NOTE: Most of the reports are from the early 1980s.
Dose of lipid administration: high rate of infusion that exceeds the ability of the body's lipoprotein lipase to clear the emulsion. This is > 3.8 g fat per kg body weight per 24 hours in a healthy adult, but may be lower in a person with underlying disease.
Clinical findings:
(1) fever
(2) jaundice
(3) spontaneous hemorrhage and/or easy bruisability
(4) tachycardia
(5) tachypnea
(6) headache
(7) lethargy or irritability
(8) nausea and vomiting
(9) abdominal pain
(10) hepatosplenomegaly
(11) cough, occasionally with hemoptysis
(12) seizures
(13) cardiac failure
The serum is thick, creamy and burgundy colored.
Laboratory findings:
(1) leukocytosis with "vacuolated" neutrophils (can demonstrate vacuoles as containing lipid)
(2) anemia with burr cells in the peripheral blood smear
(3) normal platelet count with large platelets seen on the peripheral blood smear
(4) prolonged bleeding time with abnormal platelet function
(5) abnormal coagulation tests which may reflect liver disease and/or DIC (normal to prolonged PT, prolonged aPTT, prolonged thrombin time, normal to decreased fibrinogen, elevated fibrin degradation products)
(6) elevated liver function tests (ALT, AST, alkaline phosphatase, conjugated bilirubin)
(7) normal to low serum sodium (pseudohyponatremia associated with lipid)
(8) markedly elevated serum triglyceride levels (up to 10,000 mg/dL)
Differential diagnosis:
(1) sepsis
(2) other causes of hypertriglyceridemia
Therapy:
(1) discontinue parenteral infusion, with use of lower dose after recovery
(2) plasma exchange/apheresis
