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Fat overload syndrome causing respiratory insufficiency.

D E Wesson, R H Rich, S H Zlotkin

    Journal of Pediatric Surgery
    |December 1, 1984
    PubMed
    Summary
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    Fat overload syndrome occurred in a child receiving home parenteral nutrition (TPN) with Intralipid. Symptoms included respiratory distress and hypoxia, which resolved as lipid levels decreased.

    Area of Science:

    • Pediatric Medicine
    • Clinical Nutrition
    • Critical Care

    Background:

    • Home total parenteral nutrition (TPN) is a vital therapy for children with intestinal failure.
    • Lipid emulsions, such as Intralipid, are essential components of TPN, providing necessary calories and fatty acids.
    • Monitoring for potential complications, like fat overload syndrome, is crucial in patients on long-term TPN.

    Observation:

    • A 7-year-old girl on home TPN developed fat overload syndrome.
    • The patient received 20% Intralipid at a total lipid dose of 3.2 g/kg/d.
    • Clinical presentation included acute respiratory insufficiency with cough, dyspnea, tachypnea, and cyanosis.

    Findings:

    • Chest X-ray revealed mild cardiomegaly and pulmonary edema.
    • Arterial blood gases demonstrated profound hypoxia (PaO2 29 torr on room air).

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  • Lipemia was evident, correlating with the clinical symptoms.

    • Implications:

    • This case highlights the potential for fat overload syndrome in pediatric patients receiving high-dose Intralipid via home TPN.
    • Prompt recognition and management, including lipid clearance, are essential for recovery.
    • Clinicians should maintain a high index of suspicion for this syndrome in TPN-dependent children presenting with respiratory distress.