Intralipid Side Effects: What to Expect and When to Call Your Doctor

Intralipid is generally well-tolerated when used according to guidelines, but like all IV medications, it carries risks. Knowing which side effects to expect — and which ones are medical emergencies — is essential for patients receiving home parenteral nutrition (PN) and their caregivers.

Common Side Effects of Intralipid

Based on clinical trial data in adults, the most common adverse reactions (occurring in 5% or more of patients) are:

Nausea — often mild; can sometimes be reduced by slowing the infusion rate

Vomiting — usually associated with elevated triglycerides or infusion rate issues

Pyrexia (fever) — a low-grade fever during or shortly after infusion; always report fever to your provider, as it may also indicate line infection

Elevated triglycerides (hypertriglyceridemia) — often detected on routine lab monitoring; Intralipid should be held or dose-reduced if triglycerides exceed 1,000 mg/dL

Serious Side Effects and Boxed Warnings

Intralipid carries a boxed warning (the FDA's most serious safety alert) regarding its use in neonates and infants. All patients on long-term Intralipid therapy should be monitored for the following serious risks:

Rapid infusion reactions in neonates and infants (BOXED WARNING): Acute respiratory distress, metabolic acidosis, and death have been reported in neonates and infants from rapid infusion of IV lipid emulsions. The maximum hourly infusion rate for neonates is 0.125 g/kg/hour. Never exceed recommended rates in this population.

Parenteral Nutrition-Associated Liver Disease (PNALD): Also called intestinal failure-associated liver disease (IFALD). Risk increases with long-term PN, especially in preterm neonates. Signs include elevated liver enzymes, jaundice, and hepatomegaly. Monitor liver function tests during therapy.

Fat Overload Syndrome: Can occur when lipid is infused too rapidly or at excessive doses. Symptoms include fever, anemia, coagulopathy, enlarged liver and spleen, altered mental status, and seizures. Requires immediate evaluation.

Hypersensitivity reactions: Because Intralipid contains soybean oil, egg phospholipids, and glycerin, it is contraindicated in patients with allergies to eggs, soybeans, or peanuts. Signs of allergic reaction include rash, itching, shortness of breath, swelling, or anaphylaxis.

Infections and sepsis: Long-term central venous catheter (CVC) use for PN delivery carries a significant risk of central line-associated bloodstream infections (CLABSI). Fever during PN infusion should always prompt evaluation for line infection.

Refeeding syndrome: In severely malnourished patients, reintroducing nutrition (including PN with Intralipid) too rapidly can cause dangerous electrolyte shifts — particularly low phosphate, potassium, and magnesium. Requires careful laboratory monitoring during initiation.

Aluminum toxicity: Long-term PN patients, especially those with kidney disease or preterm neonates, may accumulate aluminum from PN components. Monitor for neurological symptoms in high-risk patients.

Thrombocytopenia in neonates: Low platelet counts have been reported in neonates receiving IV lipid emulsions. Monitor CBC in this population.

When to Call Your Doctor During Intralipid Therapy

Contact your healthcare provider right away if you experience any of the following:

Fever (temperature ≥ 100.4°F / 38°C) during or within 24 hours of PN infusion

Chills, shaking, or rigors during infusion

Redness, swelling, warmth, or discharge at your IV catheter site

Skin rash, itching, or hives

Yellowing of the skin or eyes (jaundice)

Unusual fatigue, confusion, or changes in mental status

When to Call 911 or Go to the Emergency Room

Seek emergency care immediately if you experience:

Difficulty breathing or shortness of breath during infusion

Signs of anaphylaxis: throat swelling, severe rash, dizziness, loss of consciousness

Severe chest pain or palpitations

Seizures or loss of consciousness (may indicate fat overload syndrome or electrolyte emergency)

Lab Monitoring During Intralipid Therapy

Your provider will monitor these labs regularly to detect side effects early:

Serum triglycerides (typically checked 4-6 hours after infusion at initiation, then periodically)

Liver function tests: ALT, AST, GGT, total bilirubin, direct bilirubin

Complete blood count (CBC): checking for thrombocytopenia

Basic metabolic panel: sodium, potassium, phosphate, magnesium

For information on what medications to avoid while on Intralipid, see: Intralipid Drug Interactions: What to Avoid and What to Tell Your Doctor.