Failure of topical vegetable oils to prevent essential fatty acid deficiency in a critically ill patient receiving long-term parenteral nutrition.
This case report describes the failure of topical vegetable oils containing esters of linoleic acid to prevent essential fatty acid deficiency in a critically ill patient with trauma. A 40-year-old black man injured in a motor vehicle accident developed essential fatty acid deficiency after being maintained on long-term, fat-free parenteral nutrition plus topical vegetable oil application because of the presence of severe hypertriglyceridemia. Biochemical evidence of this deficiency included a decrease in serum linoleic, a-linolenic, and arachidonic acid levels with a corresponding increase in oleic and palmitoleic acid levels. Cutaneous manifestations consistent with this syndrome were also present. After 3 weeks of daily topical treatments with vegetable oils rich in linoleic acid, biochemical abnormalities of deficiency were still evident. Over the following 2 1/2 months, 4% to 22% of the total caloric intake was delivered as intravenous fat in addition to continued topical administration of vegetable oil. Only after supplementation with intravenous fat did the patient demonstrate clinical and biochemical signs of improvement. The results show that cutaneous administration of vegetable oils as the sole source of linoleic acid may be unable to prevent or treat essential fatty acid deficiency in a critically ill surgical patient.
Sacks
G S
GS
Department of Clinical Pharmacy, University of Tennessee, Memphis.
Brown
R O
RO
Collier
P
P
Kudsk
K A
KA
D000279:Administration, Cutaneous; D000328:Adult; D016718:Arachidonic Acid / Q000097:blood; D003422:Critical Care; D005223:Fats / Q000008:administration & dosage; D005228:Fatty Acids, Essential / Q000172:deficiency*; D005229:Fatty Acids, Monounsaturated / Q000097:blood; D006801:Humans; D019787:Linoleic Acid; D008041:Linoleic Acids / Q000097:blood; D008297:Male; D009104:Multiple Trauma / Q000150:complications / Q000628:therapy; D019301:Oleic Acid; D009829:Oleic Acids / Q000097:blood; D010288:Parenteral Nutrition; D010938:Plant Oils / Q000008:administration & dosage* / Q000627:therapeutic use; D017962:alpha-Linolenic Acid / Q000097:blood
D005223:Fats; D005228:Fatty Acids, Essential; D005229:Fatty Acids, Monounsaturated; D008041:Linoleic Acids; D009829:Oleic Acids; D010938:Plant Oils; D017962:alpha-Linolenic Acid; C008757:palmitoleic acid; D016718:Arachidonic Acid; D019301:Oleic Acid; D019787:Linoleic Acid