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American Journal of Clinical Nutrition, Vol. 74, No. 2, 272, August 2001
© 2001 American Society for Clinical Nutrition

Letter to the Editor

Fat emulsion infusions and prolongation of the Q-T interval

Mark R Goldstein

466 Crescent Drive, West Chester, PA 19382, E-mail: mrgolds{at}aol.com

Dear Sir:

The article by Marfella et al (1) showing that elevated plasma fatty acid concentrations prolong cardiac repolorization has important implications for hospitalized patients. In that study, healthy volunteers were given an infusion of a 10%-fat emulsion (Intralipid; Pharmacia, Uppsala, Sweden) or a saline solution. Infusion of the fat emulsion resulted in a significant prolongation of the Q-T interval. Increases in plasma fatty acids and epinephrine resulting from the fat infusion were each independently associated with the prolongation of the Q-T interval.

Infusions of fat emulsions are routinely used as a source of energy and essential fatty acids in critically ill patients requiring parenteral nutrition (2). The same patients may be at risk of acquired Q-T interval prolongation from the use of medications such as antiarrhythmics, phenothiazines, tricyclic antidepressants, and erythromycin or electrolyte disturbances such as hypokalemia and hypomagnesemia (3). Because prolongation of the Q-T interval is associated with arryhythmias and sudden death (4), infusion of fat emulsions in patients receiving drugs or with conditions that can also prolong the Q-T interval should be monitored closely and, perhaps, contraindicated if the Q-T interval is prolonged.

REFERENCES

  1. Marfella R, De Angelis L, Nappo F, et al. Elevated plasma fatty acid concentrations prolong cardiac repolarization in healthy subjects. Am J Clin Nutr 2001;73:27–30.[Abstract/Free Full Text]
  2. McMahon MM. Parenteral nutrition. In: Goldman L, Bennett JC, eds. Cecil textbook of medicine. Philadelphia: WB Saunders, 2000: 1166–70.
  3. Zipes DP. Specific arrhythmias: diagnosis and treatment. In: Braunwald E, ed. Heart disease. A textbook of cardiovascular medicine. Philadelphia: WB Saunders, 1997:640–704.
  4. Zipes DP. The long QT interval syndrome: a Rosetta stone for sympathetic related ventricular tachyarrhythmias. Circulation 1991;84: 1414–9.[Free Full Text]




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