The administration of multivitamins to patients receiving home parenteral n
utrition (HPN) was decreased from once daily to three times weekly during t
he parenteral multivitamin shortage in 1997. Blood vitamin levels were meas
ured to examine whether the decrement in the infused vitamins affected the
levels. Six patients with normal renal and liver function. receiving HPN fo
r 6 months to 10 years, were studied 6 months after the institution of 10 m
L of multivitamins thrice weekly. Two patients with renal insufficiency who
required hemodialysis and HPN were also studied. Multivitamin administrati
on was eliminated in one patient and was reduced to once weekly when elevat
ed pyridoxine levels were found in association with possible neurotoxicity.
Five of the six patients with normal renal function had low serum ascorbic
acid levels. Serum riboflavin levels were found to be low in one patient,
serum pyridoxine was low in one, serum retinoids were low in three, and ser
um niacin was low in one. There were no clinically obvious untoward effects
caused by the vitamin deficiencies. Each of the dialysis patients had elev
ated serum pyridoxine levels and had some neurologic disturbance (periphera
l neuropathy, involuntary movements). The serum pyridoxine levels fell to n
ormal in each after the cessation or decrease of the multivitamin preparati
on. Ascorbic acid levels were low in one patient and fell into abnormally l
ow levels in the other when the parenteral multivitamins were reduced. but
they corrected with the separate administration of intravenous vitamin C. I
n conclusion, the reduced administration of multivitamins in 1997 resulted
in diminished ascorbic acid levels in seven of eight patients receiving tot
al parenteral nutrition. Less often, low levels of retinoids, niacin. pyrid
oxine, and riboflavin were seen. Patients with chronic renal failure receiv
ing HPN with multivitamins may develop elevated pyridoxine levels, which mi
ght result in neurologic sequelae.