Acute folate deficiency in surgical patients on aminoacid/ethanol intravenous nutrition

Acute folate deficiency with pancytopenia and megaloblastic haemopoiesis developed in four patients after abdominal operations; all four responded to folic acid over 3-9 days. Three of them had been given intravenous nutrition with amino-acid/ethanol before the blood changes developed. A prospective study of twenty-five surgical patients with gastrointestinal diseases revealed a high frequency of acutely developing negative folate balance. Megaloblastic haemopoiesis and consequent blood changes were found in five patients. Treatment with intravenous nutrition correlated strongly with a fall in serum-folate and megaloblastic haemopoiesis. Some surgical patients develop acute folate deficiency which may proceed to megaloblastic arrest of haemopoiesis. Patients receiving intravenous nutrition containing ethanol are especially prone to this complication, which may be life-threatening if untreated. It is not yet known whether other forms of intravenous nutrition carry a similar risk.