title: Fat overload syndrome after the rapid infusion of SMOFlipid emulsion.
abstract: Fat overload syndrome is a well-known complication of intravenous lipid emulsion therapy. It is characterized by headaches, fever, jaundice, hepatosplenomegaly, respiratory distress, and spontaneous hemorrhage. Other symptoms include anemia, leukopenia, thrombocytopenia, low fibrinogen levels, and coagulopathy. Several reports in the literature describe fat overload syndrome caused by rapid infusion of lipid emulsions, all with soybean-based lipid emulsions. We report fat overload syndrome in a 2-year-old girl with short bowel syndrome on home parenteral nutrition. Fat overload syndrome occurred as a result of accidental, very rapid infusion of a 20% soy oil, medium-chain triglyceride, olive and fish oil-based lipid emulsion (SMOFlipid) that showed the same complications seen with an earlier lipid emulsion (Intralipid). The patient was successfully treated with supportive care combining fluid infusion, transfusion of platelets, and substitution of serum albumin (0.5 g/kg/d) and fresh-frozen plasma (10 mL/kg). In the next couple of days, she received extra platelets, erythrocyte transfusion, and filgrastim (Neupogen; 5 µg/kg/d) due to a very low leukocyte count. To the best of our knowledge, this is the first case of fat overload syndrome caused by SMOFlipid emulsion described in the literature.
authors.affiliation: Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia.
authors.forename: Iva
authors.initials: I
authors.lastname: Hojsak
authors.forename: Sanja
authors.initials: S
authors.lastname: Kolaček
mesh_terms: D002675:Child, Preschool; D004655:Emulsions / Q000008:administration & dosage; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage; D006801:Humans; D016331:Parenteral Nutrition, Home; D010743:Phospholipids / Q000008:administration & dosage; D010938:Plant Oils / Q000008:administration & dosage; D012778:Short Bowel Syndrome / Q000628:therapy; D013024:Soybean Oil / Q000008:administration & dosage; D014280:Triglycerides / Q000008:administration & dosage
chemical_list: D004655:Emulsions; D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D010743:Phospholipids; D010938:Plant Oils; D014280:Triglycerides; C545823:soybean oil, phospholipid emulsion; D013024:Soybean Oil
keywords: SMOFlipids; children; lipid emulsion; lipid overload syndrome; parenteral nutrition