Effects of Multiple Infusions of a Fat Emulsion on Blood Coagulation, Liver Function and Urinary Excretion of Steroids in Schizophrenic Patients

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Abstract
The present study was designed to investigate the cause of the delayed adverse reaction in patients given multiple intravenous infusions of fat emulsion; thirteen patients institutionalized with schizophrenia (eight men and five women) were given 1.05 to 2.0 gm. of fat per kg. of body weight per day as a 15 per cent cottonseed oil emulsion (Lipomul I.V.) for twenty to twenty-nine consecutive days. A “delayed adverse reaction” or “overloading syndrome” was observed in two men and two women, an incidence of 31 per cent. The delayed adverse reaction was mild in three patients, but moderately severe in the fourth. Bromsulfalein retention was increased in nine patients, slightly in most instances. Results of other liver function tests including serum alkaline phosphatase and prothrombin time did not show any significant or consistent changes. The average coagulation time of whole blood decreased immediately after the completion of individual fat infusions, but became prolonged as a result of long-term administration of fat. The weekly determinations of blood platelets showed a progressive decrease, but no significant changes were observed during or immediately after the individual infusions. Plasma fibrinogen did not show any significant changes; however, fresh oxalated plasma, obtained after fourteen to twenty infusions had been given, failed to form firm clots after recalcification. Clot retraction of blood was poor during the latter part of the long-term infusions. In all patients the 24 hour urinary excretion of both 17-hydroxycorti-costeroids (17-OHCS) and 17-ketosteroids (17-KS) was decreased; the decrease reaching the extremely low level of less than 4 mg per 24 hours in the delayed adverse reaction.