I think you need to switch from Intralipid to an Omega 3 based lipid solution (Omegaven). Intralipid should be held in cases like yours as it can make the liver disease worse. Tons of work has been done on Omegaven at Boston Children's with a lot of it published in accessible journal articles. I would switch, at least for a trial period, for two months. We have done it on a few occasions when nothing else would work and in all cases it cleared the TPN induced jaundice. It is expensive but in cases like these it saves the liver and the patient. In Quebec it requires pre-approval as it is a drug of exception. It is well worth the paper work. We only use it on an exceptional patient such as yours. If you feel the problem is primarily TPN induced you could hold off the liver biopsy if the timing supports this diagnosis and imaging shows nothing suspicious.
Elizabeth Mac Namara
Jewish General Hospital
McGill University
Montreal
Elizabeth Mac Namara
On 2012-08-13, at 11:34 AM, "JENNIFER GLAYSHER" <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Dear all,
We have a case of a long-term TPN patient who has developed liver impairment and is awaiting a biopsy for investigation. We want to rule out TPN as a cause but all of the usual steps of fat free nights / longer feeding time etc have failed to improve the liver function. The next proposal is to have a complete break from lipid for a few months however we are concerned about the risk of developing essential fatty acid deficiency. Does anyone have any experience / literature about how long it would take for a deficiency to develop? Any alternative suggestions as to how to replace fatty acids would be welcome, the patient does not have enough distal bowel for oral replacement but there was some talk of potential for skin creams? I would also be interested to hear if any labs have a protocol for this situation they would be willing to share?
Thanks
Jen
Jennifer Glaysher
Senior Clinical Biochemist
Aintree University Hospitals NHS Trust
Longmoor Lane
L9 7AL
Phone: 0151 529 3990
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