Histopathological and ultra-structural investigation of the damaging effects of hypoinsulinemia, hyper glycaemia and oxidative stress caused by parenteral nutrition combined with fasting on the small intestine of rabbits

Parenteral nutrition (PN) is a life-saving procedure whereby the body’s nutritional, mineral, and liquid-electrolyte needs are met when the use of the gastrointestinal tract is not appropriate [1]. Since the first known attempt to deliver an intravenous nutritional supplement by Sir Cristopher Wren in 1658, parenteral nutrition has developed impressively [2]. In the early 1900s, with the spread of surgical treatments, the importance of preoperative and postoperative nutritional support became obvious [2], [3]. In injuries and diseases treated surgically, nutritional requirements increase due to increased catabolism and affect the success of the treatment [3], [4]. Although the ideal way to provide nutritional support is via the alimentary tract, in some cases, this route cannot be used for a certain period [4], [5]. In these cases, PN positively affects the treatment’s success [4]. The use of central catheters and concentrated glucose and amino acid solution infusions has been a critical development [2].

Despite its great benefits, however, PN may cause several complications [1], [2], [6], [7], [8], [9], [10], [11], [12]. Many studies have reported complications related to the composition of PN formulas [6], [7], [8], [9], [10]. Hepatobiliary, infection, overfeeding, and technical complications have been widely reported [2]. Other complications include liver steatosis, cholestasis, portal inflammation, liver disease, intestinal bacterial colonization, sepsis, heavy metal accumulation in organs, vascular endothelial damage, and cardio toxic effects related to hyperglycaemia complication [1], [2], [6], [7], [8], [9], [10], [11], [12]. In a previous experimental study, we observed destructive cardiac effects due to PN when combined with starvation [11]. This suggests that the toxic effects that are expected of PN can be devastating when it is combined with starvation.

The mechanism that turns the combination of PN with starvation into a destructive force in small intestine tissue has yet to be elucidated. This study aimed to investigate the damaging effect of PN on the small intestines of rabbits histopathologically and ultra-structurally and to examine whether the damage had devastating effects when PN was combined with starvation.

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