Table 4.

Disease-related complications of short bowel syndrome/intestinal failure

Complication	Pathophysiology	Management	Prevention
Intestinal failure liver disease (IFALD)	• Multifactorial condition (sepsis, intestinal anatomy, oral nutrition/EN, PN infusion modality, nutrition deficiency or excess)	• Reduce the total lipid amount and/or decrease omega-6/omega-3 PUFA ratio	• Identify/treat sepsis
	• Soybean-lipid emulsions in excess	• Revise potential inflammatory/infectious foci	• Identify/treat sepsis
	• Steatosis (adults)	• No evidence to recommend lipid-free regimens, as well as the use of ursodeoxycholic acid, choline, taurine, or carnitine	• Preserve small intestine length and colon in continuity
	• Hepatocellular injury or cholestasis (children)		• Increase oral/enteral intake
			• Cycled PN with soybean oil-based lipid content less than 1 g/kg/day
Gallbladder sludge and stones	• Negligible oral intake	• Endoscopic/surgical procedures as for the general population	• Preserve small intestine length and colon in continuity
	• Intestinal remnant length less than 180 cm	• Increase oral/enteral intake	• Increase oral/enteral intake
	• Crohn’s disease
Kidney disease and stones	• Chronic dehydration (kidney disease)	• Management as for the general population	• Monitor fluid balance and renal function*
	• Increased absorption of oxalate, hypovolemia, hypomagnesemia and metabolic acidosis (kidney stones)		• Low-fat and low-oxalate diet*
			• Calcium carbonate and potassium citrate supplementation*
Bone disease	• Toxicity from aluminum contamination of the nutrition formula	• Supplement calcium and vitamin D as needed	• Correct metabolic acidosis when present
	• Increased sensitivity to vitamin D suppressing PTH secretion		• Periodic assessment of bone mineral density, calcium, magnesium, vitamin D and supplement as needed
	• Hypercalciuria
	• Micronutrient deficiency (vitamin C and copper)
	• Vitamin A toxicity

EN, enteral nutrition; PN, parenteral nutrition; PUFA, poly-unsaturated fatty acid.

*Especially in patients with colon in continuity.