Accidental, Intravenous Infusion of a Peanut Oil-Based Medication

• Published in: Journal of toxicology. Clinical toxicology Vol. 36; no. 7; pp. 733 - 736
• Main Authors: Seifert, Steven A., Dart, Richard C., Kaplan, Edward H.
• Format: Journal Article
• Language: English
• Published: Monticello, NY Taylor & Francis 01-01-1998; Dekker
• Subjects: Antineoplastic Agents, Phytogenic - therapeutic use; Biological and medical sciences; Drug intoxications. Doping; Embolism, Fat - chemically induced; Equipment Failure; Excipients - administration & dosage; Excipients - poisoning; Female; Humans; Infusions, Intravenous; Medical sciences; Medication Errors; Medroxyprogesterone - administration & dosage; Medroxyprogesterone - therapeutic use; Middle Aged; Ovarian Neoplasms - drug therapy; Paclitaxel - therapeutic use; Peanut Oil; Pharmacology. Drug treatments; Plant Oils - administration & dosage; Plant Oils - poisoning; Pneumonia, Lipid - chemically induced; Progesterone Congeners - administration & dosage; Progesterone Congeners - therapeutic use; Syndrome; Case study; Human; Pneumonia; Intravenous administration; Accident; Respiratory disease; Perfusion; Toxicity; Error; Peanut oil
• ISSN: 0731-3810; 1097-9875
• DOI: 10.3109/15563659809162624

Objectives
: To describe a case of fat embolus syndrome with lipoid pneumonia resulting from intravenous infusion of lipid and to illustrate the potential for accidental intravenous administration of vegetable oil-based progesterone preparations in the treatment of oncology patients.
Case Report
: A patient with recurrent ovarian carcinoma accidentally received approximately 20 mL (0.29mL/kg) of a peanut oil-based methylprogesterone product intravenously via infusion pump over 24 hours. The patient developed a lipoid pneumonia with dyspnea, cough, hypoxia, radiographic infiltrates, and a pleural effusion. She was hospitalized for 4 days, and signs and symptoms resolved over 2 weeks following steroids and supportive care.
Discussion
: Experience with accidental or intentional intravenous lipid overdose in humans is limited. Typical findings of fat embolus syndrome are similar to lipid aspiration, with respiratory distress, hypoxia, and pulmonary infiltrates. In contrast to aspiration, however, fat embolus syndrome results in lipogranulomas surrounding blood vessels, rather than air passages, and potentially produces cerebrovascular, accident-like symptoms. Management of fat embolus syndrome is similar to that for lipid aspiration. However, as seen in this case, fat embolus syndrome typically resolves over several weeks as opposed to the 3-month to 1-year period seen with aspiration lipoid pneumonias.
Conclusions
: Accidental intravenous infusion of vegetable oil-based products is a potential complication of the increased use of intravenous progesterones.