Adverse metabolic consequences of total parenteral nutrition

Recently described metabolic complications of total parenteral nutrition (TPN) are discussed. Included are descriptions of disorders affecting the hepatobiliary system and the musculoskeletal system. The effects of TPN on the hepatobiliary system include cholestatic hepatitis and cholelithiasis; the complications affecting the musculoskeletal system include acute polymyopathy and low-turnover, osteomalacic bone disease. With the exception of the acute polymyopathy, which is probably due to essential fatty acid deficiency, the other systemic disorders may have multiple etiologies. Also summarized are the relatively recent findings of iatrogenic micronutrient deficiencies, including chromium, selenium, and molybdenum. These trace element deficiencies appear to have multisystem manifestations. Recommendations for management are discussed.