Reducing Metabolic Bone Disease Burden in Intestinal Failure Children on Home Parenteral Nutrition

Author:

Tridimas Andreas12,Padidela Raja34,Bassett John1,Wood Rachel5,Lawson Maureen6,Fagbemi Andrew6,Morris Timothy J.17

Affiliation:

1. Directorate of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester, UK

2. Clinical Biochemistry Department, Countess of Chester Hospital, Chester, UK

3. Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, UK

4. Faculty of Biology Medicine and Health, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK

5. Department of Therapy and Dietetics, Royal Manchester Children’s Hospital, Manchester, UK

6. Department of Paediatric Gastroenterology, Royal Manchester Children’s Hospital, Manchester, UK

7. Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.

Abstract

Objective: To determine the prevalence of secondary hyperparathyroidism in a cohort of pediatric patients receiving home parenteral nutrition. Methods: For a service review, a population-based cohort of 37 pediatric intestinal failure patients receiving long-term parenteral nutrition that underwent serial biochemical monitoring during a study period of approximately 4 years were examined. Following the production of an algorithm, a follow-up audit was carried out (n = 33) after approximately 6 months. Results: Of the 37 patients examined in the initial service review, 22 (59%) were found to have an elevated parathyroid hormone (PTH) during the period of monitoring and 5 (14%) had a persistently elevated PTH. In the follow-up audit following the implementation of an algorithm, the number with elevated PTH reduced to 6 (18%) and no patients had persistently high levels. Conclusion: Elevated PTH is a common biochemical finding in pediatric intestinal failure patients receiving home parenteral nutrition and its presence should alert clinicians to the need to optimize nutritional parameters such as calcium to phosphate molar ratio and vitamin D status; failure to do so may increase the future burden of metabolic bone disease in such patients. We propose that an algorithm may help in this endeavor.

Publisher

Wiley

Subject

General Earth and Planetary Sciences,General Environmental Science

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