Fatembolism ininfancy after intravenous fatinfusions

SUMMARY Fourcasesoffatembolism aredescribed ininfants receiving prolonged intravenous infusion offat(Intralipid 20%).Thistherapeutic complication hasbeentermed'fatoverloading syndrome' butbears a clinical similarity topost-traumatic fatembolism. These4casesarethefirst toberecorded ininfancy, andwithhistopathological proof offatembolism. Transient highrates ofinfusion ofIntralipid appearstobea factor intheaetiology ofthecondition. Intravenous administration ofemulsified lipid to supplement thecaloric requirements ofinfants with nutritional deficiencies was usedover40yearsago (Holt etal., 1935). Itthenbecame an essential componentofregimens forthecomplete parenteral nutrition ofthesickchild (Helfrick andAbelson, 1944). Clinical situations inwhichintravenous fat emulsions areauseful adjunct totherapy arise most frequently outside paediatrics andmostpublished reports relate toexperience withadult patients. Serious adverse reactions arecomparatively rare. Johnson etal.(1952) reported thatthemostcommon reaction was a riseintemperature which returned tonormalwithin 4to8hoursofstarting theinfusion, accompanied occasionally byanorexia, nausea,vomiting, diarrhoea, andheadache. However,theseauthors were thefirst todocument a decreased platelet countanda prolonged bleeding timein4adults receiving 3to4gfat/kg perdayfor up to11days. Subsequently fever, jaundice, and hepatomegaly were described ina patient after receiving parenteral fatfor25consecutive days (Watkin, 1957), andanaemia, fever, vomiting, and abdominal painwere produced in2healthy volunteersafter 4weeksofintravenous lipid (Levenson etal., 1957). Theadverse reactions following prolonged intravenousfattherapy came tobeknownas 'fat overloading syndrome', anditwas notuntil 1961that attention was drawntotheclinical similarity ofthis phenomenon topost-traumatic fatembolism (Alexanderand Zieve,1961).The hypothesis that pulmonary fatembolism mightresult fromlongtermparenteral lipid hasrecently received further support fromcasesreported byHorisberger (1966),