Toxicities Associated with Parenteral Nutrition

Parenteral nutrition is a life-sustaining therapy for patients with structural or functional intestinal diseases who are unable to tolerate sufficient enteral intake or absorb sufficient calories to support energy requirements. Despite its unquestionable value under these circumstances, prolonged dependence on parenteral nutrition is fraught with potentially life-threatening complications related to the presence of unintended chemical and microbial contaminants of parenteral nutrition solutions, and insufficient knowledge of the optimal dosing of various parenteral nutrition additives thought to be essential to human nutrition. Infants and children with congenital or acquired gastrointestinal tract diseases who are dependent on parenteral nutrition to supply essential nutrients and calories for growth and development are particularly vulnerable. This chapter will review the potential toxicities associated with both unintended contaminants in parenteral nutrition, including microbes, phthalates, bisphenol-A, particulates, lipid peroxidation products and aluminium, as well as intentional supplementation with potentially toxic substances, including trace metals, amino-acid mixtures and lipid emulsions, when provided in excessive amounts or suboptimal ratios, or when normal metabolism or excretion are altered by an underlying medical condition. Practical applications and areas in need of further laboratory and human research are highlighted. Keywords: parenteral nutrition; microbial contamination; precipitates; phthalates; bisphenol-A; aluminium; essential trace-metal toxicity; amino acids; lipid emulsions; neonate; infant