Sacks G S, Brown R O, Collier P, Kudsk K A
Department of Clinical Pharmacy, University of Tennessee, Memphis.
JPEN J Parenter Enteral Nutr. 1994 May-Jun;18(3):274-7. doi: 10.1177/0148607194018003274.
This case report describes the failure of topical vegetable oils containing esters of linoleic acid to prevent essential fatty acid deficiency in a critically ill patient with trauma. A 40-year-old black man injured in a motor vehicle accident developed essential fatty acid deficiency after being maintained on long-term, fat-free parenteral nutrition plus topical vegetable oil application because of the presence of severe hypertriglyceridemia. Biochemical evidence of this deficiency included a decrease in serum linoleic, a-linolenic, and arachidonic acid levels with a corresponding increase in oleic and palmitoleic acid levels. Cutaneous manifestations consistent with this syndrome were also present. After 3 weeks of daily topical treatments with vegetable oils rich in linoleic acid, biochemical abnormalities of deficiency were still evident. Over the following 2 1/2 months, 4% to 22% of the total caloric intake was delivered as intravenous fat in addition to continued topical administration of vegetable oil. Only after supplementation with intravenous fat did the patient demonstrate clinical and biochemical signs of improvement. The results show that cutaneous administration of vegetable oils as the sole source of linoleic acid may be unable to prevent or treat essential fatty acid deficiency in a critically ill surgical patient.
本病例报告描述了含亚油酸酯的外用植物油未能预防一名重症创伤患者发生必需脂肪酸缺乏症的情况。一名40岁黑人男性在机动车事故中受伤，因存在严重高甘油三酯血症，在接受长期无脂肠外营养加外用植物油治疗后发生了必需脂肪酸缺乏症。这种缺乏症的生化证据包括血清亚油酸、α-亚麻酸和花生四烯酸水平降低，同时油酸和棕榈油酸水平相应升高。还出现了与该综合征相符的皮肤表现。在用富含亚油酸的植物油进行每日外用治疗3周后，缺乏症的生化异常仍然明显。在接下来的2个半月里，除了继续外用植物油外，总热量摄入的4%至22%通过静脉输注脂肪提供。仅在补充静脉脂肪后，患者才表现出临床和生化改善迹象。结果表明，将植物油作为亚油酸的唯一来源进行皮肤给药可能无法预防或治疗重症外科患者的必需脂肪酸缺乏症。
