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.