No abstract

Total parenteral nutrition (TPN) is now used widely in the treatment of nutritional depletion. It improves the survival of malnourished patients, especially those suffering from chronic inflammatory bowel disease.Despite progress in the development of the TPN formula, problems persist in the management of TPN-treated patients, and hepatic complications have received increasing attention. In particular, 30 to 60% of patients undergoing TPN treatment develop intrahepatic cholestasis after a few weeks of treatment (Allardyce 1982;Fouin-Fortunet et al. 1982;Wagner et al. 1983). There is still no adequate treatment for this complication and, apart from manipulating the TPN formula in an attempt to minimise overfeeding, stopping the TPN infusion is often the only alternative when cholestasis develops. S-Adenosylmethionine (SAMe) has been shown to effectively prevent and antagonise bile secretion impairment experimentally and improve pruritus and liver biochemistry in pregnant women and patients with chronic intrahepatic cholestasis. We report on a patient with intrahepatic cholestasis induced by TPN who benefitted from treatment with intravenous SAMe. Patient and MethodsA 34-year-old male suffering from ulcerative colitis in the active phase was given TPN for 29 days. The TPN formula consisted of the following, administered individually: 100mi glucose 50%, equivalent to 2000 kcal/L; 500ml lipid emulsion 10%, equivalent to 500 kcal/L; a synthetic aminoacid solution providing nitrogen 15g, equivalent to 500 kcal/L; and electrolytes, vitamins and oligoelements. The solution was administered continuously by a catheter inserted into the superior vena cava via the subclavian vein. Liver function tests were carried out before and then weekly during TPN treatment. When intrahepatic cholestasis developed, intravenous SAMe 800 mg/day diluted in glucose solution 50% was administered and TPN therapy continued unmodified.