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Intestinal Failure - Science topic

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I would be interested to hear if anybody has experience in choline supplementation in long-term PN patients (ideally neonates/paediatrics):
- How do you diagnose deficiency or decide who needs supplementation?
- Do you supplement in PN or enterally?
- What products do you you use?
- What doses do you give?
Many thanks in advance.
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Hi Moriam, Not sure of the clinical scenario you are dealing with here but if the neonate or child has normal liver function then they should be able to synthesise choline themselves. The assumption here is that they are getting adequate supplies of the sulphur containing amino acids and they are B12 sufficient. All three compounds are easily determined in a blood sample at a good clinical biochemistry lab. Choline can be determined in blood but is not usually regarded as an adequate indicator of metabolic sufficiency. Take a look at these two pages ... Choline metabolism and its dependence of other nutrients : https://www.sciencedirect.com/sdfe/pdf/download/eid/3-s2.0-B012227055X002297/first-page-pdf ,
As a rule of thumb we avoided making supplements without first having some clinical evidence. Agreed you don't want to wait until there are 'indisputable' symptoms but there does need to be some good circumstantial evidence. Then you will have to talk the whole thing through with your pharmacists because additions can compromise TPN soln stabilities especially if you are using a three in one bag approach (amino acids + lipids + glucose) Hope this helps. Happy to hear more from you TomH (my email address is medlabstats@iinet.net.au)
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I work in an intestinal failure unit and perform approximately 40 ECF repairs per annum. I find it hard to believe that these plugs would work in any of our patients. NICE have recently published guidelines. The surgery is complex but with good success rates. Also what about the abdominal wall? We normally have to reconstruct this with Ramirez type techniques and biological mesh etc. A plug would obviously leave this unattended. Which type of fistulas would be suitable? The evidence seems extremely poor to say the least.
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collagene plugs can be used but the success rate is low. As it's without rusk why not trying to avoid a new intervention. To be successfull collagene plug neds to be inserted on a clean fistula ( no collected infection) so use irrigation before.