Clinical Effects of Inadvertent Increased Lipid Infusion in Neonates: Two Case Reports. (8th February 2023)

• Record Type: Journal Article
• Authors: Hulgan, Christina Marie; Snow, Timothy; Check, Jennifer
• Editors: Bell, Tracey
• Is Part Of: Advances in neonatal care. Volume 23:Number 1(2023)
• Page Start: 23
• Page End: 30
• Publication Date: 2023-02-08
• Subjects: fat-overload -- hyperalimentation -- hyperlipidemia -- hypertriglyceridemia -- infusion error -- lipemia -- lipid infusion -- medication error -- neonates; Newborn infants -- Medical care -- Periodicals; Newborn infants -- Diseases -- Nursing -- Periodicals; Premature infants -- Hospital care -- Periodicals; 618.9201
• DOI: 10.1097/ANC.0000000000000986
• Languages: English
• ISSNs: 1536-0903

Abstract

Abstract : Background: Utility of total parenteral nutrition (TPN) with an intravenous lipid emulsion (IVLE) component is common in the neonatal intensive care unit; however, there are inherent risks to TPN use. With IVLE administered separate from other TPN components, opportunities exist for additional error and subsequent potential harm. Clinical Findings: We present 2 cases in term infants where IVLE infusions were noted to be inadvertently administered at higher than prescribed rates, prompting concern for lipemia and end-organ damage due to hyperviscosity. Primary Diagnosis: Both infants developed iatrogenic hypertriglyceridemia and hyponatremia. Intervention: Upon recognition of the error, IVLE was immediately discontinued in each case. Triglyceride levels were serially monitored until they reached a normal level. Electrolyte panels and hepatic function panels were also drawn to assess for electrolyte derangements and function. Radiologic studies were performed for evaluation of end-organ effects of hyperviscosity. Outcomes: Triglyceride levels for both infants normalized within 7 hours. Both infants survived to discharge without any known effects related to the inadvertent excessive lipid infusion. Conclusion: It is helpful to perform a root-cause analysis for these types of events; have the exact amount of lipids in the bag needed and no overfill; consider having lipids in 4-hour dosage aliquots; require 2 nurses to verify infusion rates hourly; and educational sessions and unit protocols for any infusion may reduce the risk of administration error.