LONG-TERM TOTAL PARENTERAL-NUTRITION AND OSTEOPOROSIS - REPORT OF A CASE

A patient WhO had been supported with total parenteral nutrition (TPN) for over 8 years is herein presented, with emphasis on the changes ob served in calcium metabolism. The patient was a 31-year-old female, wh o had undergone a subtotal jejunal and ileal resection for superior me senteric artery occlusion. TPN was started soon after the surgery. She had been on TPN support for 105 months. Back pain developed at 97 mon ths after the initiation of TPN. During her course, the serum calcium levels were judged to be within the normal ranges, while the 1alpha, 2 5(OH)2Vit.D declined. Intermittent hypercalciuria was occasionally obs erved. Both the serum level of calcium and urinary calcium loss correl ated closely to the amount of calcium infused, but they were not influ enced by the amount of vitamin D (ergocalciferol) received. The serum level of parathormone and calcitonin were also within the normal range s. The patient's vertebral bone, which was obtained at autopsy, reveal ed histopathological changes characteristic of osteoporosis. Based on the above, we conclude that a careful monitoring of the amount of calc ium infused is called for to prevent bone disease in patients on long- term parenteral nutrition.