Fat emulsion in surgical patients with liver disorders

Total parenteral nutrition (TPN) with fat emulsion was evaluated in 68 patients with liver disorders who were admitted to the First Department of Surgery, Osaka City University Medical School. All patients received transabdominal direct operation for esophageal varices. Immediately after their operations, 28 received TPN with carbohydrate and fat emulsion as an energy source (FAT group), and 40 received TPN with only carbohydrate as an energy source (non-FAT group). Liver function tests, blood glucose levels, intravenous fat tolerance tests, serum lipid levels, fatty acid composition of serum total lipids, and nitrogen balance of the two groups were compared during postoperative TPN. The administration of fat emulsion during postoperative TPN in patients with liver disorders did not worsen the results of liver function tests and the relatively low levels of blood glucose were retained, thereby correcting the abnormalities in the fatty acid composition of serum total lipids. Rates of clearance of fat emulsion during postoperative TPN were significantly higher than in the preoperative period, and changes in serum lipid levels revealed no tendency toward retention of fat emulsion administered intravenously. Nitrogen balance and change in body weight during postoperative TPN were similar in both groups. These results suggest that for patients with liver disorders, the administration of fat emulsion is useful during postoperative TPN.