MICRONUTRIENT STATUS IN PATIENTS RECEIVING HOME PARENTERAL-NUTRITION

Administration of home parenteral nutrition (HPN) to patients with int estinal failure requires attention to caloric content of feeds, fluid, electrolyte balance, and micronutrient status. Peripheral blood estim ations of vitamins and trace elements may be abnormal, but their clini cal significance in relation to deficiency or toxicity states is not a lways clear. We sought to determine the incidence and nature of clinic al micronutrient; abnormality in our HPN program. Clinical assessment and case record review of 49 patients actively receiving HPN was under taken, and, in 32 of these patients, serum micronutrient levels were a ssayed. Clinical evidence of micronutrient deficiency was identified i n 16 patients (33%). Iron deficiency anemia occurred in 14 patients wh ich resolved after iron supplementation in all except 1 patient who ha d persistent intestinal blood loss. Anemia was precipitated in six pat ients by identifiable clinical events (acute gastrointestinal disease in five and menorrhagia in one), and in two others folate deficiency c oexisted. Biotin deficiency developed in three patients, manifested by dry eyes and angular cheilitis or hair loss. Vitamin A deficiency res ulting in visual disturbance developed in one patient who was not rece iving multivitamin supplements at that time. Serum levels of zinc, cop per, selenium, manganese, vitamin A, and vitamin E were measured in 32 patients. No patient had normal levels of all six micronutrients, Nev ertheless, there was no clinical evidence of toxicity or deficiency in any of these patients at the time assays were performed. In conclusio n, abnormalities of micronutrient status are common in HPN patients, b ut serious sequelae appear to be unusual. (C) Elsevier Science Inc. 19 97.