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Failure of Topical Vegetable Oils to Prevent Essential Fatty Acid Deficiency in a Critically III Patient Receiving Long‐term Parenteral Nutrition
Author(s) -
Sacks Gordon S.,
Brown Rex O.,
Collier Paige,
Kudsk Kenneth A.
Publication year - 1994
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607194018003274
Subject(s) - parenteral nutrition , medicine , linoleic acid , hypertriglyceridemia , enteral administration , oleic acid , essential fatty acid , fatty acid , linolenic acid , surgery , triglyceride , biochemistry , chemistry , cholesterol
This case report describes the failure of topical vegetable oils containing esters of linoleic acid to prevent essential fatty acid deficiency in a critically ill patient with trauma. A 40‐year‐old black man injured in a motor vehicle accident developed essential fatty acid deficiency after being maintained on long‐term, fat‐free parenteral nutrition plus topical vegetable oil application because of the presence of severe hypertriglyceridemia. Biochemical evidence of this deficiency included a decrease in serum linoleic, a‐linolenic, and arachidonic acid levels with a corresponding increase in oleic and palmitoleic acid levels. Cutaneous manifestations consistent with this syndrome were also present. After 3 weeks of daily topical treatments with vegetable oils rich in linoleic acid, biochemical abnormalities of deficiency were still evident. Over the following 2 1/2 months, 4% to 22% of the total caloric intake was delivered as intravenous fat in addition to continued topical administration of vegetable oil. Only after supplementation with intravenous fat did the patient demonstrate clinical and biochemical signs of improvement. The results show that cutaneous administration of vegetable oils as the sole source of linoleic acid may be unable to prevent or treat essential fatty acid deficiency in a critically ill surgical patient. ( Journal of Parenteral and Enteral Nutrition 18: 274–277, 1994)