Last reviewed:September 2019
Last updated:June  2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • weight loss
  • diarrhoea
  • volume depletion
  • peripheral or pre-sacral oedema

Other diagnostic factors

  • fatigue
  • fractures
  • post-prandial epigastric or RUQ abdominal pain
  • dysuria or renal colic
  • abnormal neurological examination
  • jaundice and pruritus
  • dermatological signs
  • night blindness
  • motor weakness or altered gait
  • proximal muscle weakness
  • excessive bleeding
  • confusion

Risk factors

  • bowel resection
  • extensive abdominal radiation injury
  • gastroschisis

Diagnostic investigations

1st investigations to order

  • FBC
  • serum electrolytes
  • serum urea and creatinine
  • serum albumin
  • serum calcium, zinc, selenium, folate
  • vitamins A, B1, B2, B6, B12, C, D, and E
  • methylmalonic acid (MMA)
  • INR
Full details

Investigations to consider

  • serum hepatic aminotransferases, alkaline phosphatase, and bilirubin (total and direct)
  • urine analysis
  • serum D-lactate
  • faecal fat quantification
  • upper GI contrast series
  • DXA scan
  • abdominal ultrasound
  • CT abdomen
Full details

Treatment algorithm


Alan Buchman

Visiting Professor of Clinical Surgery and Medical Director of the Intestinal Transplant and Rehabilitation Center

University of Illinois at Chicago

Medical Director

Health Care Services Corporation




AB is an author of references cited in this topic.

Dr Alan Buchman would like to gratefully acknowledge Dr Michael Roth, a previous contributor to this topic. MR is an author of a reference cited in this topic.

Peer reviewersVIEW ALL

Associate Professor of Medicine

Division of Gastroenterology, Hepatology and Nutrition


Vanderbilt Center for Human Nutrition

Vanderbilt University Medical Center




DS has been an advisor for B. Braun and Baxter Healthcare; has received lecture fees from Coram Healthcare, EMD Serono, and Nutrishare; has prepared a newsletter for Mayne Pharma; and has received research funding from Baxter Healthcare and NPS Pharmaceutical.

Hospital Dean

Intestinal Failure Unit

Hope Hospital





Not disclosed. JS is the author of references cited in this monograph.

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