Background Abnormal liver functioning is associated with long term treatment with total parenteral nutrition (TPN).

Purpose To assess the influence of a lipid emulsion based exclusively on omega-3 fatty acids on the progress of abnormal liver functioning in a patient receiving long term TPN.

Material and methods This was a descriptive retrospective study regarding a case of parenteral nutrition. The case was a 52-year-old woman with cyclic TPN at home due to intestinal obstruction secondary to a recurrent appendix tumour. The patient had external gallbladder flush and oral intake was impossible. Lipid input was founded on a solution based exclusively on omega-3 fatty acids. Clinical, analytical and nutritional variables were gathered.

Results The patient was initially administered a lipid formulation made up of medium chain triglycerides, soy oil and AG-omega3 (1 g/kg/day), ratio of carbohydrates–lipids 60:40 and 15 g nitrogen/day. Liver function parameters: ALP 150 U/L, TB 0.32 mg/dL, GGT 92 U/L, AST 26 U/L and ALT 28 U/L.

After the worsening of cholestasis pattern ALP was 499 U/L, TB 0.89 mg/dL, GGT 608 U/L, AST 354 U/L and ALT 280 U/L. The composition of TPN was modified, replacing the lipid emulsion with another one containing medium chain triglycerides, soy oil, olive oil and omega-3 fatty acids. The nitrogenated solution was also replaced with a taurine enriched solution. As liver function did not normalise, the lipid input was reduced, and its administration was eventually suspended.

Due to a sudden worsening of cholestasis (ALP 1619 U/L, TB 0.7 mg/dL, GGT 1324 U/L, AST 77 U/L, ALT 247 U/L and marked jaundice), the lipid formulation was replaced with another formulation based exclusively on omega-3 fatty acids ( 1g/kg/day). After 6 weeks, an improvement in the cholestasis pattern was observed, with a decrease in ALP and GGT by 68.5% and 67%, respectively: ALP 510 U/L, TB 0.4 mg/dL, GGT 435 U/L, AST 33 U/L and ALT 47U/L. The patient tolerated the treatment and no adverse effects were observed in relation to fish oil, such as thrombocytopenia or INR increases. The deficit in essential fatty acids was monitored, and values were found to be within normal limits. The clinical and analytical parameters remained stable until the patient died due to progression of her condition.

Conclusion Administration of this formulation for 7 months as the only lipid formulation was well tolerated by the patient and no deficit in essential fatty acids was detected.

References and/or acknowledgements Pharmacy and endocrinology department.

No conflict of interest