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Parenteral nutrition-associated cholestasis--what do we know, what can we do?

Abstract
In the early days of parenteral nutrition of children liver disease resulting in steatosis and cholestasis was assumed to be an inevitable complication of the procedure. Since then, the management of parenteral nutrition has improved so much that nowadays adolescents have a fair chance of surviving more than 15 to 20 years without severe liver disease. Nevertheless, we still see cases of parenteral nutrition-associated cholestasis (PNAC) due to various conditions such as recurrent infections, inflammatory response, inappropriate composition of the nutrient mixture, contaminants of the nutrient solution, and toxic substances from infusion bags and tubes. Recent research indicates that the administration of ursodesoxycholic acid and cysteine can prevent or even improve the cholestasis. A reversal of PNAC has been documented in an adolescent after small bowel transplantation from Japan. There is ample opportunity for prevention of PNAC with respect to the various pathophysiologic aspects: prevention, early detection, and management of infections, avoiding glucose overloads, cyclic infusion of nutrients, light protection of the solution, choice of paediatric amino acid solutions, and most important, oral or enteral feeding to support the bile flow by stimulating the cholecystokinine release.
AuthorsM B Krawinkel
JournalEuropean journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie (Eur J Pediatr Surg) Vol. 14 Issue 4 Pg. 230-4 (Aug 2004) ISSN: 0939-7248 [Print] United States
PMID15343461 (Publication Type: Journal Article)
Chemical References
  • Bile Acids and Salts
  • Vitamins
Topics
  • Bile Acids and Salts (metabolism)
  • Child
  • Child, Preschool
  • Cholestasis (etiology, prevention & control, therapy)
  • Humans
  • Infant
  • Infant, Newborn
  • Infections (complications)
  • Nutritional Physiological Phenomena
  • Nutritive Value
  • Parenteral Nutrition (adverse effects)
  • Transplantation (adverse effects)
  • Vitamins (pharmacology)

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