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Newsletters: The Cleveland Clinic’s Experience with HPN-Associated Liver Disease
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The Cleveland Clinic’s Experience with HPN-Associated Liver Disease

 

Table 1: Categorization of Liver Test Levels

 

Mild

Moderate

Severe

Liver-Associated Enzyme (LAEs)      

  aspartate aminotransferase
  alkaline phosphatase

upper normal to
<2 times normal

2-5 times
normal

>5 times 
normal

     

Liver Function Tests (LFTs)



 

  total bilirubin

1.5-1.9 mg/dL

2-3 mg/dL

>3 mg/dL

  albumin

3.6-3.9 mg/dL

2.8-3.5 mg/dL

<2.8 mg/dL

  prothrombin time

 13-16.9 sec.

17-19 sec.

>19 sec.

 

Note: these levels were used for the purpose of this study and are not used for general medical care.

 


Table 2: Clinical Characteristics of 162 Cleveland Clinic Patients Receiving Long-term PN

Demographics
Age
Male
Female

53 years +/- 14 years
60
102

Underlying Diagnosis
Inflammatory bowel disease
Mesenteric ischemia
Radiation enteritis
Other gastrointestinal disorders
Other medical disorders

56
15
9
32
43

Indication for parenteral nutrition
Malabsorption
Fistula
Bowel obstruction
Other

79
35
20
18

 

*Diagnosis was only available for 155 patients and indication for parenteral nutrition was only available for 152 patients.

 


Table 3: Possible nutrient deficiencies and toxicities that may contribute to PN associated liver disease

Nutrient Deficiencies


Carnitine

Carnitine may be supplied by lysine and methionine in PN amino acids. Serum levels can be measured; if low, may supplement in PN.

Choline

Not currently approved by the US FDA. Clinical trials are underway to determine if it is useful in the prevention or treatment of fatty liver.

Essential fatty
acid deficiency

May occur in patients on lipid-free PN and with inadequate oral fat intake. Lipid emulsion should provide ≥ 4-8% of total calories.

Nutrient Toxicities


Excess calories/
carbohydrate

Total calories should be appropriate for patient’s goal weight. Excess carbohydrate may lead to fatty liver or high blood glucose levels.

Excess IV
lipid emulsion

Avoid lipid administration of greater than 1 g/kg/d.

Manganese and
copper

Manganese and copper are excreted by the biliary tract. If cholestasis or restricted bile flow is present these trace elements should be temporarily removed from the PN.

 


 

more Calendar

9/26/2016 » 9/30/2016
Malnutrition Awareness Week

5/6/2017
Oley Regional Conference

This website is an educational resource. It is not intended to provide medical advice or recommend a course of treatment. You should discuss all issues, ideas, suggestions, etc. with your clinician prior to use. Clinicians in a relevant field have reviewed the medical information; however, the Oley Foundation does not guarantee the accuracy of the information presented, and is not liable if information is incorrect or incomplete. If you have questions please contact Oley staff.

 

Updated in 2015 with a generous grant from Shire, Inc. 

 

This website was updated in 2015 with a generous grant from Shire, Inc. This website is an educational resource. It is not intended to provide medical advice or recommend a course of treatment. You should discuss all issues, ideas, suggestions, etc. with your clinician prior to use. Clinicians in a relevant field have reviewed the medical information; however, the Oley Foundation does not guarantee the accuracy of the information presented, and is not liable if information is incorrect or incomplete. If you have questions please contact Oley staff.
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