A importância do uso de filtros, durante a infusão de nutrições parenterais adicionadas de emulsões lipídicas

Nutrições parenterais com adicionamento de emulsões lipídicas podem apresentar alterações físico-químicas, caracterizadas pela formação de precipitados amorfos ou cristalinos, bem como pelo aumento do tamanho das gotículas de gordura que se agregam. A verificação macroscópica dessas alterações nem sempre é possível, tendo em vista o aspecto opaco das emulsões. Utilizando-se estudo in vitro, este trabalho teve como objetivo evidenciar a presença de precipitados de fosfato de cálcio, de gotículas de gordura da emulsão lipídica com diâmetros superiores aos de hemácias, em nutrições parenterais, e a importância do uso de filtros na retenção dos mesmos. Esses eventos foram demonstrados por meio de inspeção macroscópica e microscópica, em nutrições parenterais contendo fosfato dibásico de potássio e de gluconato de cálcio, como fonte de fósforo e de cálcio, respectivamente, adicionados à mistura de soluções de aminoácidos a 10% p/v, com glicose a 50% p/v, emulsão lipídica a 20% p/v e minerais em diferentes proporções. Os resultados mostraram presença de precipitado de cálcio e de gotículas de gordura aumentadas e/ou agregadas antes da filtração, e ausência dos mesmos imediatamente após. Conclusão: o uso de filtros com poros de 1,2 mm foi capaz de reter precipitados e de impedir a passagem das gotículas de gordura com dimensões tais que pudessem causar embolias microvasculares em pacientes submetidos à nutrição parenteral.Parenteral nutrition preparations supplemented with lipid emulsions may present physicochemical alterations characterized by the formation of amorphous or crystalline precipitates and by an increased size of fat droplets, which aggregate. A macroscopic verification of these changes is not always possible because of the opaque aspect of the emulsions. The objective of the present in vitro study was to determine the presence of calcium phosphate precipitates, of fat droplets of the lipid emulsion with wider diameters than red blood cells in parenteral nutrition preparations and the importance of the use of filters for the retention of suchprecipitates. These events were demonstrated by macroscopic and microscopic inspection of parenteral nutrition preparations containing potassium dibasic phosphate and calcium gluconate as a source of phosphorus and calcium, respectively, added to the mixture of amino acid solutions at the proportion of 10% (w/v), with 50% glucose (w/v), a 20% lipid emulsion (w/v) and minerals at different proportions. The results showed the presence of a calcium precipitate and of enlarged and/or aggregated fat droplets before filtration, and their absence immediately after filtration. Conclusion:the use of filters with 1.2 mm pores was sufficient to retain the precipitates and to prevent the passage of fat droplets with dimensions that might cause microvascular embolism in patients submitted to parenteral nutrition

Effects of APOE, APOB and LDLR variants on serum lipids and lack of association with xanthelasma in individuals from Southeastern Brazil

Xanthelasma might be a clinical manifestation of dyslipidemia, a recognized risk factor for coronary artery disease. We investigated the association of apolipoprotein E (APOE HhaI), apolipoprotein B (APOB XbaI and Ins/Del) and LDL receptor (LDLR AvaII and HincII) gene polymorphisms with lipid profiles in 100 Brazilians with xanthelasma and 100 controls. Allele frequencies were similar in both groups. APOE, APOB and LDLR genotypes were not correlated with differences in the serum lipid profile. In individuals with xanthelasma, the APOB D allele was associated with less chance of having increased LDL-cholesterol (O.R. = 0.16, CI95% = 0.03-0.94, p = 0.042). In the control group, the APOB X+ allele was associated with less chance of having both increased total cholesterol (O.R. = 0.16, CI95% = 0.03-0.78, p = 0.023) and increased LDL-cholesterol (O.R. = 0.10, CI95% = 0.02-0.60, p = 0.012). Moreover, there was a significantly higher frequency of control individuals (68%) with elevated serum triglyceride levels, compared to patients (48%, p = 0.008). On the other hand, triglyceride levels in controls also seemed to be influenced by all other gene polymorphisms studied, an effect that might be enhanced by environmental factors