Effect of intravenously administered fat emulsion on liver function in totally depancreatized dogs

Total Pancreatectomy was performed under nembutal anesthesia in 16 adult mongrel dogs after a 24-hour fast, and the depancreatized dogs were given parenteral nutrition containing fat emulsion. Serum lipids, intravenous fat tolerance and post-heparin lipolytic activity were determined and liver biopsy was done to demonstrate the presence or absence of fatty liver. The animals were divided into three groups: group A (n = 6) received fat emulsion 1 g/kg/day; group B (n = 5), fat emulsion 2 g/kg/day; and group C (n = 5), no fat emulsion. Blood levels of cholesterol and phospholipid were increased in group B, while only a mild elevation of the blood triglyceride (TG) level was noted in group A. In group C, cholesterol and phospholipid levels were decreased, and hypoglycemia was liable to occur. The rate of disappearance of blood fat (K2) was decreased two weeks after surgery in group B, but there were no significant change in the other two groups. These findings suggest that if insulin is present, the administration of fat emulsion will not cause fatty liver.     

Effects of intravenous fat emulsion administration on exocrine and endocrine pancreatic function

A study was made of alterations in exocrine and endocrine function of the pancreas following infusion of a 10% fat emulsion preparation (Intralipid) into 5 patients after pancreaticoduodenectomy and in 5 dogs with a chronic pancreatic fistula. Pancreatic exocrine secretion was significantly increased by 18.3% in the volume, 27.5% in the output of bicarbonate in humans and 8.9% in the volume, 26.1% in the output of amylase, 7.6% in the output of bicarbonate in dogs, by intravenous administration of the fat emulsion. The administration of the fat emulsion was followed by slight to minimal changes in blood sugar, amylase and IRI. The blood IRG level was significantly elevated but showed small fluctuations. The increase in pancreatic exocrine secretion induced by the fat emulsion was considered not to be mediated by intrinsic hormones but rather to be due to other humoral mechanisms.     

Effects of intravenous fat emulsion administration on exocrine and endocrine pancreatic function

A study was made of alterations in exocrine and endocrine function of the pancreas following infusion of a 10% fat emulsion preparation (Intralipid) into 5 patients after pancreaticoduodenectomy and in 5 dogs with a chronic pancreatic fistula. Pancreatic exocrine secretion was significantly increased by 18.3% in the volume, 27.5% in the output of bicarbonate in humans and 8.9% in the volume, 26.1% in the output of amylase, 7.6% in the output of bicarbonate in dogs, by intravenous administration of the fat emulsion. The administration of the fat emulsion was followed by slight to minimal changes in blood sugar, amylase and IRI. The blood IRG level was significantly elevated but showed small fluctuations. The increase in pancreatic exocrine secretion induced by the fat emulsion was considered not to be mediated by intrinsic hormones but rather to be due to other humoral mechanisms.     

Massive subcutaneous fat necrosis after extravasation of intravenous infusion of fat emulsion

The recognized usefulness of intravenously administered fat emulsion is not negated by the possibility that extravasation may lead to subcutaneous fat necrosis. With proper administration of the emulsion extravasation will not occur. Subcutaneous extravasation of intravenously administered fat emulsion is not an innocuous occurrence, and may lead to extensive subcutaneous infection and fat necrosis. Our experience suggests that such extravasations may be easily mistaken for local thrombophlebitis or cellulitis. Incisions into the involved area and debridement of necrotic fat tissue should be carried out as soon as the lesion is recognized.     

Metabolism of intravenous fat emulsion in the surgical newborn

The metabolism of an intravenous (IV) fat emulsion was investigated by the combination of chemical balance and computerized indirect calorimetry techniques in 21 newborns (birth weight, 3.0 +/- 0.1 kg; mean +/- SE). All babies were appropriate for gestational age and received total parenteral nutrition after a major surgical procedure. The study was divided into two consecutive periods. Phase 1 consisted of infusion of 10% glucose and 2% amino acid solutions for 24 hours, and phase 2 involved the "Intralipid utilization test" (isocaloric and isovolemic infusion of Intralipid 10% for four hours). The caloric intake was 67.1 +/- 1.9 kcal/kg/d during both phases of the study. The resting energy expenditure was 44.8 +/- 1.6 and 46.5 +/- 1.8 kcal/kg/d during phases 1 and 2 respectively. During glucose/amino acid infusion, 12 patients oxidized endogenous fat, and de novo lipogenesis from glucose was observed in nine. During the Intralipid infusion, there was a significant and progressive decrease of carbon dioxide production, respiratory quotient, and carbohydrate utilization (oxidation plus conversion to fat). Net lipogenesis ended and fat utilization significantly increased. By the second hour of Intralipid infusion, 58% of energy expenditure was derived from fat oxidation. The drop in carbon dioxide production correlated positively with the decrease in carbohydrate utilization (r = .07; P less than .001). During the third and fourth hours of phase 2, the percentage of fat utilized was negatively correlated with the amount of fat given (r = -.07; P less than .01). The surgical neonate showed rapid metabolic adaptation to Intralipid infusion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Differential effects of IGF-I and insulin on glucoregulation and fat metabolism in depancreatized dogs

The effects of equipotent glucose-lowering doses of insulinlike growth factor I (IGF-I) and insulin on tracer-determined glucose kinetics and several metabolites were compared in 14 experiments (7 in each group) in fasted, totally depancreatized dogs. This model prevented variations in insulin secretion induced by IGF-I and permitted evaluation of the effects of IGF-I on extrapancreatic glucagon. Steady-state moderate hyperglycemia (9.9 +/- 0.2 mM) was maintained by a subbasal intraportal infusion of insulin (1.29 +/- 0.17 pmol.kg-1.min-1). This was continued throughout the experiment, allowing evaluation of IGF-I effects on insulin clearance. Human recombinant IGF-I or insulin was given intravenously as a primed infusion for 90 min, followed by a 50-min recovery period. The dose of IGF-I was a 2.6-nmol/kg bolus plus 57.4 pmol.kg-1.min-1. The insulin dose required to induce the same plasma glucose decline as IGF-I (44 +/- 6 vs. 43 +/- 5%, NS) was 9-12 times lower (0.06-nmol/kg bolus + 6.4 +/- 0.6 pmol.kg-1.min-1). However, the mechanism of this decline differed with IGF-I and insulin; glucose production was much less suppressed (25 +/- 9 vs. 42 +/- 11%, P less than 0.001) and glucose utilization was more stimulated (68 +/- 18 vs. 38 +/- 19%, P less than 0.05) with IGF-I.(ABSTRACT TRUNCATED AT 250 WORDS)     

Metabolic utilization of intravenous fat emulsion during total parenteral nutrition

The effect of nutritional therapy on the utilization of an intravenous fat emulsion was studied in patients with injury, infection, and nutritional depletion using I-14C-trioleate labeled Intralipid. The plasma fractional removal rate and 14C-Intralipid oxidation rate was 55% ad 25% higher, respectively, in patients following trauma and during periods of infection receiving 5% dextrose than in healthy control subjects. Total parenteral nutrition (TPN) was administered as either 1) nonprotein calories given as glucose (Glucose System) or 2) equal proportions of glucose and intravenous fat emulsion (Lipid System). In comparison to TPN with the Lipid System, administration using the Glucose System resulted in higher plasma clearance rates and lower oxidation rates in both acutely ill and depleted patients. There was no correlation between the rates of plasma removal and oxidation of the intravenous fat emulsion (r = -0.04; NS) indicating that the removal of exogenous fat from plasma cannot be used as an indicator of oxidation. A negative linear relationship was seen between the oxidation rate of intravenous fat and carbohydrate intake (r = -0.92; p less than 0.001). Glucose intakes exceeding energy expenditure did not totally inhibit oxidation of the fat emulsion. The oxidation rate of 14C-Intralipid was linearly related to net whole body fat oxidation calculated using indirect calorimetry (r = -0.90; p less than 0.001) suggesting that the fat emulsion was oxidized in a similar manner to endogenous lipids. This study suggests that intravenous fat emulsions are utilized as an energy substrate in patients with major injury, infection or nutritional depletion. This observation, along with a relative unresponsiveness to glucose in surgical patients suggests that fat emulsions may be useful as a calorie source in patients receiving parenteral nutrition.     

Effect of adrenergic agents on the secretion of gastrointestinal immunoreactive glucagon in depancreatized dogs

To elucidate the mode of action of adrenergic agents on gastric A cells, the effects of infusion of adrenergic agonists and antagonists on the secretion of gastrointestinal immunoreactive glucagon (gastrointestinal IRG) from gastric A cells were investigated in 45 conscious, depancreatized dogs untreated with insulin. Large amounts (0.6 micrograms/kg/min) of epinephrine, norepinephrine, and isoproterenol stimulated the release of gastrointestinal IRG, and catecholamine-induced gastrointestinal IRG release was completely abolished by simultaneous infusion of the specific beta receptor-blocking compound, propranolol, but not by alpha receptor blockade with phentolamine. These findings suggest that, when adrenergic agonists are infused in large amounts, they may act through a beta receptor to increase the release of gastrointestinal IRG.     

Hepatic “intravenous fat pigment” in infants and children receiving lipid emulsion

In 23 patients who received fat emulsion (Intralipid) intravenously and had subsequent necropsy, the deposition of pigment in the liver was evaluated quantitatively. Pigment was found in hepatic cells (HC) in 14 of 23 patients as well as reticuloendothelial cells (REC) in 22 of 23 patients. There was more pigment deposition in HC in younger children. HC pigment deposition occurred most frequently in patients with acute inflammatory processes within the abdomen. Patients infused with emulsion at rates less than 0.5 g/kg body wt/hr had less pigment deposition than patients infused at faster rates. Neonates infused at rates less than 0.2 g/kg body wt/hr for 24 hr had less HC pigment than neonates infused at higher rates. The quantity of REC pigment bore no apparent relationship to age, clinical diagnosis, rate or total dose of fat emulsion, but was increased in groups infused more than 14 days.     

静脉输注脂肪乳剂对大鼠血清游离脂肪酸谱的影响

目的 研究静脉输注脂肪乳剂对大鼠血清游离脂肪酸的影响。方法 将24只雄性Wistar大鼠随机分成3组，每组8只。(1)对照组(NS组)：输人生理盐水，正常饲养；(2)长链脂肪乳组(LCT组)：静脉输注10％长链脂肪乳剂intralipid；(3)中长链脂肪乳组(MCT／LCT组)：静脉输注中长链脂肪乳剂lipofundin。两脂肪乳剂组大鼠以等能量、等氮量、等液量匀速连续输入“全合一”肠外营养液。于第8天取血标本进行血清游离脂肪酸测定。结果 两脂肪乳剂组各大鼠血清游离脂肪酸明显高于对照组，但两种脂肪乳组间差异无显著意义。结论 静脉输注脂肪乳剂能使大鼠血清游离脂肪酸明显升高。