The last two decades have seen an increased drive to administer parenteral nutrition (PN) to patients in their home environments, thereby reducing associated hospital costs and improving patient quality of life. The occurrence of deranged nutritional biochemistry results has baffled PN experts for years because PN additives are marketed for the general needs of patients and PN is tailored to each patient’s requirements (both formulation and regimen). This thesis documents the investigations into HPN population characteristics, the extent of nutritional abnormalities (deficiencies and excesses) in a cohort of LT PN patients in Wales. Both cross-sectional and longitudinal retrospective study designs were employed alongside small-scale laboratory efforts to investigate stability of vitamin D in PN additives using High Performance Liquid Chromatography (HPLC). Characteristics of the HPN population in Wales were shown to be variable in terms of PN requirements for a predominantly female sample population (2:1); in whom 78.6% of patients received PN for indications relating to short bowel syndrome (SBS). A database analysis of micronutrient test results revealed a high prevalence of deficiencies of vitamin D and selenium, as well as excesses of manganese and water-soluble vitamins; which can lead to clinically relevant effects in patients. The sample population was shown to have impaired bone health since first receiving PN; respective sites of the femoral neck and total hip presented 58% and 60.8% of patients had osteopenia, while 28% and 19.6% had osteoporosis. Evidence in the literature links these clinical outcomes of metabolic bone disease (MBD) to patients’ inadequate vitamin D status. A final study exploring the adequacy of the trace element (TE) preparation Additrace®, found it lacking in selenium and excessive in manganese for the general requirements of the PN population. Clinician-directed supplementation of PN outside of Additrace® was associated with better micronutrient status in patients and more test results within range.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:742880 |
| Date | January 2018 |
| Creators | Dodington, Sean Rhys |
| Publisher | Cardiff University |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://orca.cf.ac.uk/111542/ |
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