TEACHING CASE Pharmacologic Influence on Nutrition Support Therapy: Use of Propofol in a Patient Receiving Combined Enteral and Parenteral Nutrition Support

ABSTRACT: Propofol is a lipid-based sedative that pro-vides 1.1 kcal/mL. Because propofol has rapid onset and quick recovery, it is becoming used widely in critical care units. A 15-year-old critically ill pregnant patient re-ceived specialized nutrition support concomitantly with propofol infusion for sedation. A serum triglyceride con-centration obtained on day 6 of the propofol infusion was 1100 mg/dL with no previous history of hyperlipidemia. Caloric intakes from propofol averaged 1275 kcal/d (range 445 to 2354 kcal/d) over a 5-day period. Infusion of propofol or any other lipid-based drug must be monitored closely when given in conjunction with enteral or parenteral nutrition to avoid the pitfalls of overfeeding and hypertriglyceridemia. Enteral and parenteral formu-las must be manipulated to provide optimal nutrien