Pharmacologic influence on nutrition support therapy: use of propofol in a patient receiving combined enteral and parenteral nutrition support.

Propofol is a lipid-based sedative that provides 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 received specialized nutrition support concomitantly with propofol infusion for sedation. A serum triglyceride concentration 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 formulas must be manipulated to provide optimal nutrient intakes while not overfeeding with fat when using increased amounts of lipid-based drugs.