{
  "abstract": "Introduction Patients on Home Parenteral Nutrition (HPN) are routinely monitored for several micronutrient and vitamin deficiencies. 1 However, there are no established guidelines regarding the screening or management of plasma vitamin C levels in paediatric HPN patients.Aims Assess the vitamin C status in paediatric patients on HPN, describe the clinical features associated with deficiency and review the treatment provided.Methods Retrospective data collection from electronic records for paediatric HPN patients (<17 years) assessing the vitamin C levels on a single tertiary IF unit. Most blood samples were collected in clinic by 2 PN nurses, light protected and hand delivered to the laboratory within 20 minutes.Results Thirteen paediatric HPN patients (8 females, median age 7.4 years [IQR 5–13]) were assessed after a median of 2.9 years on PN [IQR 2.5–5.7]. Underlying diagnoses included dysmotility 8/13 (62%), short bowel syndrome (SBS) 3/13 (23%), and enteropathy 2/13 (15%). Vitamin C levels were normal (>26µmol/l) in 6/13 (46%) patients, low (10-26µmol/l) in 4/13 (31%) and very low (<10µmol/l) in 3/13 (23%).Patients received PN a median of 7 nights/week (range 5–7) for 16 hours/night (range 12–24), with a median EAR% of 83% [IQR 75–105]. Five patients received enteral nutrition (two Neocate, three standard diet), while eight were nil enterally. Although not statistically significant, all patients with very low vitamin C levels had dysmotility, all with SBS had low levels, and all with enteropathy had normal levels. Patients with low levels were asymptomatic, while among those with very low levels, one presented with scurvy and one with lower limb pain. All patients with very low levels received 24-hour PN vs. a median of 16 PN hours [IQR 12-20] (p=0.019). The median PN duration was significantly longer in patients with abnormal vitamin C levels compared with those with normal levels (69 vs. 27 months, p=0.003). No associations were observed between vitamin C levels and CRP, EAR%, or enteral feeding. Vitamin C deficiency was corrected with Pabrinex® infusions and doubling of ascorbic acid in PN to 200 mg for the ones with very low levels or by only doubling the dose in the ones with low levels leading to symptom resolution and normalization of levels.Conclusions Paediatric HPN patients are susceptible to vitamin C deficiency, emphasizing the need for monitoring. Sample instability requires full consideration. Prolonged PN and long-term administration further increases deficiency risk, potentially due to temperature-related degradation.References Bronsky J, Campoy C, Braegger C; ESPGHAN/ESPEN/ESPR/CSPEN working group on pediatric parenteral nutrition. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: vitamins. Clin Nutr. 2018 Dec;37(6 Pt B):2366–2378. doi: 10.1016/j.clnu.2018.06.951. Epub 2018 Jun 18. PMID: 30100105.Gorman SR, et al. Journal of Pediatric Gastroenterology and Nutrition 2002;35:93–95.",
  "authors": [
    {
      "affiliations": [
        "Leeds General Infirmary"
      ],
      "name": "Shilpa Dugar"
    }
  ],
  "title": "OC55 Vitamin C levels in home parenteral nutrition patients - the need for monitoring",
  "uid": "2aad9518-d88a-5fbb-a400-f037d32f3f31"
}