Effects of different parenteral nutrition infusions in a patient with short bowel syndrome.
In this case study, we demonstrate the effects of different lipid emulsions on liver function in a 52-year-old woman with short bowel syndrome who was totally dependent on parenteral nutrition. Over a 13-month period after small bowel resection and jejunostomy, we followed the patient's plasma triglycerides and liver enzyme levels as well as body weight and discomfort levels. During the first 3 months when parenteral nutrition including a lipid emulsion containing 50% soybean oil/50% medium-chain triglyerides was administered daily, the patient reported feeling unwell (experiencing dizziness and palpitations) and her triglycerides and liver enzyme levels rose to 366 mg/dL and 145 U/L (alanine aminotransferase [ALT]), respectively; these levels recovered when this emulsion was discontinued. For the following 9 months, an emulsion containing 80% olive oil and 20% soybean oil was administered, and the patient's triglycerides (182 mg/dL) did not increase to abnormal levels and liver enzyme levels were only mildly elevated (109 U/L). The patient felt well and her body weight increased from 51 kg to 55 kg during this period. These results suggest that parenteral nutrition with a reduced soybean oil content may better preserve liver function in patients with short bowel syndrome.
Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.
Chia-Chee
CC
Weng
Department of Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan. Email: ychen@mail.femh.org.tw.|Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan, Taiwan.
Yun
Y
Chen
D000410:Alanine Transaminase / Q000097:blood; D003110:Colonic Neoplasms / Q000601:surgery; D005217:Fat Emulsions, Intravenous; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D007582:Jejunostomy; D007583:Jejunum / Q000601:surgery; D008099:Liver / Q000201:enzymology / Q000503:physiopathology; D008875:Middle Aged; D000069463:Olive Oil; D010288:Parenteral Nutrition / Q000379:methods; D057947:Parenteral Nutrition Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D010938:Plant Oils / Q000008:administration & dosage; D012778:Short Bowel Syndrome / Q000503:physiopathology / Q000628:therapy*; D013024:Soybean Oil / Q000008:administration & dosage; D014280:Triglycerides / Q000008:administration & dosage / Q000097:blood
D005217:Fat Emulsions, Intravenous; D000069463:Olive Oil; D057947:Parenteral Nutrition Solutions; D010938:Plant Oils; D014280:Triglycerides; D013024:Soybean Oil; D000410:Alanine Transaminase