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Ref #673 : Priapism in a patient treated with total parenteral nutrition
Author(s):
Hebuterne X, Frere AM, Bayle J, Rampal P.
Date:
1992
Reference Type:
Journal
Periodical:
Journal of Parenteral and Enteral Nutrition
Issue:
16
Volume:
2
Page range:
171 - 174
Keywords:
Acids, Activity, Amino-acids, Blood, Case-reports, Cells, Complications, Effects, Glucose, Infusion, Leukaemia, Male genital diseases, Man, Nutrition, Parenteral-feeding, Patients, Penis, Thrombosis, Trauma.
Abstract / Notes:
Venous thrombosis is a common complication of total parenteral nutrition. A case report of priapism in a 40-year-old man after administration of total parenteral nutrition for chronic idiopathic intestinal pseudo-obstruction is presented. The patient received glucose, amino acids and 20% fat emulsion; 12 h after administration, the patient complained of a persistent, painful penile erection lasting 5 h. Bilateral corpora cavernosa spongiosum shunts achieved immediate and sustained detumescence, but the patient remained impotent. There was no history of penile or pelvic trauma, haemoglobinopathy, coagulopathy, venous thrombosis or leukaemia. The medical literature describes 7 other cases of priapism related to total parenteral nutrition. All of the patients received 20% fat emulsion; 2 patients developed priapism during the weekly infusion of fat emulsion. Among the multiple factors that can favour thrombosis and therefore priapism during total parenteral nutrition, fat infusion appears to be the most important. 3 different mechanisms have been postulated: increase in blood coagulability, effects on red blood cells, and fat embolism. In this patient, platelet function was estimated in vivo by the levels of antiheparin platelet factor 4 and beta -thromboglobulin. These 2 parameters were both elevated before 20% lipid emulsion and were higher after the 20% fat-emulsion infusion. Therefore, even if a direct thromboplastic effect is possible, 20% fat emulsion increases platelet activity, which was already high in this patient, and thereby favours priapism674