Abstract
Ten infants of gestational ages 26-40 weeks with G.I. defects, but without cholestasis, received total parenteral nutrition with intralipid (2-4g/kg/day) during the first 6 weeks of life. Within 24 hrs there was an increase in plasma free cholesterol of 38 ± 4mg% (mean±SEM, n=10). In 3 infants, infused for 1-3 weeks the increases in free cholesterol were 105, 115 and 117mg%. Cholesterol esters remained constant. The rise in free cholesterol occurred exclusively in the density range 1.006-1.063g/m. corresponding to low density Lipoproteins (LDL). Fractionation of this LDL on hydroxyapatite yielded 2 components, one corresponding to LP-X and the other an LDL-like particle with Apo B but increased cholesterol and phospholipid concentrations. LP-X, indistinguishable from that seen in cholestatic states, was confirmed by chromatographic and electrophoretic techniques; and on analysis contained free cholesterol (26%), phospholipid (65%), albumin and Apo C proteins (6%). Using agar electrophoresis LP-X appeared in the plasma within 8hrs of starting the Intralipid infusion and disappeared within 48hrs of stopping. LP-X appeared despite close monitoring of plasma Intralipid levels which were maintained at 100mg% or less. Because LP-X is associated with excessive tissue cholesterol accumulation, this Intralipid induced dysliproproteinemia cannot be viewed as a trivial metabolic complication.
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