Total parenteral nutrition in twin pregnancy after suicide attempt with corrosive

Introduction. Self-poisoning is not frequent during pregnancy. We present the successful treatment of a woman 20 weeks pregnant with twins with self-inflicted poisoning by a caustic substance. Case report. A 34-year old caucasian pregnant woman was admitted to our institution after self-inflicted poisoning with concentrated acetic acid. Initial clinical evaluation showed severe diffuse erythema of the mouth and oropharynx, a systemic inflammatory response syndrome, and dichorionic diamniotic twin pregnancy in the 20th week of gestation confirmed on abdominal ultrasound. An indirect laryngoscopic examination revealed severe generalised hyperemia of the laryngeal mucosa with corrosive changes in the pharyngeal mucosa especially of the posterior pharyngeal wall. Due to pain an urgent esophagogastroduodenoscopy could not be performed, and because of patient refusal a feeding gastrostomy or jejunostomy could not be created. The patient was given "All-in-One" total parenteral nutrition (TPN) in addition to the other supportive therapy. Gradual introduction of enteral nutrition (EN) via a nasoenteric tube placed in the second month of hospitalization failed due to severe vomiting. After almost three months of TPN, EN was however introduced; we then started with oral fluids, increasing gradually to a regular diet, and needed almost half a month to reach an adequate nutritional goal. The delivery was spontaneous at 36 weeks pregnancy and the patient gave birth to two normal healthy girls (46cm/2580gr and 48cm⁄2960gr). Conclusion. TPN can be a safe choice for providing prolonged and adequate nutritional intake even in a twin pregnancy without adverse effects on fetal growth.