Intravenous Fat Administration Research Articles

Metabolism and nutritional support in the surgical neonate

Various factors can influence the metabolism of surgical neonates. These include prematurity, operative stress, critical illness, and sepsis. The nutritional management of surgical infants with congenital or acquired intestinal abnormalities has improved after the introduction of parenteral nutrition. This article is focused on the energy and protein metabolism of surgical neonates with particular reference to the metabolic response to operative trauma and sepsis. The metabolic utilization of intravenous nutrients also is discussed. The metabolic response to operative trauma is different between neonates and adults. Infants have high rates of protein turnover and are avid retainers of nitrogen. Energy expenditure increases only transiently (4 to 6 hours) after major surgery in neonates. Protein turnover and catabolism seems not to be affected by major operative procedures in neonates. In neonates on parenteral nutrition, carbohydrate and fat have an equivalent effect on protein metabolism. The main determinants of fat utilization are carbohydrate intake and resting energy expenditure. Parenteral nutrition in surgical neonates is associated with increased production of oxygen-free radicals. This seems to be related to intravenous fat administration. Promoting fat utilization by reducing the carbohydrate to fat ratio in the intravenous diet reduces free radical activity to a similar extent as fat exclusion. Glutamine appears to be safe for use in neonates and infants and is “conditionally essential” in very–low birth weight infants and in septic neonates. Enteral glutamine supplementation in very–low birth weight infants reduces the risk of sepsis. The metabolism of surgical neonates is affected by operative trauma, critical illness, and sepsis. Nutritional support in surgical neonates has a profound impact on outcome. Exogenous glutamine can modulate immune, metabolic, and inflammatory responses. Further investigations are needed to clarify the clinical benefit of parenteral or enteral glutamine administration in surgical neonates. J Pediatr Surg 37:811-822. Copyright 2002, Elsevier Science (USA). All rights reserved.

Whole body and splanchnic metabolic, circulatory, and thermal effects of oral vs. intravenous fat administration.

Relatively few studies on the physiological effects of fat administration have been published. In the present study, whole body and splanchnic oxygen consumption, blood flow, blood temperature, glucose and insulin economy, and arterial and hepatic venous concentrations of hemoglobin, free fatty acids (FFA), and glycerol were measured by indirect calorimetry and catheterization technique in seven healthy men before and during 2.5 h after oral ingestion of 850 kJ of fat and in five healthy men before and during a 2.5-h intravenous (i.v.) infusion of 850 kJ of fat. Oral fat increased the splanchnic blood flow by 57 +/- 25%, reduced the plasma volume by 6 +/- 1%, reduced the arterial concentrations of FFA and glycerol by 33 +/- 7 and 50 +/- 16%, respectively, and increased arterial insulin concentration by 52 +/- 12% despite a simultaneous reduction in splanchnic insulin release, thus suggesting a reduction of the extrasplanchnic extraction of insulin. None of these effects occurred during intravenous fat infusion, and it is suggested that intestinal hormones might elicit these effects. Body heat content, unaffected after oral fat, increased by 67 +/- 20 kJ during intravenous fat infusion.

Neonatal Parenteral Nutrition with a Fat Emulsion Containing Medium Chain Triglycerides

Fifty-one newborn infants requiring parenteral nutrition were randomly assigned to receive a 50% medium chain triglyceride/50% long chain triglyceride lipid emulsion or the conventional 100% long chain triglyceride emulsion. Fat was administered daily for 20 hours, to a maximum of 3 g/kg/day. Plasma triglycerides, cholesterol, free fatty acids, ketones, glucose and capillary blood gases were monitored daily up to the sixth day of fat infusion. There were no significant differences in mean plasma triglycerides and free fatty acids between the two groups. No cases of hyperketonaemia were detected in the infants studied. Hyperglycaemic episodes were detected with similar frequency in both groups. The group who received the emulsion containing medium chain triglycerides had significantly lower mean plasma cholesterol values during the study. After 6 days of intravenous fat administration mean plasma cholesterol was more than 100% higher in the group which received the conventional emulsion. Differences in cholesterol content between the emulsions and a cholesterol lowering effect of medium chain triglycerides are possible explanations for these findings.

Alterations in plasma levels of apolipoprotein A-IV in various clinical entities.

The serum levels of apolipoprotein A-IV (apo A-IV) were measured by rocket immunoelectrophoresis in disease-free humans, at fasting and after oral and intravenous fat administration. The studies were extended to patients with chronic pancreatitis, malabsorption syndrome, to postoperative patients on total parenteral nutrition and to patients with liver diseases, cholestasis, diabetes mellitus and chronic renal failure. Oral fat ingestion resulted in an increase of apo A-IV levels which remained elevated even when the postprandial hypertriglyceridemia had disappeared. A transient increase in apo A-IV levels was observed after intravenous fat infusion but the level declined simultaneously with decreases in triglyceride levels. Levels of serum apo A-IV were decreased under conditions where decreased fat intake or malabsorption of nutrients might have been present, such as in patients with chronic pancreatitis, malabsorption syndrome, acute hepatitis in the early stage, obstructive jaundice and in postoperative patients on total parenteral nutrition. On the other hand, the apo A-IV levels were high in patients with chronic renal failure and in those with diabetes mellitus and proteinuria.

Effects of oral and intravenous fat administration on the levels of apoproteins A-I, A-II AND C-III in human subjects

Changes of plasma levels of apoproteins A-I, A-II and C-III were determined after oral and intravenous fat administration. The A-I levels increased in three out of four subjects after fat ingestion but no changes or even a slight decrease in the levels of A-I were observed after intravenous fat infusion. The A-II levels also increased after fat ingestion in two subjects but the levels either did not change or decreased slightly after fat infusion. The levels of C-III increased concomitantly with the increase of triglyceride levels after fat ingestion as well as fat infusion. After intravenous fat infusion, part of the C-III in the d > 1.006 fraction shifted to the lighter fraction (d < 1.006). These observations suggest that the increase in the levels of A-I and A-II after fat ingestion are a consequence of an increase in apoprotein synthesis in the intestine during fat absorption. The increase in the levels of C-III after fat ingestion as well as fat infusion seemed to be related to the capture of C-III in the triglyceride rich particles, i.e. C-III accumulated in the circulation with triglyceride-rich particles. However, it appeared also to be possible that the rate of C-III synthesis increases during hyperlipidemia induced by fat infusion.

経口および非経口脂質負荷による血中アポ蛋白濃度の変動

経口および非経口脂質負荷による血中アポ蛋白濃度の変動

経口および経静脈脂質負荷による血清アポリポ蛋白A-I, A-II濃度の変動

Serum apolipoprotein A-I and A-II levels were determined after oral and intravenous fat administration to elucidate the correlation between lipid metabolism and high density lipoprotein. For oral fat administration, four normal adult males ingested 55g of butter after an overnight fast. For intravenous fat administration, five normal adult males and eleven patients with liver disease were injected 1ml of 10% fat emulsion (Intralipid) per kg of body weight after an overnight fast. The A-I and A-II measurement was carried out by the rocket immunoelectrophoresis. Serial blood specimens were taken and measured for their concentration of A-I, A-II and triglyceride.Serum apo A-I and A-II levels scarcely varied after intravenous fat administration, but in some cases decreased slightly. On the other hand, the apoprotein levels increased after oral fat administration and peaked after 60 minutes. Serum apo A-I and A-II levels varied concomitantly, therefore, the ratio of apo A-I/apo A-II remained constant. These results suggested that serum apolipoprotein A-I and A-II levels were influenced partially by their synthesis in the small intestine.

Contrasting Effects on Plasma Lipoproteins of Intravenous Versus Oral Administration of a Triglyceride‐Phospholipid Emulsion

Abstract. The effect of fat on plasma lipoproteins was compared when administered by the oral and intravenous routes to healthy control subjects on a low fat diet for 5–6 weeks. During this time each subject underwent two 5 day periods of fat supplementation with a soya bean triglyceride‐egg yolk phospholipid Emulsion (Intralipid), once via intragastric tube, once intravenously. Changes in plasma lipoproteins Were assessed by measurement of their lipid and protein content. Intragastric fat administration significantly decreased the level of very low density lipoprotein (VLDL), whereas intravenous fat administration Caused a significant rise in low density lipoprotein (LDL). Morphological evidence of persistence of exogenous phospholipid in plasma following intravenous fat administration was confirmed by alterations in the fatty acid composition of lecithin in the d 1.006‐1.063 fraction of plasma. In vitro studies showed that exchange readily occurred between Intralipid and LDL lecithin, causing the latter to assume a more saturated Pattern. It is concluded that the occurrence of similar changes in vivo could explain the rise in low density lipoprotein following intravenous fat, possibly by influencing the catabolic rate of the apoprotein. Hydrolysis of ingested phospholipids during absorption presumably explains why none of these changes occurred after oral fat supplementation, and would seem to be an important regulatory function of the small intestine in relation to plasma lipoprotein metabolism.

Contrasting Effects on Plasma Lipoproteins of Intravenous Versus Oral Administration of a Triglyceride‐Phospholipid Emulsion

The effect of fat on plasma lipoproteins was compared when administered by the oral and intravenous routes to healthy control subjects on a low fat diet for 5-6 weeks. During this time each subject underwent two 5 day periods of fat supplementation with a soya bean triglyceride-egg yolk phospholipid emulsion (Intralipid), once via intragastric tube, once intravenously. Changes in plasma lipoproteins were assessed by measurement of their lipid and protein content. Intragastric fat administration significantly decreased the level of very low density lipoprotein (VLDL), whereas intravenous fat administration caused a significant rise in low density lipoprotein (LDL). Morphological evidence of persistence of exogenous phospholipid in plasma following intravenous fat administration was confirmed by alterations in the fatty acid composition of lecithin in the d 1.006-1.063 fraction of plasma. In vitro studies showed that exchange readily occurred between Intralipid and LDL lecithin, causing the latter to assume a more saturated pattern. It is concluded that the occurrence of similar changes in vivo could explain the rise in low density lipoprotein following intravenous fat, possibly by influencing the catabolic rate of the apoprotein. Hydrolysis of ingested phospholipids during absorption presumably explains why none of these changes occurred after oral fat supplementation, and would seem to be an important regulatory function of the small intestine in relation to plasma lipoprotein metabolism.

Plasma post-heparin lipolytic activity in patients with malabsorption: effect of intravenous fat administration.

1. Post-heparin lipolytic activity was determined in the plasma of thirteen patients with malabsorption and fourteen healthy controls, with a coconut-oil emulsion (Ediol), triolein and very-low-density lipoprotein (VLDL) as substrates. 2. Significantly lower post-heparin lipolytic activities were found in malabsorbers, whichever substrate was used. Lipolysis was inhibited by 0–5 mol/l sodium chloride when VLDL was the substrate but not when the two artificial substrates were used. 3. Plasma post-heparin lipolytic activities rose in malabsorbers after therapeutic doses of an intravenous fat emulsion (Intralipid), especially when assayed against VLDL. 4. The abnormal fatty acid composition of VLDL from malabsorbers did not affect its properties as a substrate for lipolysis by post-heparin plasma from normal subjects. 5. These findings support the concept that PHLA is heterogeneous in origin. They also suggest that if reduced clearance is a factor in the hypertriglyceridaemia sometimes seen in malabsorption, it is due to an enzyme deficit rather than a substrate defect.

Effect of glucose and fat loading on lipoprotein lipase activity in plasma and tissues of diabetes.

The authors previously noted a more significantly decreased response of lipoprotein lipase activity to dextran sulfate injection in diabetic patients than in normal subjects and suggested that the lowered plasma lipoprotein lipase activity may contribute to hypertriglyceridemia in diabetic patients. In the present report the authors have studied on human subjects and rats with and without diabetes, the regulation of lipoprotein hpase activity in postdextransulfate plasma and tissues following administration of glucose or fat. In normal subjects the response of plasma lipoprotein lipase activity to injected dextran sulfate one hr. after feeding or oral glucose administration was significantly higher than the response after an over night fast. In diabetic patients, however, the difference between feeding or glucose administration and over night fast was insignificant. In normal rats the increase of tissue lipoprotein lipase activity to intravenously administered glucose was significant in adipose tissue and insignificant in muscles. After intravenous fat administration no significant changes were observed either in aciinose tissue or in muscles. In alloxan diabetic rats decrease in activity of lipoprotein lipase was significant in adipose tissue, but insignificant in heart muscle and diaphragm compared with normal rats. From the facts above it is suggested that markedly elevated plasma lipoprotein lipase activity after glucose loading in normal subjects is released from tissue in response to intravenously administered dextran sulfate. The authors have also discussed the probability of induction of lipoprotein lipase in adipose tissue by the metabolic effects of glucose and/or insulin.

Coagulation Changes with intravenous Administration of Fat after Blocking the RES

SummaryRabbits were treated in 3 groups : Group A received 20 ml/kg Lipofundin, group B received 150 mg/kg india ink and 20 ml/kg Lipofundin, group C received 150 mg/kg india ink and 20 ml/kg isotonic glucose. Group A and B showed a decrease of activity of the factors II, V, VII, serumcomplex and a decrease of the platelet count. The changes were more pronounced in group B and 6 of 8 animals of this group died after the infusion. In group A only 1 animal died. All controll animals (group C) survived. There were no significant changes in the coagulation system in group C. The contact factors showed an activation in group B, little activation in group A and inconsistent activation in group C. In vitro india ink was able to produce a moderate activation of the contact system. The high death rate after administration of india ink and fat is thought to be due to a consumptive coagulopathy.

The Effects of Choline on Hepatic Ultrastructural Changes Associated with the Intravenous Administration of Fat

Abstract : The administration of intravenous fat emulsion to rats produces dilatation of the hepatic rough endoplasmic reticulum similar to that which occurs in choline deficiency. In the present study the changes occurring in the livers of rats receiving multiple injections of an intravenous fat emulsion while maintained on choline-deficient, cholinerich and stock diets were determined by light and electron microscopy. Severe fatty metamorphosis of the liver developed in all rats on choline-deficient diets. This fatty change was increased by intravenous injection of Intralipid. Dilatation of the hepatic rough endoplasmic reticulum was produced in rats on a stock diet given injections of Intralipid, as well as in rats on choline-deficient diets, rats on choline-deficient diets given injections of Intralipid and in rats on choline-rich diets given injections of Intralipid. Dilatation of the rough endoplasmic reticulum associated with the intravenous administration of Intralipid was not prevented by dietary supplementation with choline. This indicates that the mechanism by which Intralipid produces dilatation of the hepatic rough endoplasmic reticulum is more complex than simply the production of a relative choline deficiency. A possible explanation for dilatation of the rough endoplasmic reticulum is presented on the hypothesis that rough endoplasmic reticulum undergoes morphologic and quantitative enzymatic change to become smooth endoplasmic reticulum. This is thought to be a compensatory phenomenon of the hepatocyte to metabolize the increased intracellular lipid. (Author)

Fats and Thrombus Formation

Summary and conclusions1. Alimentary and intravenous administration of fat causes intravascular aggregation of blood cells and an increased tendency to formation of thrombi in ligated veins.2. This aggregation and thrombus formation after fat is completely prevented by heparin but is not influenced by the lengthening of clotting time induced by dicumarol.

CLINICAL USE OF FAT INJECTED INTRAVENOUSLY

A MAJOR problem in parenteral feeding is associated with the need for a nonsclerosing preparation for intravenous administration which contains a large supply of calories in a small volume of fluid. Fat emulsions appear to offer a solution to this problem. Fat particles do not exert an osmotic effect; accordingly, fat may be injected in high concentrations without damage to veins and in a relatively small fluid volume. Unlike dextrose and amino acids, fat is not excreted in the urine in significant amounts. Among the earliest clinical studies involving the intravenous administration of fat emulsions for caloric purposes was one reported by Yamakawa in Japan in 1920. 1 Later, in this country, Holt, Tidwell, and Scott 2 studied the effect of intravenous fat administration in experimental animals and in children. In the interim, although fat emulsions for intravenous administration still have not become available commercially, their use in man is

Febrile Response Following Intravenous Administration of Fat

ArticleFebrile Response Following Intravenous Administration of FatG. Frederick Lambert, Jonathan P. Miller, and Douglas V. FrostG. Frederick LambertFrom the Nutritional Research Department, Abbott Laboratories North Chicago, Illinois, Jonathan P. MillerFrom the Nutritional Research Department, Abbott Laboratories North Chicago, Illinois, and Douglas V. FrostFrom the Nutritional Research Department, Abbott Laboratories North Chicago, IllinoisPublished Online:31 Jan 1951https://doi.org/10.1152/ajplegacy.1951.164.2.490MoreSectionsPDF (1 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation More from this issue > Volume 164Issue 2January 1951Pages 490-496 Copyright & PermissionsCopyright © 1951 by American Physiological Societyhttps://doi.org/10.1152/ajplegacy.1951.164.2.490PubMed14810957History Received 24 September 1950 Published online 31 January 1951 Published in print 31 January 1951 Metrics

Intravenous administration of fat

Intravenous administration of fat

INTRAVENOUS ADMINISTRATION OF FAT FOR NUTRITIONAL PURPOSES

Intravenous Administration of Fat for Nutritional Purposes Nutrition Reviews, Volume 3, Issue 1, January 1945, Pages 3–5, https://doi.org/10.1111/j.1753-4887.1945.tb08466.x Published: 01 January 1945

The intravenous administration of fat: A practical therapeutic procedure

Summary 1. It is possible to prepare fat emulsions that can safely be administered by vein. 2. Our experience confirms that of others, suggesting that these preparations are of value in parenteral feeding. 3. The possible limitations of their use are discussed.