Abnormal vitamin levels in patients receiving home total parenteral nutrition

Citation
V. Mikalunas et al., Abnormal vitamin levels in patients receiving home total parenteral nutrition, J CLIN GAST, 33(5), 2001, pp. 393-396
Citations number
21
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Gastroenerology and Hepatology
Journal title
JOURNAL OF CLINICAL GASTROENTEROLOGY
ISSN journal
0192-0790 → ACNP
Volume
33
Issue
5
Year of publication
2001
Pages
393 - 396
Database
ISI
SICI code
0192-0790(200111/12)33:5<393:AVLIPR>2.0.ZU;2-Q
Abstract
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.