A person who receives total parenteral nutrition (TPN) is at risk for liver disease. The risk can be reduced by aggressive management of the patient and careful preparation of the infusate.


Types of liver disease:

(1) cholestatic syndrome

(2) steatohepatitis progressing to cirrhosis


Diagnosis requires:

(1) long-term total parenteral nutrition

(2) onset after starting TPN with findings lasting > 6 months

(3) exclusion of other causes (may be difficult with concurrent liver disease)


Risk factors:

(1) prolonged TPN

(2) high lipid intake (>= 1 gram per kg per day)

(3) pre-existing or concurrent liver disease (hepatitis C, other)

(4) short bowel syndrome

(5) recurrent infection or sepsis

(6) toxic component in infusate (manganese, other)

(7) nutritional deficiency (protein, carnitine, choline, lecithin, glutathione, other essential nutrient)


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