A Case of Abnormal Liver Function Tests in a Patient Receiving Total Parenteral Nutrition

Hepatic dysfunction is prevalent in patients receiving total parenteral nutrition (TPN), resulting from steatosis, cholestasis, and cholecystitis. Regular assessments and monitoring of TPN patients are essential, even for clinically stable patients on long-term TPN. Furthermore, it is crucial to establish a differential diagnosis for hepatic dysfunction and investigate for other possible causes of elevated liver enzymes and underlying liver conditions. We present the case of a 56-year-old female patient with severe protein-calorie malnutrition on TPN, who exhibited significantly elevated liver enzymes during the routine periodic assessment. Subsequent investigation revealed that the patient had been taking traditional Chinese herbal medications concurrently with TPN. After discontinuing the herbal medications, the patient's liver enzymes returned to normal levels within 3 weeks.

Automated summary

Hepatic dysfunction is common in TPN patients and can be caused by steatosis, cholestasis, and cholecystitis. Regular assessments are necessary, even for stable patients on long-term TPN. It is important to establish a differential diagnosis and investigate other potential causes of elevated liver enzymes. We present a case of a malnourished patient on TPN who had significantly elevated liver enzymes due to concurrent use of traditional Chinese herbal medications. Liver enzymes returned to normal levels after discontinuing the herbal medications.