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.
Choline is produced by the human body but the amount produced doesn't sustain growth in adults, yet with infants less than 6 months milk weather human milk or formula milk contain enough Choline to support proper growth. Further more, Choline deficiency is very rare in children. Yet if it occurs the main sign in infants would be hepatosteosis( also known as fatty liver) caused by insufficient Choline to pack V-LDL, and this condition is reversible as long as medical intervention is made before liver cirrhosis.
parenteral feeding for infants is prepared containing all macro and micro nutrients needed for infant growth support, if blood test shows normal Choline levels and no signs of deficiency are present supplement should not be given.
Choline toxicity causes body fishy smell.
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 ,
and this one is all about how to measure choline written by a clinical biochemist - https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=6&ved=2ahUKEwj3waKVj9rnAhUeIbcAHRomA1QQFjAFegQIAhAB&url=http%3A%2F%2Fwww.nzimls.org.nz%2Fuser%2Ffile%2F61%2F&usg=AOvVaw0mdDfa6aPVX5PWzD4hk-4K .
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 [email protected])
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