高浸透圧輸液における組織変化の検討―特にブドウ糖を中心とした基礎的及び臨床的研究―

Intravenous hyperalimentation requires hyperosmolar solution to supply sufficient calorie. The present study was designed to investigate the effect of hyperosmolar solution on various organs in dogs. Further investigation in man was carried out on the pathologic changes of the liver and kidney obtained from the autopsy who had been administered intravenous hyperalimentation. The conclusion as follows. 1. In the acute experiment, the group that received hypertonic glucose solution showed much more diuresis than that of more hypertonic ones. The grade of diuresis seemed to be ralated to the volume of water that was infused. 2. Cloudy swelling of the proximal kidney tubules was observed markedly in the higher glucose concentration group and there was high correlation between the change of tubules and glucose concentration. When dehydration was accompanied, these changes became more severe. 3. In the group infused fructose, the tissue damage was not observed. In the group infused xylitol, the liver and kidney damage was remarkable and all animals died during the experiment. 4. In the autopsy study, osmotic nephrosis was found 13 of 35 cases that had been administered intravenous hyperalimentation. All 7 cases that had been infused dextran showed osmotic nephrosis but there was no relation between the grade of osmotic nephrosis and infused volume or time of infused dextran. 5. Study of different combination of solutions revealed that lipofuscin of the liver which means consumption pigments was noticed in the group infused glucose exclusively. Therefore careful considerations should be taken on the possibility of over-load to the various organs during intravenous hyperalimentation.