OHP-024 Controversy between cyclic parenteral nutrition and total parenteral nutrition

BackgroundPatients receiving long term total parenteral nutrition (TPN) often present some complications such as liver and biliary disorders. The most common hepatic markers are elevated bilirubin, alkaline phosphatase (AP), gamma glutamyl transpeptidase (GGT) and transaminases (ALT/AST). Strategies to overcome these complications include setting the caloric intake of TPN and cyclic infusions.PurposeTo analyse the variation in liver enzymes in changing from a continuous infusion of 24 hours to cyclic PN.Material and methodsA retrospective study was conducted between July and September 2016. 23 patients who received TPN for more than 7 days and that had changed the infusion time were included. The following data were collected: starting day of PN, start day and end day of cyclic PN, and variations in bilirubin, GGT, ALT/AST and AP.Results65% were men with a mean age of 56 years and 35% were women with a mean of 51 years. Mean time taken to start cycling was 9.3 days, with a mean of 20.39 days with TPN and a mean of 11.09 days of cyclic PN. When starting cyclic PN, no data were available for 47.82% of patients regarding AP, 52.17% for bilirubin, 8.69% for AST and 4.35% for both GGT and ALT. After PN, 83.33% had increased levels of AP and only 16.67% had decreased levels. 54.55% had increased levels of bilirubin, 36.6% decreased levels and 9.09% had no change. 63.64% had increased levels of GGT and 36.36% decreased levels. 66.67% had decreased AST levels compared with 33.33% with increased levels. 50% had increased levels of ALT versus 45.45% with decreased levels and 4.55% with no change.ConclusionBased on the results obtained from our sample, our population did not benefit from cyclic PN. We found increased levels of enzyme markers of cholestasis. We should consider whether the selection of patients to cycle the PN was correct; in several patients, data for enzyme levels of cholestasis were not available or were previously raised at the beginning of TPN, which could be indicative of intrahepatic cholestasis.References and/or acknowledgementsRev.OFIL 2016;26(3):171–174.No conflict of interest