Persistent Rash in a Patient Receiving Total Parenteral Nutrition

Fowler, Vance G.

doi:10.1001/jama.2016.4154

Cited by 3 publications

(3 citation statements)

References 10 publications

(24 reference statements)

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“…In these patients, it took between 4 and 34 weeks from the initiation of zinc‐deficient parenteral nutrition to arrive at the diagnosis of a zinc deficiency disorder. A separate report also details an adult oncologic patient who received zinc‐deficient parenteral nutrition for 1 year and developed acquired AE …”

Section: Discussionmentioning

confidence: 99%

Acquired acrodermatitis enteropathica due to zinc‐depleted parenteral nutrition

Wiznia

Bhansali

Brinster

et al. 2019

Pediatric Dermatology

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Well-known causes of zinc deficiency, also referred to as acrodermatitis enteropathica (AE), include defects in intestinal zinc transporters and inadequate intake, but a rare cause of acquired zinc deficiency discussed here is an iatrogenic nutritional deficiency caused by parenteral nutrition administered without trace elements. While zinc-depleted parenteral nutrition causing dermatosis of acquired zinc deficiency was first reported in the 1990s, it is now again relevant due to a national vitamin and trace element shortage. A high index of suspicion may be necessary to diagnose zinc deficiency, particularly because early clinical findings are nonspecific. We present this case of acquired zinc deficiency in a patient admitted to a pediatric intensive care unit for respiratory distress and atypical pneumonia, who subsequently developed a severe bullous eruption due to iatrogenic zinc deficiency but was treated effectively with enteral and parenteral zinc supplementation, allowing for rapid re-epithelialization of previously denuded skin. K E Y W O R D S acrodermatitis enteropathica, bullous, trace element shortage, zinc deficiency How to cite this article: Wiznia LE, Bhansali S, Brinster N, Al-Qaqaa YM, Orlow SJ, Oza V. Acquired acrodermatitis enteropathica due to zinc-depleted parenteral nutrition. Pediatr

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Section: Discussionmentioning

confidence: 99%

Acquired acrodermatitis enteropathica due to zinc‐depleted parenteral nutrition

Wiznia

Bhansali

Brinster

et al. 2019

Pediatric Dermatology

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“…A fourth infant in Houston with zinc deficiency died of liver failure and sepsis. An adult patient presenting with a desquamating rash combined with alopecia was diagnosed with acquired acrodermatitis enteropathica caused by zinc deficiency after receiving PN without trace elements for a year 45 . Copper deficiency associated with symptomatic anemia and leukopenia developed in an adult with intestinal dysmotility after receiving PN without copper for a 4‐month period 46 …”

Section: Harm Associated With Pn Shortagesmentioning

confidence: 99%

“…An adult patient presenting with a desquamating rash combined with alopecia was diagnosed with acquired acrodermatitis enteropathica caused by zinc deficiency after receiving PN without trace elements for a year. 45 Copper deficiency associated with symptomatic anemia and leukopenia developed in an adult with intestinal dysmotility after receiving PN without copper for a 4-month period. 46 All cited case reports were noted to be associated with national product shortages of multi-trace element preparations.…”

Section: Trace Elementsmentioning

confidence: 99%

Managing nutrition support product shortages: What have we learned?

2022

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Product shortages related to the components of parenteral nutrition (PN) therapy have been well described over the past decade. The situation has more recently worsened and expanded globally because of the impact the COVID-19 pandemic has placed on supply chain issues and workforce demand. The impact of enteral nutrition (EN) product shortages is less well documented when compared with PN, and development of management strategies is often left up to the discretion of individual providers. The recent crisis in infant formula supply has heightened the national awareness of how a nutrition support product shortage can significantly impact patient safety. This review provides a historical perspective of PN and EN product shortages to gain insight into the lessons learned and applies this to strategies for managing current and future product shortages. Strategies for managing PN and EN shortages can best succeed if they are tailored to address aspects that are unique to the inpatient and outpatient care setting. In addition, patients who transition between care settings are vulnerable to harm related to product shortages if measures are not in place to communicate and address these shortages. Teamwork and communication within an organization and among key stakeholders are necessary to develop processes that aim to minimize patient harm related to product shortages.

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