Acid–base disturbance during home parenteral nutrition – An observational cohort study

Abstract

Summary Background & aims Intestinal failure is associated with loss of homeostatic mechanisms which can lead to metabolic instability which may be compounded by treatments such as parenteral nutrition. We report our experience of those patients on established Home Parenteral Nutrition who developed acute or chronic hyperchloraemic metabolic acidosis and acute hypochloraemic alkalosis, both hitherto poorly recognised problems. Methods A retrospective observational single centre study of 39 consecutive patients under our care from 1989 to 2006 on home parenteral nutrition. Results In our cohort of 39 patients with intestinal failure, there were 11 episodes of acid–base disturbance in 10 (25.6%) patients. In 5 of these episodes the presentation was severe and associated with raised serum creatinine. The remaining 6 episodes followed a sub-clinical chronic course of acid–base abnormality detected on routine screening but only 1 of these had a raised serum creatinine. Proton pump inhibitors (PPI) were also considered a likely cause of some episodes of acidosis. Ileal conduit was present in 2 cases. None had d -lactic acidosis. Conclusions Acid–base disturbance is an underreported complication of Home Parenteral Nutrition, occurring in around one quarter of our series but without evidence of d -lactic acidosis. This may be a severe complication of parenteral nutrition in patients with intestinal failure, particularly in patients with renal impairment, PPI treatment or ileal conduit. Chloride and bicarbonate should be monitored during home parenteral nutrition.