In addition to pulmonary toxicity, large dose and/or more rapid infusion of IFE have the potential to induce a fat overload syndrome. The fat overload syndrome is characterized by hyperlipemia, fever, fat infiltration, hepatomegaly, jaundice, splenomegaly, anemia, leukopenia, thrombocytopenia, coagulation disturbances, seizures, and coma. Multiple end-organ dysfunction is attributed to inadequate clearance of lipids and sludging in the lungs, brain, kidney, retina, and liver.7,8,12,17,22,24,34,35,40 Because of the rapid redistribution of most local anesthetics, prolonged IFE infusion should not be required (see Chap. 66). However, many other lipid-soluble xenobiotics have a long duration of toxicity and prolonged IFE infusions may be recommended, resulting in a fat overload syndrome.