Final answer:
An elevated serum conjugated bilirubin level in an adult with short bowel syndrome receiving home parenteral nutrition may lead to the evaluation for dextrose and fat emulsion overfeeding, increasing lipid calories, and the addition of carnitine and choline to support liver function.
Step-by-step explanation:
When an adult patient with short bowel syndrome exhibits an elevated serum conjugated bilirubin level, there are various clinical interventions that a clinician may consider. Conjugated bilirubin is the form that has been processed by the liver and is normally excreted in bile. However, if the bowel is not functioning properly, as in short bowel syndrome, bilirubin clearance might become compromised .The clinical plan may include several steps such as evaluation for possible overfeeding of dextrose and/or intravenous fat emulsion since overfeeding can lead to liver dysfunction and increased bilirubin levels. An alternative would be to increase lipid calories to prevent essential fatty acid deficiency; this benefits the patient's nutritional status without additional strain on the liver. Some clinicians may add substances like carnitine and choline to the home parenteral nutrition (HPN) solution to support liver function and prevent fat accumulation in the liver. Removal of all trace elements from HPN may not be directly related to bilirubin levels but may be considered in specific cases where trace elements could contribute to liver dysfunction.