Abstract
We report a 27-year-old male with sclerosing encapsulated peritonitis (SEP) who presented with dilated cardiomyopathy 7 months after the initiation of home parenteral nutrition (HPN). The cause of heart failure may have been due to selenium (Se) deficiency induced by the lack of Se as a trace element in the commercially available hyperalimentation fluids.
This patient required dialysis (CAPD) in 1983 because of steroid-resistant nephrotic syndrome that led to end-stage renal disease (ESRD). He had been on CAPD for 12 years since then. He sustained SEP in 1995 and was switched to chronic hemodialysis (HD) and total parenteral nutrition (TPN) and/or enteral liquid diet. In May 1997, HPN was started to improve the quality of life. Seven months later, he presented with heart failure demonstrating an ejection fraction (EF) of 30%. The diagnosis was dilated cardiomyopathy. We investigated the etiology of heart failure and finally found that his plasma levels of Se were extremely low (<25μg/l, below the detectable range). Because it was known that Se deficiency may cause dilated cardiomyopathy, we made a clinical diagnosis of dilated cardiomyopathy due to Se deficiency. After intravenous supplementation of Se, his heart failure symptoms were apparently improved with an increased EF on echocardiography.
SEP is one of the most serious complications derived from long-term CAPD, which requires TPN or enteral liquid diet for most patients. When an SEP patient requires long-term TPN, the physiciam must consider the possibility of Se deficiency as a cause of heart failure.
