Liver Disease in Patients Qualified for Home Parenteral Nutrition – A Consequence of a Failure to Adjust Rtu Bags in the Primary Centre?
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If planned improperly, parenteral nutrition may result in a number of severe metabolic complications caused by insufficient or excessive delivery of individual nutrients. One of the most common and the most dangerous complication is parenteral nutrition-associated liver disease (PNALD). Such a complication may also result from using RTU (ready-to-use) bags that are not adjusted adequately to individual patients. The aim of the study was the analysis of prevalence and determining the cause of liver disease in patients who had been receiving parenteral nutrition in primary centres prior to the implementation of home parenteral nutrition in the specialist centre. Material and methods. The study enrolled 146 patients who were referred to the Clinic in the period of 2006-2012 in order to be qualified for home parenteral nutrition. Interview and medical documentation revealed that 100 patients had been receiving parenteral nutrition by means of ready-to-use (RTU) bags in their primary centres. In the remaining 46 patients, such feeding had not been implemented. Upon admission, the following parameters were evaluated: bilirubin, aspartate aminotransferase (AspAT), alanine aminotransferase (AlAT), lactate dehydrogenase (LDH), gamma-glutamyltranspeptidase (GGTP), alkaline phosphatase (AP), triglycerides (TG), cholesterol, protein, albumins, amylase, urea, creatinine and C-reactive protein (CRP). The analysis of the results was conducted with the use of the Student’s T-test. Results. The patients who had been receiving parenteral nutrition manifested significantly increased (p < 0.05) levels of total bilirubin, TG, AlAT, LDH, GGTP, AP and CRP. 23% of patients were diagnosed with jaundice, in 70%, GGTP > 100 i.u. and a half manifested biochemical features of cholestasis. No correlation was observed between the CRP level and results of liver function tests. Conclusions. It was found that there is a correlation between parenteral nutrition with RTU bags and liver disease. The probable cause of liver disease associated with parenteral nutrition received prior to the transfer to the Clinic is excessive administration of lipids. It can be accompanied by excessive administration of glucose. Modification of parenteral nutrition helped to compensate for liver disorders in all patients
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- 1. Rangel SJ1, Calkins CM, Cowles RA et al.: Parenteral nutrition-associated cholestasis: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg 2012; 47(1): 225-40.[Crossref][PubMed]
- 2. Tillman EM: Review and clinical update on parenteral nutrition-associated liver disease. Nutr Clin Pract 2013; 28(1): 30-39.[PubMed][Crossref]
- 3. Ekema G, Milianti S, Boroni G: Total parenteral nutrition in patients with short bowel syndrome. Minerva Pediatr 2009; 61(3): 283-91. Review.
- 4. PinheiroVolp C, Esteves de Oliveira FC, Duarte Moreira Alves R et al.: Energy expenditure: components and evaluation methods. Nutr Hosp 2011; 26(3): 430-40.[WoS]
- 5. Kross EK, Sena M, Schmidt K, Stapleton RD : A comparison of predictive equations of energy expenditure and measured energy expenditure in critically ill patients. J Critical Care 2012; 27: 321. e5-321.e12.[WoS]
- 6. Wooley JA, Sax HC : Indirect calorimetry: applications to practice. Nutr Clin Pract 2003; 18(5): 434-39.[PubMed][Crossref]
- 7. Amirkalali B, Hosseini S, Heshmat R, Larijani B: Comparison of Harris Benedict and Mifflin-ST Jeor equations with indirect calorimetry in evaluating resting energy expenditure. Indian J Med Sci 2008; 62: 283-90.
- 8. Cober MP, Teitelbaum DH : Prevention of parenteral nutrition-associated liver disease: lipid mini mization. Curr Opin Organ Transplant 2010; 15(3): 330-33.[Crossref]
- 9. de Meijer VE, Gura KM, Le HD et al.: Fish oilbased lipid emulsions prevent and reverse parenteral nutrition-associated liver disease: the Boston experience. JPEN J Parenter Enteral Nutr 2009; 33(5): 541-47.[Crossref][WoS]
- 10. Kumpf VJ: Parenteral nutrition-associated liver disease in adult and pediatric patients. Nutr Clin Pract 2006; 21(3): 279-90. [PubMed][Crossref]
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