Essential fatty acid sufficiency does not preclude fat-soluble-vitamin deficiency in short-bowel syndrome.
Patients with extensive small-bowel resection may experience malabsorption and nutrient deficiencies. We evaluated the ability to absorb fat and fat-soluble vitamins in a short-gut patient. For 18 wk after stopping intravenous lipid, while consuming a low-lactose, low-fat diet, he exhibited no clinical manifestations of essential fatty acid deficiency (EFAD). Serum 20:4n-6 (20:4 omega-6) and 18:2n-6 fatty acid concentrations were normal, whereas the concentration of 20:3n-9 remained less than or equal to 0.1% of total serum fatty acids. Although serum vitamin A was normal, beta-carotene was undetectable despite oral supplementation. Prothrombin time was elevated until parenteral vitamin K was given. This patient has fat absorption adequate to prevent EFAD but inadequate absorption of fat-soluble vitamins. In patients with short bowel, the requirements for parenteral lipids and fat-soluble vitamins should be determined independently.
Edes
T E
TE
Department of Medicine, Harry S Truman Memorial Veterans Hospital, Columbia, MO 65201.
Walk
B E
BE
Thornton
W H
WH
Fritsche
K L
KL
D000042:Absorption; D000328:Adult; D001361:Avitaminosis / Q000209:etiology*; D002338:Carotenoids / Q000097:blood; D005223:Fats; D005228:Fatty Acids, Essential / Q000378:metabolism*; D006801:Humans; D007263:Infusions, Parenteral; D008055:Lipids / Q000097:blood; D008297:Male; D011517:Prothrombin Time; D012778:Short Bowel Syndrome / Q000097:blood / Q000150:complications* / Q000378:metabolism; D012995:Solubility; D014812:Vitamin K / Q000008:administration & dosage / Q000627:therapeutic use; D014813:Vitamin K Deficiency / Q000188:drug therapy / Q000209:etiology; D019207:beta Carotene
D005223:Fats; D005228:Fatty Acids, Essential; D008055:Lipids; D019207:beta Carotene; D014812:Vitamin K; D002338:Carotenoids