Essential Fatty Acid Deficiency in Surgical Patients

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Abstract
Parenteral nutrition may protect patients unable to eat from malnutrition almost indefinitely. If fat is not also given EFAD [essential fatty acid deficiency] will occur. The developmental course of EFAD and the response to therapy was studied in 28 patients on total i.v. fat free nutrition. Twenty-eight patients ranging from newborn to 66 yr receiving parenteral nutrition without fat had regular determinations of the composition of total plasma fatty acids and the triene/tetraene ratio using GLC. Physical signs of EFAD were looked for also. Patients having evidence of EFAD were treated with 10% Intralipid. Topical safflower oil was used in 3 infants. Total plasma fatty acid composition was restudied following therapy. Infants on fat-free i.v. nutrition developed biochemical EFAD within 2 wk, but dermatitis took longer to become evident. Older individuals took over 4 wk to develop a diagnostic triene/tetraene ratio (> 0.4; range 0.4-3.75). Therapeutic correction of biochemical EFAD took 7-10 days but dermatitis took longer to correct. Cutaneous application of safflower oil alleviated the cutaneous manifestations but did not correct the triene/tetraene ratio of total plasma fatty acids. Surgical patients who are unable to eat for 2-4 wk, depending upon age and expected fat stores, should receive fat as a part of their i.v. regimen.