Nagata M J
Department of Pharmacy, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
Ann Pharmacother. 1993 Feb;27(2):174-7. doi: 10.1177/106002809302700207.
To report a case of hypersensitivity reaction to total parenteral nutrition (TPN) and to review the available literature on this rare adverse effect.
The reaction occurred in a 52-year-old woman with pancreatic carcinoma who received intravenous metronidazole, tobramycin, vancomycin, ranitidine, morphine, TPN, and lipid emulsion postoperatively. Within 30 minutes of starting the TPN and lipid emulsion, the patient complained of dyspnea and pruritus. She began hyperventilating and was hypoxic. The reaction resolved after discontinuation of the TPN and lipid emulsion. The reaction recurred when lipid-free TPN was initiated on two subsequent occasions, and resolved spontaneously following the discontinuation of the lipid-free TPN. The antibiotics, ranitidine, and morphine therapy were continued with no further adverse effects and the patient was discharged on postoperative day 17.
Case reports in the literature on TPN-related hypersensitivity reactions were reviewed. It was speculated that the multivitamin preparation (MVI) may have been the causative agent in our patient; however, this was not confirmed by MVI-free TPN administration or by epicutaneous allergy testing.
Hypersensitivity reactions to TPN can be managed by withholding the TPN and treating with antihistamines if needed until the reaction resolves. Identification, possibly by epicutaneous allergy testing, and removal of the offending agent(s) from the TPN is necessary if TPN therapy must be restarted.
报告一例全胃肠外营养（TPN）过敏反应病例，并回顾关于这种罕见不良反应的现有文献。
该反应发生在一名52岁的胰腺癌女性患者身上，她术后接受了静脉注射甲硝唑、妥布霉素、万古霉素、雷尼替丁、吗啡、TPN和脂肪乳剂治疗。在开始TPN和脂肪乳剂治疗后30分钟内，患者出现呼吸困难和瘙痒。她开始过度通气并出现缺氧症状。停用TPN和脂肪乳剂后反应缓解。随后两次在开始无脂肪TPN治疗时反应复发，停用无脂肪TPN后反应自行缓解。抗生素、雷尼替丁和吗啡治疗继续进行，未再出现不良反应，患者于术后第17天出院。
回顾了文献中关于TPN相关过敏反应的病例报告。推测多种维生素制剂（MVI）可能是我们这位患者过敏反应的病因；然而，停用MVI的TPN治疗或皮肤过敏试验均未证实这一点。
TPN过敏反应可通过停用TPN进行处理，必要时使用抗组胺药治疗，直至反应缓解。如果必须重新开始TPN治疗，可能需要通过皮肤过敏试验来识别并去除TPN中引起过敏的成分。
