Fat overload syndrome in pediatric patients: One case and ten at risk

Fat overload syndrome is a rare but serious complication associated with intravenous lipid emulsion in parenteral nutrition. Timely identification of causes, recognition of symptoms, close monitoring of complications, and appropriate management are vital for improving outcomes and preventing recurrence. This case series reviews etiologies, complications, management, and outcomes in pediatric patients who developed fat overload syndrome as well as those identified to be at risk of this condition.

A retrospective chart review was performed over a five-year period at a tertiary care hospital, including 11 pediatric patients who received lipid emulsions at infusion rates exceeding the recom-mended limit. Data on patient demographics, lipid emulsion details, clinical presentations, laboratory results, managements, and outcomes were collected and analyzed.

Eleven patients were included, ranging in age from 9 months to 15 years, with a male-to-female ratio of 7:4. The identified causes of intravenous lipid administration incidents were inadvertent switching of infusion rates between the parenteral nutrition solution bag and the lipid bag, and incorrect infusion pump programming. Fat overload syndrome was identified in one patient, presenting with oliguria and metabolic acidosis. Management primarily consisted of discontinuing intravenous lipid emulsions and providing supportive care. Although most patients had no complications, four required additional supportive interventions.

Although uncommon, fat overload syndrome requires prompt recognition and timely intervention. This case series underscores the importance of careful parenteral lipid administration and vigilant monitoring of at-risk patients. Root cause analysis is critical to preventing recurrence of such incidents.