Parenteral Nutrients and Formulations


TABLE 3.1 Daily Doses of Different Intravenous Lipid Emulsion Formulas to Prevent Essential Fatty Acid Deficiency9


Intravenous lipid emulsion formulation


100% soybean oil


2-oil mixture (80% olive oil and 20% soybean oil)


4-oil mixture (30% soybean oil, 30% medium-chain triglycerides, 25% olive oil, and 15% fish oil)


a


Dosage to prevent essential fatty acid deficiency based on energy needs (g)a


1,000 kcal/d 1,500 kcal/d 2,000 kcal/d 4


6 12 12 18 18 8 25 25


These amounts may be provided in larger, less frequent doses as clinically appropriate (eg, 50 g 4 times weekly, rather than 25 g daily).


states, such as acute respiratory distress syndrome and sepsis.12 alternative ILE should be considered in patients who are critically ill.5,9,13


Use of


Contraindications to Intravenous Lipid Emulsions ILE should not be used in patients with triglyceride-induced pancreatitis or in those who have serum triglyceride levels greater than 1,000 mg/ dL. When triglyceride levels are greater than 400 mg/ dL, the ILE dose may be reduced or held altogether. However, when lipids are omitted from PN, monitoring for EFAD is essential, and ILE should be restarted when the hypertriglyceridemia is resolved.9 Adverse reactions to ILE have been reported, although their occurrence


is rare. Risk of adverse events may be affected by lipid infusion rate, total daily volume, and duration of use.14


Any food allergies noted by the patient


should also be considered. The egg phospholipid component used as an emulsifier or soybean protein may generate an allergic response charac- terized by dyspnea, flushing, sweating, dizziness, headache, nausea, or vomiting. It is usually assumed that sensitivity to the lipid infusion is the cause if symptoms resolve following discontinuation of the lipid infusion. Because there is cross-reactivity between peanut and soybean, use caution when considering the use of soybean-based ILE in patients with peanut allergies. The severity of the patient’s allergy and availability of alternative ILE should be considered when determining whether the patient should receive soybean-based ILE.9


Alternative ILEs contain fish oil, olive oil,


35


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