Vitamin Serum Level Variations Between Cycles of Intermittent Parenteral Nutrition in Adult Patients With Short Bowel Syndrome

Abstract

This study documented that patients did not receive an adequate administration of oral vitamin supplements of vitamins A, C, and E through PN. More studies need to be conducted investigating higher doses of vitamin administration (oral or intravenous administration), assessing differences between water and liposoluble supplements.

Bone mineral density in short bowel syndrome: correlation with BMI and serum vitamins C, E and K

“…Although there are several degrees of anatomical and functional adapta tion in the remaining bowel, some patients are unable to keep a satisfactory nutritional status by oral route, thus becoming dependent on parenteral nutrition (PN) (1). Recently, we showed that SBS patients present deficien cies in vitamins E, D (3,4) and K (3), regardless of venous infusion. Within this context, efforts are primarily devo ted to intestinal adaptation to oral route nutrition (5).…”

“…Pa tients with severe malabsorption need home PN (5), but it is not a therapeutic option provided by the Brazilian public health system. In our service, these patients receive intermittent PN in periodic hospital admissions (3,4).…”

Vitamins During Cycles of Intermittent Parenteral Nutrition

“…While critically ill patients on IPN presented normal serum levels of folic acid and vitamin B 12 , serum levels of vitamins A and C were lower than normal values (Ferreira et al 2013). Hypovitaminosis D and E were detected in 88 % and nearly 100 % of patients on IPN, respectively (Braga et al 2011;Ferreira et al 2013), even receiving an intravenous supply that exceeded the recommended values by the American Society for Parenteral and Enteral Nutrition and the US Food and Drug Administration guidelines (2000).…”

“…Hypovitaminosis D and E were detected in 88 % and nearly 100 % of patients on IPN, respectively (Braga et al 2011;Ferreira et al 2013), even receiving an intravenous supply that exceeded the recommended values by the American Society for Parenteral and Enteral Nutrition and the US Food and Drug Administration guidelines (2000). A deeper decrease in vitamin E serum concentrations occurred after the period in which patients stayed at home (Ferreira et al 2013). In addition, patients with intestinal failure on IPN presented vitamin K deficiency, determined by the measurement of serum phylloquinone concentrations (Braga et al 2011).…”

“…Due to limitations to the use of intravenous access in a home environment, the medical nutrition team, composed of physicians and dietitians, advises patients to follow an appropriate oral diet (Nonino et al 2001) and vitamin and mineral supplements on a daily basis at the time of discharge. Although the patients receive intravenous vitamin administration according to the current recommendations, IPN infusion may not be adequate to ensure serum vitamin levels within normal values (Braga et al 2011;Ferreira et al 2013).…”