The fat overload syndrome: successful treatment with plasma exchange

Article Abstract:

Fat overload syndrome is a complication of parenteral nutrition (intravenous provision of nutritional needs) which includes fat emulsion. A sudden elevation of serum triglyceride fats is associated with enlargement of the liver and spleen, and the impaired function of various organs. Reported cases have indicated no effective therapy other than supportive care for the patient. However, in the case of a 39-year-old man hospitalized for asthma, a reversal of the syndrome was achieved with plasma exchange. The patient developed hypoxia (oxygen deficiency) one day after parenteral feeding was begun; the intravenous feeding included a 20 percent fat emulsion. The hypoxia resulted from pulmonary infiltrates which continued to worsen, and the patient developed gross peripheral edema (severe swelling). Examination of the retina showed lipemia retinalis (retinal vessels appeared reddish white or white, indicating excess blood lipid levels), and microscopic examination of the blood revealed neutrophils (a type of white blood cell) laden with fat-filled vacuoles. Macrophages (a cell of the immune system) obtained from lavage of the lungs were full of fat globules. Plasma exchange was begun, and 5.6 liters of fatty plasma were replaced with fresh frozen plasma and albumin. Within 18 hours, a dramatic improvement in the patient could be seen. Five days later, the patient no longer required ventilation; three weeks later he was discharged. Residual damage included numerous retinal infarctions. Multiple small cerebral infarctions that were visible on magnetic resonance imaging where attributed to the blocking of arterioles with fat emboli; this left the patient with some short-term memory abnormalities. Fat overload syndrome, which can cause extensive damage as organs fill with fatty sludge, should be treated with plasma exchange if the condition does not respond to conservative therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Artificial feeding, Feeding methods, Plasma exchange (Therapeutics), Fat embolism

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Fatal and nonfatal hepatotoxicity associated with flutamide

Article Abstract:

Flutamide, a drug used to treat prostate cancer and benign prostatic hypertrophy, has been linked to toxic effects on the liver which can lead to death. Flutamide is an antiandrogen. During Food and Drug Administration testing for special uses for the drug, 19 cases of hepatotoxicity were reported. Five of these patients died from progressive liver disease. Two of the 19 patients were being treated for benign prostatic hypertrophy. The others were being treated for prostate cancer. Ten patients recovered without hospitalization when they discontinued taking flutamide. Autopsies on three of the five patients indicated hepatic necrosis, or death of liver cells, caused by the action of enzymes. Patients taking flutamide should immediately report any jaundice, nausea, fatigue, anorexia or discolored urine to their doctors.

Prostate cancer, Prostate, Prostatic hyperplasia, Flutamide

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Prevalence of Liver Disease and Contributing Factors in Patients Receiving Home Parenteral Nutrition for Permanent Intestinal Failure

Article Abstract:

Home parenteral nutrition may cause liver disease. Parenteral nutrition is given to people who cannot eat and is usually delivered through a stomach tube. In a study of 90 patients with permanent intestinal failure who were receiving home parenteral nutrition, 26% developed liver disease within two years and 50% developed liver disease within six years. Six patients died from the liver disease, which represented 22% of all deaths.

Cholestasis

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