Biotin Deficiency Complicating Parenteral Alimentation: Diagnosis, Metabolic Repercussions, and Treatment

    Donald M. Mock, David L. Baswell, Herman Baker, Ralph T. Holman, Lawrence Sweetman
    TLDR Biotin deficiency in patients on total parenteral nutrition can cause serious symptoms but can be treated with biotin supplements.
    The document discussed biotin deficiency as a complication of total parenteral nutrition (TPN), highlighting its diagnosis, metabolic repercussions, and treatment. Three patients with biotin deficiency were successfully treated; all exhibited alopecia totalis, hypotonia, and developmental delay, with two showing scaly periorificial dermatitis. Diagnosis was confirmed by decreased urinary biotin excretion and increased organic acid excretion, indicating deficiencies in biotin-dependent enzymes. Treatment with biotin (100 μg/day, with one patient receiving an initial larger dose) led to dramatic improvements in symptoms, although one patient continued to show abnormal organic acid excretion. The study suggested that the standard biotin supplement for pediatric patients (20 μg/day) might be insufficient during TPN.
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