Iodine Deficiency in a Parenteral Nutrition–Dependent Adolescent With Intestinal Pseudo‐Obstruction

Abstract

Routine supplementation of iodine in parenteral nutrition (PN) solutions is not current practice in the United States. In this case study, we describe an incidental finding of goiter in a long-term PN-dependent adolescent. With increased iodine screening, we then identified additional patients with undetectable urinary iodine concentrations in our population of children with short bowel receiving long-term PN. We hypothesize that 2 practice changes are possibly reducing iodine provision to long-term PN-dependent patients: transition to alcohol-based skin preparations and lipid minimization.

Trace Element Provision in Parenteral Nutrition in Children: One Size Does Not Fit All

“…In North America, iodine is not routinely included in PN [ 1 , 37 , 38 , 39 , 40 ], whereas European [ 3 , 7 ] and Australian [ 2 ] trace elements commercial solutions usually contain iodine.…”

“…While some studies have revealed adequate iodine status under this dose [ 42 ], other authors claim it is not sufficient to meet the needs of children on PN [ 43 , 44 ]. There are pediatric reports of iodine deficiency and hypothyroidism described with iodine-free PN use [ 37 , 38 , 39 , 40 , 45 ], highlighting the importance of iodine substitution given its impact on neurodevelopment. Other authors have reported the absence of iodine deficiency despite absence of supplementation [ 42 ], likely secondary to adventitious iodine sources.…”

Survey of Nutrition Management Practices in Centers for Pediatric Intestinal Rehabilitation

“…Although infrequently mentioned by survey respondents, the monitoring of iodine status in pediatric IF patients has garnered much attention in the literature since the submission of survey results, particularly in light of numerous studies demonstrating the potential increased risk of iodine deficiency in pediatric patients requiring long‐term PN supplementation. Two case studies and 1 retrospective cohort analysis revealed varied use of iodine biomarkers (thyroid‐stimulating hormone, T4, serum vs urine iodine) and varied frequency of monitoring in investigating iodine deficiency in their chronic PN pediatric patients. The high variability in laboratory test selection and monitoring frequency may be reflective of a lack of national guidelines.…”

“…Two case studies and 1 retrospective cohort analysis revealed varied use of iodine biomarkers (thyroid-stimulating hormone, T4, serum vs urine iodine) and varied frequency of monitoring [59][60][61] in investigating iodine deficiency in their chronic PN pediatric patients. The high variability in laboratory test selection and monitoring frequency may be reflective of a lack of national guidelines.…”

Iodine Deficiency in Parenteral Nutrition

“…We have read the case report entitled “Iodine Deficiency in a Parenteral Nutrition–Dependent Adolescent With Intestinal Pseudo‐Obstruction” by Mortenson et al 1 We appreciate the timeliness of this case report as we recently encountered a similar case.…”