings of 7 of 8 TPN animals but in none of the controls (P <0.001). Animals that received TPN had bilirubin levels that were significantly higher in gallbladder bile (24.8 ± 7.0 vs 5.1 ± 0.9, P <0.05). Similarly, TPN animals had calcium levels that were significantly higher in gallbladder (30.0 ± 3.6 vs 13.9 ± 2.1, P <0.005) as well as hepatic (10.5 ± 0.6 vs 7.4 ± 0.6, P <0.005) bile. The Rsa values were also significantly lower (P <0.01) in TPN animals (0.57 ± 0.07 vs 1.06 ± 0.14). CSI, serum bilirubin, serum calcium, hematocrit, and reticulocyte counts did not differ between groups. These data indicate that TPN alters gallbladder bile concentrations of bilirubin and calcium and causes gallbladder stasis. Further concentration of bile by the gallbladder results in bilirubin supersaturation, precipitation of calcium bilirubinate crystals and, ultimately, pigment gallstone formation.

Original languageEnglish (US)
Pages (from-to)55-62
Number of pages8
JournalJournal of Surgical Research
Volume40
Issue number1
DOIs
StatePublished - 1986
Externally publishedYes

Fingerprint

Total Parenteral Nutrition
Parenteral Nutrition
Bilirubin
Gallbladder
Bile
Calcium
Gallstones
Cholesterol
Vitamin U
Reticulocyte Count
Sciuridae
Liver
Sewage
Serum
Hematocrit
Electrolytes
Insulin
Diet
Glucose

ASJC Scopus subject areas

  • Surgery

Cite this

The effect of parenteral nutrition on biliary calcium and bilirubin. / Muller, Elvira L.; Grace, Pierce A.; Pitt, Henry A.

In: Journal of Surgical Research, Vol. 40, No. 1, 1986, p. 55-62.

Research output: Contribution to journalArticle

Muller, Elvira L. ; Grace, Pierce A. ; Pitt, Henry A. / The effect of parenteral nutrition on biliary calcium and bilirubin. In: Journal of Surgical Research. 1986 ; Vol. 40, No. 1. pp. 55-62.
@article{7bb8a447afe64aac86b44c2a24e30a72,
title = "The effect of parenteral nutrition on biliary calcium and bilirubin",
abstract = "Recent studies have suggested that patients maintained on prolonged total parenteral nutrition (TPN) are at increased risk for gallstone formation. Animal and human data suggest that TPN causes calcium bilirubinate sludge and pigment gallstones. However, the effect of TPN on bile bilirubin and calcium concentrations has not previously been investigated. We, therefore, tested the hypothesis that TPN alters biliary bilirubin and calcium. Eight adult male prairie dogs received TPN (dextrose 15{\%}, FreAmine III 4.25{\%}, Intralipid 10{\%}, insulin 25 U, electrolytes, and vitamins) at a rate of 80 cc/kg/day for 10 days. Eight additional animals maintained on a trace cholesterol diet served as controls. Gallbladder and hepatic bile samples were assayed for bilirubin and calcium. Cholesterol saturation index (CSI) and Rsa, a measure of gallbladder stasis, were also calculated. Calcium bilirubinate crystals were seen in gallbladder bile or wall scrapings of 7 of 8 TPN animals but in none of the controls (P <0.001). Animals that received TPN had bilirubin levels that were significantly higher in gallbladder bile (24.8 ± 7.0 vs 5.1 ± 0.9, P <0.05). Similarly, TPN animals had calcium levels that were significantly higher in gallbladder (30.0 ± 3.6 vs 13.9 ± 2.1, P <0.005) as well as hepatic (10.5 ± 0.6 vs 7.4 ± 0.6, P <0.005) bile. The Rsa values were also significantly lower (P <0.01) in TPN animals (0.57 ± 0.07 vs 1.06 ± 0.14). CSI, serum bilirubin, serum calcium, hematocrit, and reticulocyte counts did not differ between groups. These data indicate that TPN alters gallbladder bile concentrations of bilirubin and calcium and causes gallbladder stasis. Further concentration of bile by the gallbladder results in bilirubin supersaturation, precipitation of calcium bilirubinate crystals and, ultimately, pigment gallstone formation.",
author = "Muller, {Elvira L.} and Grace, {Pierce A.} and Pitt, {Henry A.}",
year = "1986",
doi = "10.1016/0022-4804(86)90145-9",
language = "English (US)",
volume = "40",
pages = "55--62",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",
number = "1",

}

TY - JOUR

T1 - The effect of parenteral nutrition on biliary calcium and bilirubin

AU - Muller, Elvira L.

AU - Grace, Pierce A.

AU - Pitt, Henry A.

PY - 1986

Y1 - 1986

N2 - Recent studies have suggested that patients maintained on prolonged total parenteral nutrition (TPN) are at increased risk for gallstone formation. Animal and human data suggest that TPN causes calcium bilirubinate sludge and pigment gallstones. However, the effect of TPN on bile bilirubin and calcium concentrations has not previously been investigated. We, therefore, tested the hypothesis that TPN alters biliary bilirubin and calcium. Eight adult male prairie dogs received TPN (dextrose 15%, FreAmine III 4.25%, Intralipid 10%, insulin 25 U, electrolytes, and vitamins) at a rate of 80 cc/kg/day for 10 days. Eight additional animals maintained on a trace cholesterol diet served as controls. Gallbladder and hepatic bile samples were assayed for bilirubin and calcium. Cholesterol saturation index (CSI) and Rsa, a measure of gallbladder stasis, were also calculated. Calcium bilirubinate crystals were seen in gallbladder bile or wall scrapings of 7 of 8 TPN animals but in none of the controls (P <0.001). Animals that received TPN had bilirubin levels that were significantly higher in gallbladder bile (24.8 ± 7.0 vs 5.1 ± 0.9, P <0.05). Similarly, TPN animals had calcium levels that were significantly higher in gallbladder (30.0 ± 3.6 vs 13.9 ± 2.1, P <0.005) as well as hepatic (10.5 ± 0.6 vs 7.4 ± 0.6, P <0.005) bile. The Rsa values were also significantly lower (P <0.01) in TPN animals (0.57 ± 0.07 vs 1.06 ± 0.14). CSI, serum bilirubin, serum calcium, hematocrit, and reticulocyte counts did not differ between groups. These data indicate that TPN alters gallbladder bile concentrations of bilirubin and calcium and causes gallbladder stasis. Further concentration of bile by the gallbladder results in bilirubin supersaturation, precipitation of calcium bilirubinate crystals and, ultimately, pigment gallstone formation.

AB - Recent studies have suggested that patients maintained on prolonged total parenteral nutrition (TPN) are at increased risk for gallstone formation. Animal and human data suggest that TPN causes calcium bilirubinate sludge and pigment gallstones. However, the effect of TPN on bile bilirubin and calcium concentrations has not previously been investigated. We, therefore, tested the hypothesis that TPN alters biliary bilirubin and calcium. Eight adult male prairie dogs received TPN (dextrose 15%, FreAmine III 4.25%, Intralipid 10%, insulin 25 U, electrolytes, and vitamins) at a rate of 80 cc/kg/day for 10 days. Eight additional animals maintained on a trace cholesterol diet served as controls. Gallbladder and hepatic bile samples were assayed for bilirubin and calcium. Cholesterol saturation index (CSI) and Rsa, a measure of gallbladder stasis, were also calculated. Calcium bilirubinate crystals were seen in gallbladder bile or wall scrapings of 7 of 8 TPN animals but in none of the controls (P <0.001). Animals that received TPN had bilirubin levels that were significantly higher in gallbladder bile (24.8 ± 7.0 vs 5.1 ± 0.9, P <0.05). Similarly, TPN animals had calcium levels that were significantly higher in gallbladder (30.0 ± 3.6 vs 13.9 ± 2.1, P <0.005) as well as hepatic (10.5 ± 0.6 vs 7.4 ± 0.6, P <0.005) bile. The Rsa values were also significantly lower (P <0.01) in TPN animals (0.57 ± 0.07 vs 1.06 ± 0.14). CSI, serum bilirubin, serum calcium, hematocrit, and reticulocyte counts did not differ between groups. These data indicate that TPN alters gallbladder bile concentrations of bilirubin and calcium and causes gallbladder stasis. Further concentration of bile by the gallbladder results in bilirubin supersaturation, precipitation of calcium bilirubinate crystals and, ultimately, pigment gallstone formation.

UR - http://www.scopus.com/inward/record.url?scp=0022644945&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0022644945&partnerID=8YFLogxK

U2 - 10.1016/0022-4804(86)90145-9

DO - 10.1016/0022-4804(86)90145-9

M3 - Article

C2 - 3079846

AN - SCOPUS:0022644945

VL - 40

SP - 55

EP - 62

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

IS - 1

ER -