The patient, a 55-year-old man without known allergies diagnosed with gastric adenocarcinoma, was admitted in November 2001 to the Digestive Service of Son Dureta Hospital where a subtotal gastrectomy and reconstruction of the gastrojero II were performed.
Five days after surgery the patient's clinical condition requires the prescription of artificial nutrition, starting central administration of TPN.
The preparation administered is Kabimix® (see detailed composition in Table I), a diet of 2,553 kilocalories supplemented in the A Care Service with alternating days with a multivitamin preparation® (vitPMV).
48 hours after parenteral nutrition was established, it was decided to change the type of diet, in order to administer a formula more adjusted to the nutritional requirements of the patient so that the patient receives the Kabiven® oligoelements.
Twenty-four hours after the start of infusion of this diet, the patient presents a significant disseminated pruritic skin rash requiring oral dexchlorpheniramine administration.
Mechanical complications cause loss of central venous access due to the removal of TPN and oral tolerance starts.
On the eighth day after surgery the patient complained of severe abdominal pain requiring an exploratory laparotomy which detected an abscess with biliary collection.
TPN is restarted by administering the Kabiven® diet supplemented with the aforementioned PMV.
A few hours after the start of infusion, a new episode of disseminated pruritic skin rash occurs, leading to permanent discontinuation of TPN.
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In March 2003, the patient came to the emergency department of that hospital for fever and abdominal pain, being diagnosed with cholangitis and admitted to the Digestive Service.
Together with antibiotic and analgesic treatment, an absolute diet is indicated and, due to a history of hypersensitivity, the prescription of PNT is avoided, with erythema or amino acid and glucose solution (Aminoven®, Table III), without mentioning
After 48 hours, lipid emulsion was added (Intralipid® 10%, Table III) by the central route without any complications.
On this occasion, it was decided not to administer PMV or trace elements to the patient.
After several days of admission, progression of the gastric neoformative process was observed and the patient died in April 2003.
