Agglutination of Intralipid by Sera of Acutely Ill Patients

Biochemical and ultra-structural reactions to parenteral nutrition with two different fat emulsions in rats

“…Opsonins like C-reactive protein (CRP) might be involved, since it can bind to the polar head of lecithin and then present the lecithin containing material for Kupffer cells and also enhance phagocytosis [28]. Lecithin is a major part of the surface structures of fat emulsions and CRP has been found to agglutinate LCT emulsions in vitro [29]. We have experienced that agglutination of fat emulsions may also occur in vivo in humans with high serum levels of CRP [30].…”

Agglutination of Intravenously Administered Phosphatidylcholine‐Containing Lipid Emulsions With Serum C‐reactive Protein

“…The serum of more than half a group of acutely ill patients agglutinated the soybean oil-based fat emulsion. 9 This reaction is precipitated by CRP. Postmortem examinations of patients who had received the soybean oil-based fat emulsion showed evidence of microembolism, which could have been caused by agglutination of the soybean oil-based fat emulsion.…”

“…If this is the case, then soybean oil-based emulsions (eg, Intralipid or Diprivan, formulated as an emulsion of 1% propofol, 10% soybean oil, and 1.2% purified egg phospholipid) perhaps should not be given to acutely ill patients. 9,19 Apart from the recommendation to improve the physical stability of parenteral nutrition (PN) admixtures, 29 a reduction of the phosphatidylcholine content of emulsions for IV use may contribute to risk prevention of fat embolism. Therefore, flow cytometric monitoring of the CRP-lipid droplets might be useful for early diagnosis of fat embolism syndrome.…”

“…Plasma-derived fat embolism can be caused by agglutination of endogenous fat or exogenous fat emulsion, with consequent embolism. 9 This therapeutic complication has been termed fat overloading syndrome but bears a clinical similarity to posttraumatic fat embolism. Following trauma, fat embolism is caused by bone marrow components, in the form of cell debris and yellow bone marrow, entering into the systemic circulation and into the parenchyma of the lungs.…”

Propofol and Intralipid cause creaming of serum from critically ill patients

“…The creaming test was then performed with propofol, Intralipid 10% and Intralipid 20% using the method described by Hulhnan et al [9] and Lindh et al [lo]. Serum (400 pl) was mixed with 10 pl of either propofol, Intralipid 10% or Intralipid 20%.…”