Education  |   June 2018
Images in Anesthesiology: A Clogged Dialysis Filter Caused by Severe Acutely Induced Hypertriglyceridemia
Author Notes
  • From Augusta University, Medical College of Georgia, Augusta, Georgia.
  • Charles D. Collard, M.D., served as Handling Editor for this article.
    Charles D. Collard, M.D., served as Handling Editor for this article.×
  • This article has been presented as a poster at the International Anesthesia Research Society meeting on May 23, 2016, titled “Hypertriglyceridemia Secondary to Propofol Infusion Complicating Renal Replacement Therapy in a Patient with Hemorrhagic Shock.”
    This article has been presented as a poster at the International Anesthesia Research Society meeting on May 23, 2016, titled “Hypertriglyceridemia Secondary to Propofol Infusion Complicating Renal Replacement Therapy in a Patient with Hemorrhagic Shock.”×
  • Address correspondence to Dr. Diaz Milian: rdiazmilian@augusta.edu
Article Information
Education / Images in Anesthesiology / Endocrine and Metabolic Systems
Education   |   June 2018
Images in Anesthesiology: A Clogged Dialysis Filter Caused by Severe Acutely Induced Hypertriglyceridemia
Anesthesiology 6 2018, Vol.128, 1237. doi:10.1097/ALN.0000000000002058
Anesthesiology 6 2018, Vol.128, 1237. doi:10.1097/ALN.0000000000002058
THE image shows a massive amount of serum fat clogging a dialysis filter in a 55-yr-old cirrhotic surgical patient, who required sedation with propofol for mechanical ventilation after developing hypoxemic respiratory failure. The propofol drip was used for a total of 40 h at an infusion rate of 60 µg · kg–1 · min–1 or less, yet serum triglycerides were found to be markedly elevated. Clogging is caused by a triglyceride-induced procoagulant state, with fibrin and clot deposition in the dialysis membrane.1 
Acute hypertriglyceridemia has been associated with propofol infusions.2  Two mechanisms have been proposed to explain this phenomenon: high fat content of the emulsion can exceed the capability of lipoprotein lipase, causing decreased cellular uptake of fatty acids2,3 ; and direct inhibition of fatty acid oxidation by the drug. If propofol-induced hypertriglyceridemia is suspected, it is crucial to stop the infusion. Treatment consists of insulin and dextrose administration, which acts by promoting lipoprotein lipase activity.
First Page Preview
First page PDF preview
First page PDF preview ×
View Large