Nutritional Support After Resection of the Cirrhotic Liver - Utilization of Fat Emulsion

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It is considered that poor nutritious condition associated with liver cirrhosis may contribute to induce liver failure after hepatic resection. In general, administration of lipid emulsion shortly after resection of the cirrhotic liver has been thought to be avoided. We have attempted to clarify theutilization of exogenous fat given after resection of the cirrhotic liver and its influence on the reticuloendothelial function experimentally. After resection of the cirrhotic liver in rats, 30 cal/kg/day of 5% glucose (Group I), 200Cal/kg/day of 5% glucose with 20% fat emulsion (Group II), and 200 Ca1/Kg/day of 5% glucose and 20% fat emulsion with 250 mg/kg of carnitine (Group III) were administered, respectively. Twelve hours after hepatic resection, ^<14>C labeled fat emulsion was administered and cumulative ^<14>CO_2 recovery for 5 hours was measured. Although ^<14>CO_2 recovery was 22% in Group I which was significantly decreased as compared to controls (hepatic resection was not perfo … More rmed), that was 28% in Group II and 37% in Group III. Hepatic ATP content and blood bata-hydroxybutyric acid concentration were also significantly higher in Group III than in Group I and Group II. In order to elucidate the proper combiation of fat emulsion, ^<14>CO_2 recovery was examined using fat contents of 20, 30 and 40%. 30% of fat content showed the highest recovery among those. Reticuloendothelial phagocytic index was significantly higher in Grup III and Group I than in Group II. In conclusion carnitine played important rolefor the utilization of exogenous fat, and appropriate combination of fat must be adiministered. Deterioration of reticuloendothelial phagocytic function was reversed in accordance with the sufficient utilization of fat emulsion.Clinical studies for the utilization of fat fave been mainly conducted using indirect calorimetry. Preoperative fat tolerance test clarified that the greater fat utilization deteriorated, the severer hepatic dysfunction existed. In postoperative periods, administered fat emulsion was well utilized postoperative course. In order to obtain early recovery from malnutrition after operative interventions, aggressive administration of fat emulsion can be recommended in those patients. Less