Evaluation of factors associated with the nutritional mixture leading to liver complications in patients treated by means of parenteral nutrition at home.
The major problem of total parenteral treatment consists in the balancing of the source and dose of the nutritional mixture, so as to not deepen malnutrition with a positive impact on the patients' organism. The aim of the study was to evaluate selected factors that induce hepato-biliary complications in patients treated by means of parenteral nutrition at home.


METHODS
The retrospective study comprised 70 patients with biochemistry performed every three months. Considering statistical analysis patients were allocated to four groups, depending on the period of treatment. Group A analysis results were based on the activity of aminotransferases, group B on the activity of bilirubin. Both groups A and B were additionally divided into group I where we assigned normal values of control lab results, and group II with improper results after treatment.


RESULTS
Differences between groups Ia vs IIa were presented on the basis of the daily supply of glucose: mean- 2.52 vs 3.49 g/kg (p=0.000003), glucose/lipids ratio: mean- 3.76 vs 4.90 g/kg (p=0.0001), daily non-protein energy: mean- 16.73 vs 21.06 kcal/kg (p=0.0001). Differences between groups Ib vs IIb were presented on the basis of the daily supply of glucose: mean- 2.76 vs 3.46 g/kg (p=0.0007), glucose/lipids ratio: mean- 3.98 vs 5.13 g/kg (p=0.01), daily non-protein energy: mean-17.96 vs 20.36 kcal/kg (p=0.04). Based on the above-mentioned analysis the main goal in the prevention of hepatic complications should lead to the reduction of the dose of glucose. Increased glucose supply leads to increased number of hepato-biliary complications.


CONCLUSIONS
Based on obtained results we were able to conclude that in case of liver complications associated with parenteral nutrition, proper management consists in the modification of nutritional mixtures (reduction in the daily glucose supply and change in the proportions of extra-protein energy). Such management has the greatest clinical effect. When determining the composition of the nutritional mixture one should adjust the glucose supply, so as to offset both sources of extra-protein energy.
Przemysław
P
Matras
Katarzyna
K
Zuchowska
Katarzyna
K
Banakiewicz
Adam
A
Bobak
Krzysztof
K
Jajko
Roman
R
Szypowski
Grzegorz
G
Zalewski
Paweł
P
Zieliński
Sławomir
S
Rudzki
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D008055:Lipids / Q000008:administration & dosage; D008099:Liver / Q000378:metabolism; D008107:Liver Diseases / Q000209:etiology* / Q000378:metabolism / Q000517:prevention & control*; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D057947:Parenteral Nutrition Solutions / Q000032:analysis* / Q000737:chemistry / Q000378:metabolism; D016562:Parenteral Nutrition, Home Total / Q000009:adverse effects*; D011506:Proteins / Q000008:administration & dosage; D012189:Retrospective Studies; D000637:Transaminases / Q000378:metabolism*; D055815:Young Adult
D008055:Lipids; D057947:Parenteral Nutrition Solutions; D011506:Proteins; D000637:Transaminases; D005947:Glucose; D001663:Bilirubin