case_images: PMC6716805_01
case_images: urticarial rash on left forearm. After receiving TPN at 2785 mOsmol/kg. Image courtesy of patient, used with permission. Cropping and minor lighting adjustments made for clarity
case_images: 13223_2019_364_Fig1_HTML.jpg
case_images: PMC6716805_01_13223_2019_364_Fig1_HTML.jpg
case_images: Fig1
case_images: Smoflipid at 5 mL/h for 6 h and cetirizine 5 mg 3 h before lipids. 2 h after starting the infusion, the TPN was temporarily infused at 100 mL/h before being lowered to the prescribed rate of 33 mL/h. 1 h afterwards, she reported itchiness, hives and erythema on both hands (see Fig. 1). Smoflipid was held. She was given one dose of diphenhydramine 25 mg.