Total parenteral nutrition increases mortality after hemorrhage.
OBJECTIVE
To determine the effect of total parenteral nutrition (TPN) and different enteral feeding formulas on survival and liver function following hemorrhage in rats.


METHODS
Prospective randomized controlled study.


METHODS
Laboratory of a large university-affiliated medical school.


METHODS
Sixty-seven male Sprague-Dawley rats weighing 350 to 450 g.


METHODS
Jugular and gastroduodenal feeding catheters were inserted in animals 1 day before hemorrhage, and animals were started on one of six different fluid or nutritional regimens: TPN, iv saline, an enteral amino acid-based formula (AA) (Vivonex-TEN), an enteral peptide-based formula (PEP) (Reabilan-HN), an enteral intact-protein based formula (PRO) (Osmolite-HN), or enteral saline. A catheter was inserted in the tail artery and animals were hemorrhaged 5 mL/kg at baseline and 1 hr later. Animals were returned to their cages and observed for survival. Liver function was determined by measuring circulating bile acid levels at baseline and 24 hr after hemorrhage.


RESULTS
Mortality was significantly increased in animals receiving TPN (63%) and AA (24%). Mortality was 13% in animals receiving PRO and 0% in animals receiving PEP and saline. Liver function deteriorated in all animals after hemorrhage except the PEP group.


CONCLUSIONS
TPN and AA increased mortality in animals after hemorrhage. PEP was associated with zero mortality and protection of liver function after hemorrhage.
Zaloga
G P
GP
Department of Anesthesia, Bowman Gray School of Medicine, Wake Forest, Winston-Salem, NC 27103.
Knowles
R
R
Black
K W
KW
Prielipp
R
R
D000596:Amino Acids / Q000008:administration & dosage; D000818:Animals; D001647:Bile Acids and Salts / Q000378:metabolism; D004044:Dietary Proteins / Q000008:administration & dosage; D004750:Enteral Nutrition / Q000009:adverse effects; D005526:Food, Formulated; D006470:Hemorrhage / Q000378:metabolism / Q000401:mortality*; D008297:Male; D010289:Parenteral Nutrition, Total / Q000009:adverse effects; D051381:Rats; D011919:Rats, Inbred Strains; D012965:Sodium Chloride / Q000008:administration & dosage
D000596:Amino Acids; D001647:Bile Acids and Salts; D004044:Dietary Proteins; D012965:Sodium Chloride