HYPERSENSITIVITY REACTIONS ASSOCIATED WITH PARENTERAL-NUTRITION - CASE-REPORT AND REVIEW OF THE LITERATURE

OBJECTIVE: To report a case of a hypersensitivity reaction to total parenteral nutrition (TPN) and to review the available literature on this rare adverse effect. CASE SUMMARY: The reaction occurred in a 52-year-old woman with pancreatic carcinoma who received intravenous metronidazole, tobramycin, vancomycin, ranitidine, morphine, TPN, and lipid emulsion postoperatively. Within 30 minutes of starting the TPN and lipid emulsion, the patient complained of dyspnea and pruritus. She began hyperventilating and was hypoxic. The reaction resolved after discontinuation of the TPN and lipid emulsion. The reaction recurred when lipid-free TPN was initiated on two subsequent occasions, and resolved spontaneously following the discontinuation of the lipid-free TPN. The antibiotics, ranitidine, and morphine therapy were continued with no further adverse effects and the patient was discharged on postoperative day 17. DISCUSSION: Case reports in the literature on TPN-related hypersensitivity reactions were reviewed. It was speculated that the multivitamin preparation (MVI) may have been the causative agent in our patient; however, this was not confirmed by MVI-free TPN administration or by epicutaneous allergy testing. CONCLUSIONS: Hypersensitivity reactions to TPN can be managed by withholding the TPN and treating with antihistamines if needed until the reaction resolves. Identification, possibly by epicutaneous allergy testing, and removal of the offending agent(s) from the TPN is necessary if TPN therapy must be restarted.