Effect of route of nutrition on recovery of hepatic organic anion clearance after fasting
Waters, B.; Kudsk, K.A.; Jarvi, E.J.; Brown, R.O.; Fabian, T.C.; Wood, G.C.
Surgery 115(3): 370-374
1994
ISSN/ISBN: 0039-6060 PMID: 8128361 Document Number: 433705
Background. Previous work documented a 40% depression of hepatic indocyanine green (ICG) clearance (Cl-ICG) in pigs fasted to 20% weight loss, with return to normal within 12 days of food refeeding. Cl-ICG in pigs is insensitive to changes in hepatic bloodflow but very sensitive to changes in hepatic function (HF). Serial Cl-ICG determinations were Performed to quantify the effect of route Of nutrient delivery on recovery of HF. Methods. Fourteen pigs were fasted to 20% weight loss (12.8 days average) with both gastrostomy and intravenous catheters placed in each animal midway through the fast. Cl-ICG was measured before fast, after fast, and after 12 days reseeding through the enteral or parenteral route at 125 kcal/kg/day with isonitrogenous, isocaloric diets containing 9% fat. Urine and stool were analyzed for total nitrogen. Results. No significant differences appeared between groups in nitrogen output during fasting (4.5 +- 1.2 gm/kg enteral, 4.6 +- 1.2 gm/kg parenteral), in nitrogen intake (800 +- 19 mg/kg/day enteral, 810 +- 10 mg/kg/day parenteral), or in before or after fast Cl-ICG, but enteral feeding produced more positive nitrogen balance. Cl-ICG improved significantly with enteral but not with parenteral feeding. Conclusions. Enteral feeding produces faster nitrogen accrual and reverses the depression of major pathways of bilirubin and organic anion excretion associated with malnutrition. Parenteral feeding failed to improve organic anion clearance despite weight gain.