The development of liver complications with PN usage is primarily due to which factor?

• A. Dehydration
• B. Excessive energy intake from dextrose and/or intravenous fat emulsion
• C. Infections
• D. Nutrient deficiency

Answer: (B)

Excess energy delivery through the parenteral nutrition is the main driver of PN-associated liver complications. When the PN provides more calories than the body needs, especially from carbohydrates (dextrose) and intravenous lipids, the liver converts the surplus glucose into fat (de novo lipogenesis). This can lead to hepatic steatosis and, with lipid overload, cholestasis and inflammation over time. While infections and other factors can worsen overall illness and liver stress, they are not the primary cause of PN-related liver disease. Dehydration and nutrient deficiencies do not explain the typical fat- and bile-related liver changes seen with PN. Clinically, this means assessing and tailoring energy needs, moderating dextrose and lipid provision, and considering strategies like cycling PN or adjusting lipid type if liver enzymes or bilirubin rise.