Over-infusion of lipids

Fat overload syndrome often mimics sepsis - always strongly consider infection in this scenario (i.e. bloods cultures and empirical antibiotics)

Lipid infused at more than 3 times prescribed rate for 2 hours or more

OR

Lipid infused at more than 5 times prescribed rate for 30 minutes or more

STOP lipid and aqueous infusion and seek medical review

FAT OVERLOAD SYNDROME
Symptoms	Signs/Observations
Fever Vomiting Tachypnoea (or apnoea) Pallor	Low oxygen saturations Hypertension Tachycardia

ASSESS ABCDE AS PER APLS GUIDANCE

• Administer oxygen therapy if required
• Check blood glucose and commence appropriate intravenous maintenance +/- resuscitation fluids
• Early discussion with GI, Haematology and HDU/PICU

URGENT BLOODS (remember to record if visible fat emulsion in sample)
Test	Potential abnormalities
Lipid profile	All parameters above normal range
Full blood count	Low platelets, low white cell count, haemolysis
Capillary blood gas	Metabolic acidosis
Liver/pancreatic function tests	Raised ALT, GGT, bilirubin, amylase, lipase
Coagulation	Prolonged PT/APTT, low fibrinogen

Early consideration of ventilatory/cardiovascular support, blood products (e.g. platelets, FFP) and exchange transfusion as definitive treatment

Consider restarting lipid infusion when all parameters have normalised and be aware of possible long-term effects such as pulmonary hypertension, ongoing respiratory failure and neurodevelopmental delay.