Question

An NPO post-operative patient has been on 2-in-1 parenteral nutrition (PN) for three weeks. He develops a diffuse scaly dermatitis, hair loss, anemia and thrombocytopenia. Which of the following is the probable cause?

1: He has not been receiving IV fat emulsion (IVFE) for three weeks.
2: He has been receiving trace elements 3 times per week due to a national shortage.
3: He is receiving 20 kcal/kg per day from PN because of hyperglycemia.
4: He has PN related cholestasis and is experiencing fat malabsorption.

Answer 1

The patient's symptoms are likely due to not receiving IV fat emulsion (IVFE) for three weeks, leading to essential fatty acid deficiency, which can cause scaly dermatitis, hair loss, and further contribute to anemia and thrombocytopenia.

Step-by-step explanation:

The probable cause for the patient's diffuse scaly dermatitis, hair loss, anemia, and thrombocytopenia is that he has not been receiving IV fat emulsion (IVFE) for three weeks. This clinical presentation is consistent with essential fatty acid deficiency, which can occur when patients are on parenteral nutrition without the inclusion of IV fat emulsion. Essential fatty acids are necessary for maintaining skin health, and their deficiency can lead to dermatitis and hair loss. The anemia and thrombocytopenia can also be manifestations of malnutrition, which may include deficiencies in vitamin E and B12, both implicated in hematological abnormalities.

Given that this patient has been on 2-in-1 parenteral nutrition, it is likely that the regimen included dextrose and amino acids but not lipids, as would be included in a 3-in-1 parenteral nutrition solution, which can lead to inadequate intake of essential fatty acids and fat-soluble vitamins such as vitamin E.