Chapter 25 - Liver Disease and Parenteral Fish Oil

Abstract

Parenteral nutrition (PN) is a lifesaving therapy for patients with intestinal failure. There are, however, risks associated with PN, including infections from the central venous catheter (CVC) through which PN is delivered, metabolic derangements, and organ dysfunction. Parenteral nutrition-associated liver disease (PNALD) is a complication of PN characterized by cholestasis and hepatic inflammation that can progress to fibrosis and end-stage liver disease if not identified and managed. Soybean oil lipid emulsions (SOLE) as fat sources in PN can exacerbate the development of PNALD while fish oil lipid emulsions (FOLE) can reverse PNALD. FOLE-based strategies to treat PNALD include FOLE monotherapy, combining FOLE and SOLE, and use of new generation combination emulsions containing fish oil and other oils. Research efforts have focused on understanding the pathophysiology of PNALD, the role of SOLE in its pathogenesis, and the mechanisms by which FOLE reverses PNALD.