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DO LIPID EMULSIONS,IN TOTAL P$RENTERAL3NUTRITION PRE$IP{TATE PLASMA FIBRONECTIN

P EFICIENCY? E.Klar , R.Burger , E.Holm , Institute ofnology,

Ch.Herfarth ( Department of General Surgery, I.Med.Dept.Mannheim, University of Heidelberg)

Fibronectin (FN) is a glycoprotein found in cell surface membranes and in plasma. The soluble component has opsonic function as a mediator of phagocytosis by fixed macropha- ges. There have been conflicting reports about RES-impairment during therapy with lipid emulsions. Ingestion of fat particles by macrophages could be demonstrated. The aim of this study was to investigate the influence of i.v. administration of lipid emulsions on the plasma fibronectin concentration in intensive care patients. Methods:24 patients on a basic TPN regimen of glucose 15 kcal/kg b.w. and amino acids 1 gn50kcal were sub- jected to the following protocol: Day l:infusionRof Ringer's solution 500 mlRin 6 hrs. as control. Day 2: Infusion of either Intralipid 20% (n=121 or Lipofundin S 20 % (n=12) 500 ml in 6 hrs. (randomized). To determin immunoreactive FN and triglycerides blood samples were collected at the beginning and the end of infusion periods and 24 and 48 hrs. after fat administration. The albumin, cholinesterase and prothrombin time were measured on day 1 only. Results: Plasma FN levels at the beginning of each infu- sion period were considered a-TOM.0 significant change could be demonstrated after the administration of Ringers' solution (103+6%1, Intralipid (95+18%), or Lipofundin S (93+27%1. Within 48 hrs. following fat infusion a slight FN increase was noted (after Intralipid 24 hrs.: 115+29%, 48 hrs.: 132+35%; after Lipofundin S 24 hrs.: 102+19%, 48 hrs. : 115+38%). Albumiii and prothrombin Time showed normal values. Cholinesterase was moderately-deminished (225Ot1006 U/11. Conclusion: A decrease of pTasma FN concentration by administration of fat emulsions was not evidenced in this study. Other factors known to influence plasma FN like long-term protein catabolism, impaired hepatic function or DIC could be excluded. Since FN mediates phagocytosis by RES-macrophages, and lipid emulsions are often part of the therapeutic regimen in critically ill patients, it was significant to demonstrate that fat UDtake bv the liver in TPN does not reauire considerable amounts of olasma FN resulting in-impairment of unspecific host 'defense.

DOES FAT EMULSION INDUCE MORPHOLOGICAL CHANGES IN THE RETICULOENDOTHELIAL C. Davies, M.J. Grange, A. Pfeiffer, B. Messing. Service de Gastroentkologie

Nutrition, Hdpital Saint-Laxare, 75010 Paris.

SYSTEM ? et de

Macrophages laden with blue staining pigment and a complex lipid (sea blue histiocytes : SBH) have been reported in patients receiving fat emulsions as part of their TPN regimes. These SBH have been documented in conditions of abnormal lipid metabolism, as side effects of drugs that affect lysosomal degradation, and other apparently unrelated conditions. We wished to further elucidate the relationship between the SBH and intravenous fat emulsions in patients receiving TPN.

An adult population with GI failure, having had a bone marrow aspirate (BM) during a course of TPN between 1979 and 1985 was selected retrospectively. This population (GROUP I), n = 30, was divided into 2 subgroups and matched for age, sex and disease : Control (9, n = 13, had their first BM while on TPN 8 (l-42) days but excluding Intralipid (IL) past or present. Experimental, (E) n = 17, had TPN + IL 224 (6-1825) days at the time of their first BM. The above was compared to a second control group, (GROUP II) n = 25, consisting of 25 BM chosen at random from those submitted to a general hematology lab. A BM was considered + if one or more SBH was found. POPULATION n SBH+ SBH- %+ FISHER COMPARISON GROUP I 30 19 11 63 C/E p = 0.035 c (TPN IL-) 13 5 8 38 C/GRII p = 0.030 E (TPN IL+) 17 14 3 82 GRI/GRIX N.S. GROUP II 25 20 5 80 E/GRII N.S. The 80 % SBH(+) in GROUP II was surprisingly high. In patients with GI failure

TPN + IL seems to increase the prevalence of SBH compared to those receiving TPN without IL. However in GROUP I, of 17 patients with > 2 BM. the SBH status for each individual patient never changed, and neither the quantity or duration of IL infusion could be correlated to + SBH, p > .lO. In subgroup E, of 6 patients initially SBH (+), having a second BM after lipid was discontinued 216 (90-404) days, all remained (+). Conclusion : The presence of sea blue histiocytes in bone marrow aspirates are neither sensitive nor specific for intralipid infusions.

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