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 May occur in patients on lipid-free PN and
with inadequate oral
acid deficiency
fat intake. Lipid emulsion should provide > 4-8% of total
calories.
Nutrient Toxicities
Excess calories/ Total calories should be appropriate for patient’s
goal weight. Excess
carbohydrate carbohydrate may
lead to fatty liver or high blood glucose levels.
Excess IV
Avoid lipid administration of greater than 1 g/kg/d.
lipid emulsion
Manganese and
Manganese and copper are excreted by the biliary tract. If
copper cholestasis or restricted bile flow is present
these trace elements
should be temporarily removed from the
PN.