[Parenteral nutrition-associated complications in patients with SARS-CoV-2 infection]. / Complicaciones asociadas a la nutrición parenteral en los enfermos con infección por SARS-CoV-2.

Introduction: Background: it is unknown whether patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 are at greater risk of developing complications associated with parenteral nutrition (PN). Aim: to describe the incidence, risk factors, and clinical impact of complications in patients with ARDS-COVID-19 receiving PN. Methods: a prospective cohort study of 87 patients with ARDS-COVID-19 infection. The incidence of complications and odds ratios of risk factors were analysed. Results: age ≥ 65 years (OR, 2.52, 95 % CI: 1.16 to 5.46), obesity (OR, 3.34, 95 % CI: 2.35 to 4.33) and treatment with propofol (OR, 2.45, 95 % CI: 1.55 to 3.35) or lopinavir/ritonavir (OR, 4.98, 95 % CI: 3.60 to 6.29) were risk factors for hipertriglyceridemia. Obesity (OR, 3.11, 95 % CI: 1.10 to 8.75), dyslipidemia (OR, 3.22, 95 % CI: 1.23 to 8.40) or treatment with propofol (OR, 5.47, 95 % CI: 1.97 to 15.1) were risk factors for intravascular catheter-related infection. No risk factors were described for hiperglycemia. Mortality was higher in patients with intravascular catheter-related infection (46.7 % vs 10.8 %, p = 0.014). Mortality risk was higher in older patients (OR, 2.74, 95 % CI: 1.08 to 6.95) or patients with intravascular catheter-related infection (OR, 3.22, 95 % CI: 1.23 to 8.40). Conclusions: the incidence of complications associated with PN in patients with COVID-19-related ARDS is frequent. The mortality risk is higher in older patients or those with catheter-related infection.

Introducción: Introducción: se desconoce si los pacientes diagnosticados de infección respiratoria aguda por SARS-CoV-2 (COVID-19) presentan más riesgo de complicaciones asociadas a la nutrición parenteral (NP). Objetivo: conocer la incidencia, los factores de riesgo y la mortalidad de las complicaciones asociadas a la NP en esta población. Métodos: estudio de cohortes prospectivo de 87 pacientes diagnosticados de infección por SARS-CoV-2. Se analizan la tasa de incidencia de las complicaciones y las odds ratio (OR) de diferentes factores. Resultados: la edad ≥ 65 años (OR: 2,52, IC 95 %: 1,16 a 5,46), los antecedentes de obesidad (OR: 3,34, IC 95 %: 2,35 a 4,33) y el tratamiento con propofol (OR: 2,45, IC 95 %: 1,55 a 3,35) o lopinavir/ritonavir (OR: 4,98, IC 95 %: 3,60 a 6,29) se asociaron al desarrollo de hipertrigliceridemia. Los pacientes con obesidad (OR: 3,11, IC 95 %: 1,10 a 8,75) o dislipemia (OR: 3,22, IC 95 %: 1,23 a 8,40) y los tratados con propofol (OR: 5,47, IC 95 %: 1,97 a 15,1) presentaron mayor riesgo de infección asociada al catéter (IAC). No se observó ningún factor de riesgo relacionado con el desarrollo de hiperglucemia. La mortalidad fue mayor en los pacientes con IAC (46,7 % vs. 10,8 %, p = 0,014). El riesgo de mortalidad fue superior en los enfermos de ≥ 65 años (OR: 2,74, IC 95 %: 1,08 a 6,95) o con IAC (OR: 3,22, IC 95 %: 1,23 a 8,40). Conclusiones: la incidencia de complicaciones asociadas a la NP en pacientes diagnosticados de infección por SARS-CoV-2 es elevada. El riesgo de mortalidad es superior en los enfermos mayores de 65 años o con IAC.

Acute Hypertriglyceridemia in Patients with COVID-19 Receiving Parenteral Nutrition.

Hypertriglyceridemia is a metabolic complication associated with parenteral nutrition (PN). It is unknown if patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 are more at risk. Our aim was to describe the incidence, risk factors and clinical impact of hypertriglyceridemia in critically ill patients with ARDS-COVID-19 receiving PN. We designed a cohort study of patients with ARDS-COVID-19 infection that required admission to critical care units and nutritional support with PN. Individual PN prescriptions for macronutrients and insulin were provided. Lipid emulsion contained fish oil (SMOFlipid® or Lipoplus®). Hypertriglyceridemia was defined as plasma levels above 400 mg/dL. Eighty-seven patients, 66.6% men, 60.1 ± 10.8 years old, BMI 29.1 ± 5.6 kg/m2, 71% of whom received lopinavir/ritonavir, 56% received Propofol and 55% received Tocilizumab were included. The incidence of hypertriglyceridemia was 37 × 100 patient-days with PN. This complication was more frequent in obese patients (OR 3.34; 95% CI, 2.35-4.33) and in those treated with lopinavir/ritonavir (OR 4.98; 95% CI, 3.60-6.29) or Propofol (OR 2.45; 95% CI, 1.55-3.35). Total mortality was 33.3%, similar between the type of lipid emulsion (p = 0.478). On average, patients with hypertriglyceridemia had a longer requirement of PN compared to the group without elevated triglycerides (TG), probably because of their longer survival (p = 0.001). TG higher than 400 mg/dL was not a protective factor for mortality (OR 0.31; 95% CI, 0.01-1.30). In conclusion, the incidence of hypertriglyceridemia was 37 × 100 patient-days with PN. The risk of this complication is associated with obesity and the use of lopinavir/ritonavir or Propofol.

Recalcitrant hypocalcaemia in a patient with post-thyroidectomy hypoparathyroidism and Roux-en-Y gastric bypass.

INTRODUCTION: Roux-en-Y gastric bypass (RYGB) places patients at an increased risk of hypocalcaemia due to the reduction in calcium absorption (because the procedure bypasses the duodenum and jejunum) and vitamin D deficiency. Subsequent thyroid surgery increases the risk of severe hypocalcaemia due to potential post-operative hypoparathyroidism. Only a few cases have been published before of this type of treatment-challenging hypocalcaemia. CLINICAL PRESENTATION: We report the case of a 31-year-old woman with a previous RYGB, who suffered severe and symptomatic chronic hypocalcaemia after total thyroidectomy. She required aggressive therapy with oral calcium and calcitriol and frequent calcium infusions, but there was no improvement in serum calcium level. Due to the lack of response to standard therapy, teriparatide treatment was started (first with subcutaneous injections and thereafter with a multipulse subcutaneous infusor) but the results were disappointing. As there was no response to different medical treatments, reversal of RYGB was performed with no complications and a subsequent sustained increase in serum calcium level. CONCLUSIONS: This case shows that patients with postoperative hypoparathyroidism and RYGB have increased risk of severe recalcitrant symptomatic hypocalcaemia. In our case teriparatide was ineffective but, as this is the first patient reported, more results are needed to evaluate properly the effect of teriparatide in this multifactorial hypocalcaemia. Reversal of RYGB should be considered when medical therapy has failed, because surgery restores an adequate absorption of calcium and vitamin D from previously bypassed duodenum and proximal jejunum.

Xeroftalmía bilateral por déficit de vitamina A secundario a cirugía bariátrica / Bilateral xerophthalmia due to hypovitaminosis A after bariatric surgery

Es bien conocido que la cirugía bariátrica no está exenta de complicaciones, en especial las técnicas de hipoabsorción. Sin embargo, en la práctica clínica la pérdida de visión por déficit de vitamina A como complicación nutricional de este tipo de cirugía es poco habitual. Presentamos el caso de una paciente de 56 años con xeroftalmía bilateral con perforación corneal del ojo izquierdo y disminución de la agudeza visual bilateral después de ser sometida a cirugía bariátrica (derivación biliopancreática tipo Scopinaro) por obesidad mórbida. A pesar del tratamiento sustitutivo con altas dosis de vitamina A, la pérdida de visión del ojo izquierdo es prácticamente total (AU)

It is well known the bariatric surgery is not without complications, particularly malabsorptive techniques. However, loss of vision due to vitamin A deficiency as a nutritional complication of this type of surgery is rare in clinical practice. We report the case of a 56-year-old woman with bilateral xerophthalmia, left corneal perforation and reduced bilateral visual acuity following bariatric surgery (Scopinaro type biliopancreatic diversion) for morbid obesity. Despite treatment with very high doses of vitamin A supplements, the loss of vision in the left eye was practically complete (AU)