Total parenteral nutrition-induced cholestasis

Total parenteral nutrition (TPN) is fluid given through the vein to give nutrition to children who cannot eat by mouth or with a feeding tube. If TPN is needed for a long time it can sometimes cause liver damage (cholestasis). We do not fully know why this happens in some children.

What are the symptoms of total parenteral nutrition-induced cholestasis?

Many signs and symptoms of TPN-induced cholestasis can be seen in other causes of liver inflammation. These include yellow eyes, yellow skin (jaundice), dark urine, itching (pruritis), fatigue, abdominal pain, and poor appetite. Some people have no symptoms at all and just have abnormal liver tests. Some children get infections in the blood from the IV they need for the TPN. This usually shows as a fever. This needs admission to the hospital for antibiotics.

How is total parenteral nutrition-induced cholestasis diagnosed in children?

TPN-induced cholestasis shows high liver enzymes and bilirubin. An ultrasound will sometimes show a large liver or spleen. Sometimes a liver biopsy  |  En Español (a sample of liver taken with a needle) is needed to confirm a diagnosis and to rule out other causes of liver disease.

What is the treatment for total parenteral nutrition-induced cholestasis?

To protect the liver from damage, the doctor will try to control the sugar and fat given in the TPN. The doctor will also try to decrease the amount of TPN your child gets and stop the TPN entirely if possible.

What is the long-term outlook of total parenteral nutrition-induced cholestasis?

TPN-induced cholestasis sometimes can worsen quickly, and children can develop scarring of the liver (cirrhosis). Some of these people will go on to need a liver transplant because the liver stops working properly.