Better living through chemistry, constant monitoring, and prompt interventions: 26 years on home parenteral nutrition without major complications

Abstract

Objective: We discuss 26 y of home parenteral nutrition (HPN) in an otherwise healthy patient with severe short bowel syndrome demonstrating a decrease in life-threatening complications after various management changes.

Methods: The patient is a 41-y-old male with a midgut volvulus from malrotation who developed short bowel syndrome and has been HPN dependent since the age of 15 y. His surgical and nutritional data were collected retrospectively and prospectively and included nutritional history, anthropometric parameters, laboratory results, activity levels and types, and treatments for complications. His entire HPN course has been prospectively followed.

Results: Since becoming HPN dependent, the patient's energy intake range has been 20-45 kcal.kg(-1).d(-1), with 0.8-1.6 g of protein.kg(-1).d(-1). He receives HPN with electrolytes, multivitamins, and trace elements nightly and his intravenous fat emulsion ranges from one to seven times per week. Adjustments to magnesium, iron, zinc, selenium, vitamin E, and carnitine are often required. During his first years of HPN, he had six episodes of catheter-related sepsis and two central venous catheter occlusions. The current central venous catheter has been in place for >13 y without infection or replacement. He developed mild osteopenia but has maintained an active lifestyle without fractures. In the second and third decades of HPN, episodes of hepatic dysfunction occurred, with improvement or resolution using various interventions including oral fish oil.

Conclusion: This case illustrates the successful management of a life-long HPN-dependent patient in whom PN complications have been minimized, including a very recent occurrence of parenteral nutrition-associated cholestasis.