Effect of amino acids in total parenteral nutrition on cholestasis in newborn rabbits.

The effect of amino acids on total parenteral nutrition (TPN)-associated cholestasis was examined using a newborn rabbit TPN model. Twenty-nine newborn Japanese white rabbits were divided into four groups. Group I received a TPN solution with composition and total energy similar to that of rabbit breast milk. Group II received more dextrose than group I. Group III received a larger amount of amino acids than group II. Group IV was nourished by lactating mothers. After 7 days of TPN, blood samples and liver specimens were obtained. In group II, the serum total bilirubin level (1.44 +/- 0.68 mg/dL) was significantly higher than normal (0.28 +/- 0.07 mg/dL) and that of group I (0.49 +/- 0.12 mg/dL). In group II, histological cholestasis was present, characterized by bile plugs in bile ducts, bile pigments in Kupffer cells and hepatocytes, and nonprotein calorie overload changes in clear cell transformation of the hepatocytes. In group III, the serum total bilirubin level (0.23 +/- 0.05 mg/dL) was normal, and there were minimal cholestatic and nonprotein calorie overload changes (histologically) in the liver. These results indicate that cholestasis in this study was induced by nonprotein calorie overload and was prevented by an appropriate volume of amino acids.