Parenteral nutrition in a patient with familial Type IV hypertriglyceridemia: a dilemma

Patients with a Type IV familial hypertriglyceridemia should never receive intravenous fat emulsions. In addition, the amount of carbohydrate that can be given is limited. A 33-year-old white female, with Type IV hypertriglyceridemia, began receiving a parenteral nutrition regimen that included fat. A series of lipid studies was planned, coordinated with fat emulsion and glucose administration. The patient had persistently elevated basal triglyceride levels (greater than 250 mg/dL), which rose in response to both fat and carbohydrate administration. Serum cholesterol levels remained within the normal range. The disease was once known as "carbohydrate-induced lipemia" because of the dramatic rise in serum triglyceride following high carbohydrate diets. We suggest that serum triglyceride levels be monitored in all patients receiving parenteral nutrition; when such a patient is identified, fat emulsion should not be given and dextrose should be used in the smallest possible amounts to achieve a positive nitrogen balance.