Total parental nutrition

Liver health. As noted above, a biomarker of choline deficiency is elevated serum ALT levels, which is an indication of liver damage. One of the many functions of the liver is its role in fat metabolism. Without PC, the liver is unable to synthesize lipoproteins. Of particular importance in liver is the synthesis of very low-density lipoproteins (VLDL). With diminished VLDL production, the liver is not able to export lipid. This results in an accumulation of fat in the liver. Lipid accumulation in the liver leads to various stages of liver disease such as liver cell death, fibrosis, cirrhosis, and liver cancer (248-250). The role of choline in liver disease was underscored in the early 1990s when it was determined that patients on extended total parental nutrition (TPN) treatment developed fatty livers (251). At that time, TPN formulas did not include choline. Adding choline (in the form of lecithin) to TPN formulas reversed fatty buildup in these patients, and a... 

Septic complications associated with total parental nutrition may be partly due to neutrophil dysfunction, though this has not been demonstrated (79). 

Samlowski WE, Wiebke G, McMurty M, Mori M, Ward JH. Effects of total parental nutrition (TPN) during high-dose interleukin-2 treatment for metastatic cancer. J Immunother 1998 21(l) 65-74. 

Statutory Instrument or SystUme International d Unites (International System of Units), total parental nutrition, time weighted average. 

Plate 8 Total parental nutrition wherein up to three litres of a colloidal emulsion is administered intravenously per patient per day. Trace elements which are necessary for long-term TPjN include calcium, magnesium, iron, copper, zinc, cobalt, manganese, selenium, chromium, molybdenum, iodine, fluorine, phosphorus, chlorine, sodium, and potassium. Photograph provided by Kabi Pharmacia... 

Because choline is widely distributed in the food supply, primarily in phosphatidylcholine (lecithin), deficiencies have not been observed in humans on a normal diet. Deficiencies may occur, however, in patients on total parental nutrition (TPN), i.e., supported solely by intravenous feeding. The fatty livers that have been observed in these patients probably result from a decreased ability to synthesize phospholipids for VLDL formation. 

Massaro, S.A. and Labuza, T.P. Browning and amino acid loss in model total parental nutrition solutions, J. FoodScL, 55, 821, 1990. 

Lienhardt A, Rakotoambinina B, Colomb V, Souissi S, Sadoun E, Goulet O, Robert JJ, Ricour C. Insulin secretion and sensitivity in children on cyclic total parenteral nutrition. J Parenter Enteral Nutr 1998 22(6) 382-6. 

Smith JL, Canham JE, Wells PA. Effect of phototherapy light, sodium bisulfite, and pH on vitamin stability in total parenteral nutrition admixtures. J Parent Enter Nutr 1988 12 394-402. 

Schmutz CW, Martinelli E, Miihlebach S. Stability of vitamin Kj assessed by HPLC in total parenteral nutrition (TPN) admixtures. Clin Nutr 1992 ll(suppl) 110-lll. Billion-Rey F, Guillaumont M, Frederich A. Stability of fat-soluble vitamins A (retinol pabnitate), E (tocopherol acetate), and Kj (phylloquinone) in total parenteral nutrition at home. J Parent Enter Nutr 1993 17 56-60. 

Nnssbanm, M.S., Li, S, Bower, R.H., McFadden, D.W., Dayal, R., Fischer, J.E. Addition of lipid to total parenteral nutrition prevents hepatic steatosis in rats by lowering the portal venous insulin/glucagon ratio. J. Parent. Ent. Nutr. 1992 16 106-109... 

Hornsby-Lewis L, Shike M, Brown P, Klang M, Pearlstone D, Brennan MF. L-glutamine supplementation in home total parenteral nutrition patients stability, safety, and effects on intestinal absorption. J Parenter Enteral Nutr 1994 18(3) 268-73. 

Berkelhammer C, Wood RJ, Sitrin MD. Inorganic phosphorus reduces hypercalciuria during total parenteral nutrition by enhancing renal tubular calcium absorption. J Parenter Enteral Nutr 1998 22(3) 142-6. 

Druml W, Kleinberger G. Hypophosphatemia in patients with chronic renal failure during total parenteral nutrition. J Parenter Enteral Nutr 1999 23(l) 45-6. 

Janigan DT, Percy B, Marrie TJ, Chiasson PM, Hirsch D. Skin necrosis an unusual complication of hyperphosphatemia during total parenteral nutrition therapy. J Parenter Enteral Nutr 1997 21(l) 50-2. 

Fuhrman MP, Herrmann V, Masidonski P, Eby C. Pancytopenia after removal of copper from total parenteral nutrition. J Parenter Enteral Nutr 2000 24(6) 361-6. 

Fujita M, Itakura T, Takagi Y, Okada A. Copper deficiency during total parenteral nutrition clinical analysis of three cases. J Parenter Enteral Nutr 1989 13(4) 421-5. 

Mehta R, Reilly JJ. Manganese levels in a jaundiced longterm total parenteral nutrition patient potentiation of haloperidol toxicity Case report and literature review. J Parenter Enteral Nutr 1990 14(4) 428-30. 

Khaodhiar L, Keane-Ellison M, Tawa NE, Thibault A, Burke PA, Bistrian BR. Iron deficiency anemia in patients receiving home total parenteral nutrition. J Parenter Enteral Nutr 2002 26(2) 114-19. 

Ito Y, Shils ME. Liver dysfunction associated with longterm total parenteral nutrition in patients with massive bowel resection. J Parenter Enteral Nutr 1991 15(3) 271-6. 

Drongowski RA, Coran AG. An analysis of factors contributing to the development of total parenteral nutrition-induced cholestasis. J Parenter Enteral Nutr 1989 13(6) 586-9. 

Foldes J, Rimon B, Muggia-SuUam M, Gimmon Z, Leichter I, Steinberg R, Menczel J, Freund HR. Progressive bone loss during long-term home total parenteral nutrition. J Parenter Enteral Nutr 1990 14(2) 139-42. 

Hebuterne X, Frere AM, Bayle J, Rampal P. Priapism in a patient treated with total parenteral nutrition. J Parenter Enteral Nutr 1992 16(2) 171-4. 

Jatoi A, Hanjosten K, Ross E, Mason JB. A prospective survey for central line skin-site colonization by the pathogen Malassezia furfur among hospitalized adults receiving total parenteral nutrition. J Parenter Enteral Nutr 1997 21(4) 230-2. 

Velez RJ, Myers B, Guber MS. Severe acute metabolic acidosis (acute beriberi) an avoidable complication of total parenteral nutrition. J Parenter Enteral Nutr 1985 9 216-9. 

Malecki EA, Lo HC, Yang H, et al. Tissue manganese concentrations and antioxidant enzyme activities in rats given total parenteral nutrition with and without supplemental manganese. JPEN J Parenter Enteral Nutr 1995 19 222-226. 

Kotler DP, Fogleman L, Tierney AR. Comparison of total parenteral nutrition and an oral, semielemental diet on body composition, physical function, and nutrition-related costs in patients with malabsorption due to acquired immunodeficiency syndrome. JPEN J Parenter Enteral Nutr 1998 22 120-126. 

Dudrick SJ. Early developments and clinical applications of total parenteral nutrition. JPEN J Parenter Enter Nutt 2003 27 291-299. 

Krzyda EA, Andris DA, Whipple JK, et al. Glucose response to abrupt initiation and discontinuation of total parenteral nutrition. J Parenter Enter Nutr 1993 17 64-67. 

Eisenberg JM, Click HA, Buzby GP, et al. Does perioperative total parenteral nutrition reduce medical care costs JPEN J Parenter Enter Nutr 1993 17 201-209. 

Billionrey, F., Guillaumont, M., Frederich, A., and Aulagner, G. (1993) Stability of fat-soluble vitamin A (retinol palmitate), vitamin E (tocopherol acetate), and vitamin K1 (phyl-loquinone) in total parenteral nutrition at home, JPEN J. Parenter. Enteral. Nutr., 17, 56-60. 

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