Possible role of short-term parenteral nutrition with fat emulsions for development of haemophagocytosis with multiple organ failure in a patient with traumatic brain injury Roth B, Grande PO, Nillson-Ehle P and Eliasson I. Intensive Care Med 1993; 19: 111-114.

This paper describes a case-report of a 21-year-old woman who sustained an isolated traumatic brain injury following a road traffic accident. After a 3-day period of parenteral nutrition including fat (Intralipid 20%) she developed hypertriglyceridaemia and 'creaming plasma', with a rash, high fever, hypertension, raised inracranial pressure, hepatic and renal failure, haemolysis, marked thrombocytopenia, and leucopenia, coagulation disorder and pulmonary failure, suggestive of hyperactivation of the monocyte-macrophage system. Treatment involved cessation of the lipid emulsion infusion and steroids. 6 months after the accident, the patient was well recovered with only minor neurological sequelae.