ILE was prescribed at 3 g/kg/day of 20% lipid injectable emulsion, which ran at a pump rate of 5.5 mL/h. PN was prescribed to start at 18:00 each evening and run over 18 hours. She received PN and lipid injectable emulsion in a 2-1 solution. Her PN was prescribed with a glucose infusion rate of 17.9 mg/kg/min and lipid injectable emulsion (SMOFlipid ), which is the ILE used at our center. She was not eligible for multivisceral transplant and thus became parenteral nutrition (PN) dependent for intestinal failure.Īt 11 months of age she was still in our pediatric medicine ward for PN dependence and intestinal failure-related liver disease she had never been discharged from hospital due to complex social challenges and for need for home PN. She also screened positive on her newborn screen for severe combined immunodeficiency (SCID), which raised suspicion a mutation in tetratricopeptide repeat domain 7A (TTC7A), an autosomal recessive mutation known to cause hereditary multiple intestinal atresia with combined immunodeficiency ( 4, 5). Within 15 days, she underwent three laparotomies for meconium peritonitis and ultimately had a pylorus repair, duodenojejunostomy with end ileostomy, and gastrostomy tube insertion. She was vigorous at birth but intubated immediately and transferred to a tertiary care pediatrics center on her first day of life. She was delivered by Cesarean section for maternal rupture of membranes following an amnioreduction. The patient was born at 33 weeks and 5 days following pregnancy complicated by hydrops fetalis, severe ascites, and a fetal MRI suggestive of bowel perforation. We present an infant with inadvertent ILE overdose causing fat overload syndrome and pancreatitis in a child. ILE overdoses causing fat overload syndrome in infants and children have been reported in the medical literature since the 1980s however, no cases report fat overload syndrome causing pancreatitis in pediatric patients ( 2, 3). Fat overload syndrome can also be associated with pancreatitis, described in the adult literature. The resultant hypertriglyceridemia resolves once the ILE infusion is stopped. Treatment focuses on support of the respiratory, hepatobiliary, and hematologic complications as needed. Symptoms and signs include respiratory distress, fever, headache/irritability, jaundice, hepatosplenomegaly, cytopenias, and coagulopathy.
![fat emulsion infusion fat emulsion infusion](https://rk.md/wp-content/uploads/2019/04/intralipid-bag.jpg)
The risk of fat overload syndrome exists with many ILEs, including those that contain fish oil emulsions.
#Fat emulsion infusion license
This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.įat overload syndrome results from elevated triglyceride levels that occur when intravenous lipid emulsion (ILE) infusion rates exceed the rate of hydrolysis, free fatty acid uptake, and clearance ( 1). Approved final version for publication.Ĭorrespondence: Michael Schlegelmilch, MD, MPH, Department of Pediatrics, Faculty of Medicine, Children’s Hospital of Eastern Ontario, University of Ottawa. did conceptualization, drafting, and revision of article.
![fat emulsion infusion fat emulsion infusion](https://i1.wp.com/www.yekeey.com/wp-content/uploads/2019/07/Fat-emulsion-injection-high-shear-emulsifier.jpg)
did conceptualization, literature review, drafting and revision of article. did conceptualization, chart review, literature review, drafting and revision of article. Informed consent was obtained from our patient’s parent to publish this case report.
![fat emulsion infusion fat emulsion infusion](https://www.bbraunusa.com/content/dam/catalog/bbraun/bbraunProductCatalog/S/AEM2015/en-us/b/nutrilipid-20-soybeanoilivfatemuls.jpeg)
The authors report no funding and conflicts of interest. †Department of Pediatrics, Division of Critical Care, Faculty of Medicine, Children’s Hospital of Eastern Ontario, University of Ottawa.
![fat emulsion infusion fat emulsion infusion](https://www.fresenius-kabi.com/in/images/Intralipid.jpg)
From the *Department of Pediatrics, Faculty of Medicine, Children’s Hospital of Eastern Ontario, University of Ottawa