Total parenteral nutrition associated crystalline precipitates resulting in pulmonary artery occlusions and alveolar granulomas

Terry McNearney, Christopher Bajaj, Michael Boyars, John Cottingham, Abida Haque

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

This case report describes total parenteral nutrition (TPN) -associated crystalline precipitates occluding the pulmonary artery branches in a Crohn's disease patient who survived. These precipitates caused focal vascular disruptions and alveolar granulomas. High-resolution CT (HRCT) scan demonstrated a diffuse ground-glass appearance. Pulmonary function tests showed severe ventilatory defects, arterial hypoxemia, and decreased oxygen saturations. Energy dispersive x-ray analysis (EDAX) of the patient's lung biopsy and expectorant demonstrated similar patterns, supporting crystal migration into the alveoli. Treatment included broad-spectrum antibiotics, anticoagulation, corticosteroids, and daily pulmonary toilet. The patient required continuous supplemental oxygen for two months and then was able to use it intermittently. This patient survived widespread pulmonary vascular occlusions secondary to precipitation and crystallization of TPN solution, with moderately severe residual deficits in exercise tolerance and chest x-ray abnormalities. This case underscores the importance of surveillance and recognition and of TPN-associated complications by health care workers.

Original languageEnglish (US)
Pages (from-to)1352-1354
Number of pages3
JournalDigestive Diseases and Sciences
Volume48
Issue number7
DOIs
StatePublished - Jul 1 2003

Fingerprint

Total Parenteral Nutrition
Granuloma
Pulmonary Artery
Lung
Blood Vessels
Parenteral Nutrition Solutions
X-Rays
Oxygen
Expectorants
Exercise Tolerance
Respiratory Function Tests
Crystallization
Crohn Disease
Glass
Adrenal Cortex Hormones
Thorax
Anti-Bacterial Agents
Delivery of Health Care
Biopsy
Therapeutics

Keywords

  • Alveolar granulomas
  • Crystalline precipitates
  • Parenteral nutrition
  • Pulmonary artery occlusion

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Total parenteral nutrition associated crystalline precipitates resulting in pulmonary artery occlusions and alveolar granulomas. / McNearney, Terry; Bajaj, Christopher; Boyars, Michael; Cottingham, John; Haque, Abida.

In: Digestive Diseases and Sciences, Vol. 48, No. 7, 01.07.2003, p. 1352-1354.

Research output: Contribution to journalArticle

McNearney, Terry ; Bajaj, Christopher ; Boyars, Michael ; Cottingham, John ; Haque, Abida. / Total parenteral nutrition associated crystalline precipitates resulting in pulmonary artery occlusions and alveolar granulomas. In: Digestive Diseases and Sciences. 2003 ; Vol. 48, No. 7. pp. 1352-1354.
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