Use of Mixed-Oil Fat Emulsion to Improve Intestinal Failure–Associated Liver Disease in Long-Term Home Parenteral Nutrition

A Case Report

Ryan T Hurt, Manpreet S. Mundi

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Home parenteral nutrition (HPN) is a life-saving therapy for patients who are not able to use their gastrointestinal tract. There are a number of complications associated with HPN, including metabolic bone disease, intestinal failure–associated liver disease (IFALD), and catheter-related bloodstream infections. We present a case of a 32-year-old HPN patient who initially developed biopsy-proven IFALD (total bilirubin, 2.4 mg/dL) while on long-term HPN. His HPN was initiated due to myopathic intestinal dysmotility and pseudo-obstruction when he was 15 years old. Because of his IFALD, the intravenous (IV) fat emulsion had been reduced and dextrose increased to >500 g/d in the HPN. Although the IFALD improved, he had signs of insulin resistance and struggled with numerous episodes of pancreatitis. His dextrose was decreased and insulin resistance improved, but he began losing weight. As his IV fat emulsion was gradually increased, IFALD worsened and he was switched to mixed-oil (MO) IV fat emulsion (30% soy, 30% medium-chain triglycerides, 25% olive oil, and 15% fish oil). His IFALD improved and total bilirubin normalized (0.4 mg/dL) when switched to the MO lipid. He has been on MO lipid for >8 months (current dose 70 g given 7 days per week) with no more episodes of pancreatitis, normal liver enzymes, and weight gain.

Original languageEnglish (US)
Pages (from-to)17S-19S
JournalJournal of Parenteral and Enteral Nutrition
Volume41
Issue number1_Suppl
DOIs
StatePublished - Nov 1 2017

Fingerprint

Home Parenteral Nutrition
Emulsions
Liver Diseases
Oils
Intravenous Fat Emulsions
Fats
Bilirubin
Pancreatitis
Insulin Resistance
Intestinal Pseudo-Obstruction
Lipids
Glucose
Catheter-Related Infections
Fish Oils
Metabolic Bone Diseases
Weight Gain
Gastrointestinal Tract
Triglycerides
Biopsy
Weights and Measures

Keywords

  • home nutrition support
  • lipids
  • nutrition
  • parenteral nutrition

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

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title = "Use of Mixed-Oil Fat Emulsion to Improve Intestinal Failure–Associated Liver Disease in Long-Term Home Parenteral Nutrition: A Case Report",
abstract = "Home parenteral nutrition (HPN) is a life-saving therapy for patients who are not able to use their gastrointestinal tract. There are a number of complications associated with HPN, including metabolic bone disease, intestinal failure–associated liver disease (IFALD), and catheter-related bloodstream infections. We present a case of a 32-year-old HPN patient who initially developed biopsy-proven IFALD (total bilirubin, 2.4 mg/dL) while on long-term HPN. His HPN was initiated due to myopathic intestinal dysmotility and pseudo-obstruction when he was 15 years old. Because of his IFALD, the intravenous (IV) fat emulsion had been reduced and dextrose increased to >500 g/d in the HPN. Although the IFALD improved, he had signs of insulin resistance and struggled with numerous episodes of pancreatitis. His dextrose was decreased and insulin resistance improved, but he began losing weight. As his IV fat emulsion was gradually increased, IFALD worsened and he was switched to mixed-oil (MO) IV fat emulsion (30{\%} soy, 30{\%} medium-chain triglycerides, 25{\%} olive oil, and 15{\%} fish oil). His IFALD improved and total bilirubin normalized (0.4 mg/dL) when switched to the MO lipid. He has been on MO lipid for >8 months (current dose 70 g given 7 days per week) with no more episodes of pancreatitis, normal liver enzymes, and weight gain.",
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AB - Home parenteral nutrition (HPN) is a life-saving therapy for patients who are not able to use their gastrointestinal tract. There are a number of complications associated with HPN, including metabolic bone disease, intestinal failure–associated liver disease (IFALD), and catheter-related bloodstream infections. We present a case of a 32-year-old HPN patient who initially developed biopsy-proven IFALD (total bilirubin, 2.4 mg/dL) while on long-term HPN. His HPN was initiated due to myopathic intestinal dysmotility and pseudo-obstruction when he was 15 years old. Because of his IFALD, the intravenous (IV) fat emulsion had been reduced and dextrose increased to >500 g/d in the HPN. Although the IFALD improved, he had signs of insulin resistance and struggled with numerous episodes of pancreatitis. His dextrose was decreased and insulin resistance improved, but he began losing weight. As his IV fat emulsion was gradually increased, IFALD worsened and he was switched to mixed-oil (MO) IV fat emulsion (30% soy, 30% medium-chain triglycerides, 25% olive oil, and 15% fish oil). His IFALD improved and total bilirubin normalized (0.4 mg/dL) when switched to the MO lipid. He has been on MO lipid for >8 months (current dose 70 g given 7 days per week) with no more episodes of pancreatitis, normal liver enzymes, and weight gain.

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