Abstract
TPN therapy has been associated with cholestasis though the cause is unknown. The effect of TPN on bile formation was evaluated in 10 studies performed in three adult dogs. The bile duct was directly cannulated via Thomas cannulas, while bile salt secretion was maintained by IV taurocholic acid infusion. After a 2 h basal period, either an amino acid solution (2.5% Travasol) with 10% glucose or a lipid emulsion (Intralipid) was added for 2 h followed by a second control period. Amino acid-glucose (AA) resulted in a significant increase in bile flow (BF) which rose 33% while bile salt (BS) secretion increased transiently (11%) then returned to basal levels (Table). Cholesterol, phospholipid and bilirubin output did not change significantly. Intralipid had no effect on bile flow or solute secretion. Thus, TPN therapy is not cholestatic but rather produces a choleresis which is largely independent of bile salts. The temporary increase in bile salt secretion without any change in lipid composition suggests a washout effect from the biliary tree.
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