[A pregnant woman with active ulcerative colitis maintained on total parenteral nutrition].

A 28-year-old woman was admitted to our hospital with complaints of mucosanguinous stool and low grade fever. She was diagnosed as a typical chronic continuous type of ulcerative colitis by the findings of barium enema and colonoscopy. Since she had an allergy to sulfasalazine, prednisolone was chosen. She became pregnant during an active stage while being treated with 20 mg of prednisolone a day. Prednisolone was withdrawn to avoid the side-effects of the medicine on the fetal outcome. This resulted in her symptoms becoming far worse and the oral ingestion being discontinued. Total parenteral nutrition (TPN) was required under careful nutritional management. The TPN consisted of glucose, electrolytes, amino acids, vitamins, trace elements and intravenous lipid preparation. Her total energy intake was 2320 kcal a day. Vitamins were administered to her on the bases of the guideline of the American medical association. Rapid turnover proteins, transferrin, vitamins, trace elements and amino acids in addition to routine laboratory tests were measured to estimate her nutritional condition. The data showed that biotin was 10 times lower than the expected value and that other factors were within normal limits. This is the first case in Japan where a woman suffering from an active ulcerative colitis was treated with TPN and delivered of a healthy baby. We concluded that TPN under careful control was useful in the nutritional management and therapy of the pregnant patient who suffered from severe colitis. We believe that the amount of biotin's supplementation should be increased in this type of case because it was 10 times lower than the normal value, although the deficiency symptoms did not develop.