Parenteral Nutrition–Induced Hypersensitivity in an Adolescent

Bartels, Cathy L.; Sanz, C. Colas; Stec, Robin; Coulter, Donald W.

doi:10.1177/0148607111399288

Cited by 16 publications

(11 citation statements)

References 9 publications

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“…Our patient developed a hypersensitivity to parenteral vitamins in TPN, likely due to polysorbate 80. Polysorbate 80 is ubiquitously found in many medical agents and hypersensitivity reactions, including anaphylaxis, following various lengths of exposure have been reported . Long‐term TPN was needed in this patient secondary to prolonged poor oral intake.…”

Section: Discussionmentioning

confidence: 92%

“…During this prolonged treatment, and often because of age, these patients frequently require caloric supplementation with total parenteral nutrition (TPN) because of limited enteral intake secondary to mucositis, prolonged nausea, and subsequent food aversion. Rarely, vitamins are removed from TPN due to hypersensitivity reactions to a carrier protein/compound . These patients are at risk of developing vitamin deficiency syndromes when therapy is intensive enough to curtail adequate oral vitamin intake.…”

Section: Introductionmentioning

confidence: 99%

“…Rarely, vitamins are removed from TPN due to hypersensitivity reactions to a carrier protein/compound. [3,4] These patients are at risk of developing vitamin deficiency syndromes when therapy is intensive enough to curtail adequate oral vitamin intake.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Stem Cell Transplant-Associated Wernicke Encephalopathy in a Patient with High-Risk Neuroblastoma

Darlington

Pinto

Hecktman

et al. 2015

Pediatr Blood Cancer

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Children undergoing intense cancer treatment frequently require total parenteral nutrition (TPN). Rarely, vitamins are removed due to hypersensitivity to the carrier vehicle in the formulation. We present the case of a 5-year-old patient with stage 4, high-risk neuroblastoma who developed altered mental status, ataxia, and tachycardia during consolidative autologous stem cell transplantation. Skin findings and brain MRI were consistent with thiamine (vitamin B1) deficiency and Wernicke encephalopathy. Vitamin B1 administration rapidly reversed all skin and neurologic symptoms. This case highlights the importance of close monitoring of micronutrients in pediatric patients receiving prolonged courses of chemotherapy and stem cell transplantation.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Stem Cell Transplant-Associated Wernicke Encephalopathy in a Patient with High-Risk Neuroblastoma

Darlington

Pinto

Hecktman

et al. 2015

Pediatr Blood Cancer

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“…7 In another case report IV amino acid formulation that contained an added MVI had caused a similar type of rash. 8 Such a cutaneous reaction, in this patient, may also be attributed to the vancomycin infusion, which is known to cause a wide spectrum of skin reactions, including red man syndrome. Findings associated with vancomycin can range from minimal skin and mucosal involvement to extensive dermal exfoliation, nephritis, lymphadenopathy, hepatitis, and multiple serologic abnormalities.…”

Section: Discussionmentioning

confidence: 72%

Possible adverse drug reaction to parenteral amino acids in an infant: a case report

Kawatra

Biswas

Shivamurthy

et al. 2014

Int J Basic Clin Pharmacol

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examination revealed wheeze and bilateral crepitations. The vitals recorded on admission were pulse -146 bpm, blood pressure (BP) -88/50 mm of Hg, respiratory rate (RR) -50, temperature -100°C, SpO2 -98% on room air. The blood reports were as mentioned: hemoglobin (Hb) -11.20 g%, total erythrocyte count (TLC) -18,210/mm 3 (N-40, L-53, E-2, M-5, B-0), platelet count -658,290 mm 3 , prothrombin time -18.9, activated partial thromboplastin time -30.4, international normalized ratio -0.7, serum creatinine -0.7, Na + -138.7, K + -5.2. He was started on injection amoxicillin clavulanic acid 150 mg batrachochytrium dendrobatidis (BD) intravenous (IV) along with a salbutamol nebulization.On 04 December, 2013, on the basis of X-ray fi ndings and the various blood parameters, a diagnosis of bronchopulmonary pneumonia with ARDS with septic shock was made. The patient was started on injection amikacin 50 mg BD IV. ABSTRACTA case report of a possible adverse drug reaction to 10% parenteral aminoacid formulation in a 5½ month male patient diagnosed with bronchopulmonary pneumonia with acute respiratory distress syndrome in septic shock, is presented. There was a temporal relationship between the administration of the parenteral amino acid formulation and the onset of the exanthem. This was further evidenced by the regression of the exanthem following the discontinuation of the formulation. The causality assessment of this adverse drug reaction has been done, and the likely causes of this hypersensitivity reaction have been analyzed.

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“…A total of 28 articles dating from 1976-2016 were analyzed. The vast majority were case reports (24); the rest were case series. Relevant findings of the studies are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Systematic Review of Hypersensitivity to Parenteral Nutrition

Christian

Tallar

Walia

et al. 2018

J Parenter Enteral Nutr

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Hypersensitivity to the components of parenteral nutrition (PN) is a rare but important complication of PN. We performed a systematic review of hypersensitivity to PN to enable us to build an approach to the individual patient who presents with PN hypersensitivity. A systematic literature search was performed in Ovid Medline, CINAHL, Scopus, and Web of Science using terms for "hypersensitivity" AND "parenteral nutrition" and relevant synonyms. A total of 28 articles were analyzed, and 33 hypersensitivities to PN or components of PN were reported in these 28 articles. Reports of hypersensitivity and subsequent conclusions were based on the clinical observations made by each reporting author. These reactions were evenly split between pediatric and adult patients. Hypersensitivity to PN occurred on day of starting PN in 60.6% patients and after that time in 36.3% patients (range: 1-21 days). Of the hypersensitivities that occurred on day 1 of PN, 70% occurred in the first 30 minutes of initiation of PN. Cutaneous manifestations were the most common, followed by anaphylaxis, respiratory symptoms, and hemodynamic instability. The components most frequently identified as allergens were intravenous fat emulsion (48.4%), multivitamin solution (33.3%), and amino acid solution (9%). Based on this review, an algorithm was created to guide the practitioner on management of PN after the occurrence of such a reaction.

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Parenteral Nutrition–Induced Hypersensitivity in an Adolescent

Cited by 16 publications

References 9 publications

Stem Cell Transplant-Associated Wernicke Encephalopathy in a Patient with High-Risk Neuroblastoma

Stem Cell Transplant-Associated Wernicke Encephalopathy in a Patient with High-Risk Neuroblastoma

Possible adverse drug reaction to parenteral amino acids in an infant: a case report

Systematic Review of Hypersensitivity to Parenteral Nutrition

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