CP-232 Effectiveness of cyclic parenteral nutrition to reduce liver damage

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Abstract

Background

Liver involvement related to parenteral nutrition (PNALD) is a major problem, especially in patients requiring total parenteral nutrition (TPN) for a long time and in neonates. A common measurement made is the cyclisation of parenteral nutrition, interrupting administration between 8 and 4 hours to reduce liver damage.

Purpose

The purpose of the study was to analyse the evolution of analytical indicators of liver damage following introduction of cyclic parenteral nutrition (CPN).

Material and methods

We all patients with CPN in a period of 6 months, from 1 July 2015 to 1 January 2016. Screening conditions were: introduction of TPN for a period longer than 1 week, no previous liver disease and no deaths during the administration of TPN or on the days immediately following. We selected five analytical variables of greater importance in identifying liver damage: alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT) and total bilirubin (TBil). We recorded the data for these values before and at least 1 week after CPN.

Results

60 patients were included in our study. Mean (SD) values were: before CPN: ALP=250 IU/L (SD=294), AST=70 IU/L (SD=53), ALT=90 IU/L (SD=71), GGT=300 U/L (SD=302) and TBIL=4.29 mg/dL (SD=4.06). After CPN: ALP=272 U/L (SD=411), AST=40 U/L (SD=55), ALT=59 U/L (SD=37), GGT=294 U/L (SD=373), TBIL=3.3 mg/dL (SD=4). The results were broken down into subgroups of patients: oncology, surgical oncology and internal medicine (not included).

Conclusion

We observed an improvement in liver parameters for patients except AF after establishing CPN. This result could be attributed to unspecific character of this enzyme. There was a particularly significant improvement for AST and ALT in all subgroups. Finally, GGT improved in all subgroups except for the group of surgical patients

References and/or acknowledgements

Klein CJ. Parenteral nutrition-associated conjugated hyperbilirubinemia in hospitalised infants. J Am Diet Assoc2010;110:1684–95.

References and/or acknowledgements

No conflict of interest

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