Rapid Infusion of Fish Oil–Based Emulsion in Infants Does Not Appear to be Associated With Fat Overload Syndrome

Abstract

Inadvertent rapid infusion of parenteral lipid emulsion is an inherent risk when fats are infused separately from the dextrose-amino acid solution. Patients may experience hypertriglyceridemia that resolves upon discontinuation of the infusion; in other cases, complications such as fat overload syndrome can occur. Since 2004, fish oil-based emulsions have been used investigationally for the treatment of parenteral nutrition-associated liver disease. Anecdotal reports suggest that patients who receive rapid infusions of this emulsion do not develop symptoms consistent with fat overload syndrome. The aim of this investigation was to determine whether infants receiving a rapid infusion of a fish oil lipid emulsion exhibited symptoms consistent with fat overload syndrome. The medical records of patients treated at Children's Hospital Boston with a fish oil emulsion from September 2004 to August 2008 were reviewed for cases of rapid infusion. Six of 99 patients (6%) received a dose of fish oil emulsion at an infusion rate that exceeded 0.17 g/kg/h. Infusion rates as high as 5 g/kg/h were accidentally administered (range, 0.2-5 g/kg/h) without evidence of fat overload syndrome. Transient elevations in serum triglyceride levels were observed but promptly returned to acceptable levels. Rapid infusion of a fish oil-based emulsion in 6 infants were well tolerated. No patients developed signs or symptoms of fat overload syndrome.