Abstract
INTRAVENOUS FAT EMULSION (INTRALIPIDO) DELAYS GASTRIC EMPTYING BUT DOES NOT AFFECT LOWER ESOPHAGEAL SPHINCTER PRESSURE (LESP) IN HEALTHY VOLUNTEERS. P. Casaubon, K.A. Dahlstram, J. Vargas, R. Hawkins, M. Mogard, M.E. Ament. Department of Pediatrics. Medicine, and Nuclear Medicine, University of California, Los Angeles. Patients receiving overnight total parenteral nutrition frequently corrplain of nausea and upper abdominal discomfort after infusion of intravenous fat emulsion. The effects of infused lipid emulsion on upper gastrointestinal motility and gastrointestinal hormones (GIH) are unclear. This was evaluated in 10 healthy male volunteers (aged 28+1.5 SEM years). Group 1: 5 volunteers were studied over a 50 hour period in the Clinical Research Center. Esophageal manometry (EM) was done on admission (day 1) followed by intra-esophageal pH monitoring for 48 hours. They were fed a standardized diet (30% fat, 55% CHO, 15% proteins and 2000t 100 calories). On day 2, standard radionucleide gastTic emptying study was performed. Blood samples were taken just before and one hour after the gastric emptying for RIA of GIH (antibodies-Gastrin 1611, CCK 5135, neurotensin L170). On the second night. Intralipido 20% (500~~) was infused overnight for 10 hours. The iollowing morning, a second gastric emptying study was done in the last hour of the lipid infusion, and GIH were reassayed. The esophageal pH probe was then discontinued and Et4 repeated. Group 11: 5 other volunteers followed the same protocol, omitting EM and 48 hours pH because Group 1 subjects showed no significant change in LESP and reflux episodes before and after lipid infusion. Al1 volunteers after eating showed a significant rise in post prandial values of gastrin and CCK, but there was no significant change after lipid infuSion. Neurotensin values remained below 6 pM in al1 the samples. Gastric emptying showed a marked delay after lipid infusion in 8/10 volunteers (without lipids: 3724 SEM%; with lipids: 5424% of activity remaining in the stomach at 90 minutes, p=O.O04). Intravenous lipid emulsions delay gastric emptying. The gastric inhibitory mechanism does not appear to be mediated by the hormonal action of CCK or neurotensin.
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