Problems of Trace Elements and Vitamins during Long-Term Total Parenteral Nutrition: A Case Report of Idiopathic Intestinal Pseudo-obstruction

Abstract

An 8-year-old girl with chronic idiopathic intestinal pseudo-obstruction (CIIP), who is the first case of CIIP in Japan, has been receiving total parenteral nutrition (TPN) for more than 6 years. During this time, she experienced deficiencies of copper, zinc, vitamin A, vitamin B₁₂, folic acid, and biotin, and an excess of vitamin A; she exhibited a series of signs and symptoms due to these deficiencies and vitamin A overdosage. Nevertheless, careful monitoring of serum levels of trace elements and vitamins and appropriate therapy have almost solved these problems. She has achieved normal physical and mental development and goes to school, while receiving home parenteral nutrition with an ambulatory infusion system. (Journal of Parenteral and Enteral Nutrition 11:322-325,1987)

Get full access to this article

View all access options for this article.

References

Dudley HA , Sinclair IS , McLaren IF , et al: Intestinal pseudo-obstruction. J R Coll Surg Edinb 3:206-217, 1958

Byrne WJ , Cipel L. , Euler AR , et al: Chronic idiopathic intestinal pseudo-obstruction syndrome in children. Clinical characteristics and diagnosis. J Pediatr 90:585-589. 1977

Curry CR , Quie PG : Fungal septicemia in patients receiving parenteral hyperalimentation . N Engl J Med 285:1221-1225, 1971

Robert J. , Downing SE : Cholestasis associated with long-term parenteral hyperalimentation . Arch Surg 106:58-62, 1973

Menkes JH , Alter M. , Steigieder GK , et al: A sex-linked recessive disorder with retardation of growth, peculiar hair. and focal cerebral and cerebellar degeneration. Pediatrics 29:764-779, 1962

Kay RG , Tasman-Jones C. : Zinc deficiency and intravenous feeding. Lancet 2:605-606, 1975

Grunrich WW : Radiographic Atlas of Skeletal Development of the Hand and Wrist, 2nd ed. Publisher, City, 1959

Dudrick SJ , Macfadyen BU , Van Buren CT , et al: Parenteral hyperalimentation. Metabolic problems and solutions . Ann Surg 176:259-264, 1972

Donald M. , Dehorimer AA , Liebman WM , et al: Biotin deficiency an unusual complication of parenteral alimentation . N Engl J Med 304:820-823, 1981

10.

Arakawa T. , Tamura T. , Igarashi Y. , et al: Zinc deficiency in two infants during total parenteral hyperalimentation for diarrhea. Am J Clin Nutr 29:197-204, 1976

11.

Karpel JT , Peden VH : Copper deficiency in long-term parenteral nutrition. J Pediatr 80:32-36, 1972

12.

Vilter RW Bozian RC , Hess E. , et al: Manifestations of copper deficiency in a patient with systemic sclerosis on intravenous hyperalimentation. N Engl J Med 291:188-191. 1974

13.

Heller RM Kirchner SG , O'Neill JA , et al: Skeletal changes of copper deficiency in infants receiving prolonged total parenteral nutrition. J Pediatr 92:947-949, 1978

14.

Seibert JJ , Byrne WJ Golladay ES : Development of hypervitaminosis A in a patient on long-term parenteral hyperalimentation . Pediatr Radiol 10:173-174, 1981

15.

Howard L. , Chu R. , Feman S. , et al: Vitamin A deficiency from long-term parenteral nutrition. Ann Int Med 93:576-577, 1980

16.

Shike M. , Harrison JE , Sturtridge WC , et al: Metabolic bone disease in patients receiving long-term total parenteral nutrition. Ann Int Med 92:343-350, 1980

17.

Klein GL , Targoff CM , Ament ME , et al: Bone disease associated with total parenteral nutrition. Lancet 11:1041-1044, 1980

18.

Klein GL , Horst RL , Norman AW , et al: Reduced serum levels of 1α,25-dihydroxyvitamin D during long-term total parenteral nutrition. Ann Int Med 94:638-643, 1981

19.

McClain CJ , Baker H. , Onstad GR , et al: Biotin deficiency in an adult during home parenteral nutrition . JAMA 247:3116-3117, 1982