Diarrhea parenteral nutrition

Zinc deficiency is clinically characterized by the development of a moist eczematous dermatitis most apparent in the nasolabial folds and around orifices. Other presenting signs and symptoms may include hypogeusia (blunted sense of taste), alopecia, diarrhea, rash (which may vary from papular, scaly lesions to weeping, open erosions), apathy, and depression. Clinical zinc deficiency occurs most frequently in the setting of abnormal losses, such as in Crohn s disease, malabsorption states, and fistula losses, or from prolonged inadequate intake, such as with zinc-free parenteral nutrition. 

A 41-year-old man developed acute abdominal pain with profuse diarrhea and fever (39°C) while receiving intramuscular fluphenazine decanoate 125 mg once every 3 weeks. During the previous 3 months he had also taken oral alimemazine 50 mg/day, levomeproma-zine 50 mg/day, and amitriptyline 100 mg/day. Colonoscopy showed necrotic ulcers in the mucosa of the sigmoid and descending colon. After three weeks of parenteral nutrition, there was a marked reduction in the colonic lesions and he recovered. Levomepromazine 50 mg/day and fluphenazine decanoate 100 mg/day were reintroduced. Two days later he complained again of abdominal pain, and tomodensi-tometry confirmed distension. 

Copper occurs in many foods particularly good sources are liver, kidney, shellfish, nuts, raisins, and dried legumes. Copper deficiency due to diet is rare except in malnutrition and in children with chronic diarrhea. It occurs in total parenteral nutrition with fluids low in copper, particularly following intestinal resection and in patients who receive large amounts of zinc to improve wound healing or for management of sickle cell anemia. Copper is often removed from prepared foods to increase their shelf life. 

Gastrointestinal system Nausea and vomiting Diarrhea Constipation Anorexia Stomatitis (waste buildup) Bleeding (waste buildup, impaired clotting) Parenteral nutrition (if indicated) Enteral nutrition (if indicated) Dietary restriction of potassium (40 mEq or as ordered), sodium, phosphate based on values of labwork Protein intake based on need (0.6-2 g/kg/day)... 

Similarly, for intractable diarrhea in infants, there are no randomized controlled studies comparing TPN to starvation. However, two small experiences have been reported with 100% survival in an illness which historically has a 40% mortality rate (Hyman et al, 1971 Keating and Ternberg, 1971). The results of these and similar studies have made parenteral nutritional support an integral part of the therapy of this condition. 

Kien, C., Kohler, E., Goodman, S. I., Benlou, S., Hong, R., Horowitz, S. P., and Baker, H., 1981, Biotin—Responsive in vivo carboxylase deficiency in two siblings with secretory diarrhea receiving total parenteral nutrition, J.Pediatr. 99 546. 

Comparative studies In a systematic review of five randomized controlled comparisons of parenteral and enteral nutrition in patients with acute pancreatitis, there was diarrhea in 6 of 92 patients (7%) versus 24 of 82 (29%) respectively and hyperglycemia in 21 of 92 patients (23%) versus 7 of 82 (11%) [18 ]. The added risk of infections... 

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