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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.
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