Grand Rounds

Neonatal Cholestasis

Medical Sciences Department, Pediatric Oncall, Mumbai, India

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056

Clinical Problem :
An 8 months old boy born of non consanguineous marriage presented with jaundice, yellow urine and clay stools since day 6 of life. On examination, he had rickets, weight was 6.2 kg, He had jaundice with hepatosplenomegaly. His liver biopsy was suggestive of biliary atresia.

How to take care of his nutrition and deficiency of fat soluble vitamins_?

Discussion :
Since Vitamins A, D, E and K are fat soluble vitamins and require bile for absorption, in case of biliary atresia, due to cholestasis, bile is not secreted into the intestines and thus there is malabsorption of fat soluble vitamins. Thus, these vitamin deficiencies can occur. Supplementation of these vitamins in 10 times recommended daily allowance is thus needed. Water soluble forms of these vitamins should be administered orally so that absorption in absence of bile is not hampered. Regarding nutrition, since bile excretion is poor, even fats are not absorbed. Only Medium Chain Triglycerides {MCT} are absorbed. Thus supplements with MCT oil is required. Adequate calorie and protein intake should be taken care of so that nutrition requirements are met.

Correct Answers :  yes 40%
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