Essential fatty acid deficiency in total parenteral nutrition: time course of development and suggestions for therapy

Thirty-two patients receiving total intravenous nutrition were studied prospectively for biochemical and clinical signs of essential fatty acid deficiency. Individual constituents of the phospholipid fraction were examined consecutively and the triene:tetraene ratio was determined. All patients nourished parenterally for 4 weeks had triene:tetraene ratios of greater than 0.4. Levels of eicosatrienoic and linoleic acid were abnormal after 1 week, and arachidonic acid levels became abnormal after 2 weeks of fat-free parenteral nutrition. Skin lesions suggestive of essential fatty acid deficiency developed in two patients studied. Biochemical abnormalities responded rapidly to the intravenous administration of Intralipid.