Intravenous fat emulsions

An IV fat emulsion contains soybean or safflower oil and a mixture of natural triglycerides, predominately unsaturated fatty acids. It is used in the prevention and treatment of essential fatty acid deficiency. It also provides nonprotein calories for those receiving TPN when calorie requirements cannot be met by glucose. Examples of intravenous fat emulsion include Intralipid 10% and 20%, Liposyn II 10% and 20%, and Liposyn III 10% and 20%. Fat emulsion is used as a source of calories and essential fatty acids for... 

Patient case A patient s daily nutritional requirements have been estimated to be 100 g protein and 2,000 total kcal. The patient has a central venous access and reports no history of hyperlipidemia or egg allergy. The patient is not fluid restricted. The PN solution will be compounded as an individualized regimen using a single-bag, 24-hour infusion of a 2-in-1 solution with intravenous fat emulsion (IVFE) piggybacked into the PN infusion line. Determine the total PN volume and administration rate by calculating the macronutrient stock solution volumes required to provide the desired daily nutrients. The stock solutions used to compound this regimen are 10% crystalline amino acids (CAA), 70% dextrose, and 20% IVFE. 

Aik Phos, alkaline phosphatase ALT, alanine aminotransferase (SCPT) AST, aspartate aminotransferase (SGOT) Bili, bilirubin EFAD, essential fatty acid deficiency IVFE, intravenous fat emulsion PN, parenteral nutrition. 

F Moussa, F Depasse, V Lompret, J-Y Hautem, J-P Girardet, J-L Fontaine, P Aymard. Determination of phylloquinone in intravenous fat emulsions and soybean oil by high-performance liquid chromatography. J Chromat A 664 189-194, 1994. 

Intravenous fat emulsions contain choline, but not in sufficient amounts to prevent choline deficiency (915,916). 

The phospholipids are widely found in biological membranes and can be used as emulsifiers especially for intravenous fat emulsions, and as a key component of liposomes. The elucidation of factors governing the solubilization of drugs in phospholipid dispersions can provide some clues as to the biological role of interactions with lipid systems in vivo. " Phospholipids have been discussed above and in reference in the context of liposomes. 

Washington, C. The stability of intravenous fat emulsions 33. in total parenteral nutrition mixtures. Int. J. Pharm. 1990,... 

Hematological abnormalities have been found to be associated with prolonged administration of intravenous fat emulsion in children on a program of long-term cyclic parenteral nutrition. Recurrent thrombocytopenia is common and platelet lifespan is reduced. In one study (80), thrombocytopenia occurred in 66% of patients, but most of these had taken drugs that might have interfered with platelet function. Hypercoagulability was not found in the majority of cases. 

Davis SS. Pharmaceutical aspects of intravenous fat emulsions. ] Hasp Pharm 1974 32 149-160,165-171. 

Poloxamers are used as emulsifying agents for intravenous fat emulsions, as solubilising agents to maintain clarity in elixirs and syrups, and as wetting agents for antibacterials. They may also be used in ointment or suppository bases and as tablet binders or coaters. 

The addition of electrolyte or dmgs to intravenous fat emulsions is generally contraindicated because of the risk of destabilising the emulsion. Addition of cationic local anaesthetics reduces the electrophoretic mobility of the dispersed fat globules, and this contributes to instability. Minimum stability (and minimum zeta potential) is caused by addition to Intralipid of 3 x 10 mol dm CaCl2 and 2.5 X 10 mol dm NaCl, which are thus... 

Intravenous fat emulsions. In Wickersham RM, Novak KK, managing eds. Drug Facts and Comparisons. St. Louis, Wolters Kluwer Health, 2003 109-110. 

BattistellaFD, Wildergren IT, Anderson IT, et al. A prospective, randomized trial of intravenous fat emulsion administration in trauma victims requiring total parenteral nutrition. J Trauma 1997 43 52-58. 

Ebbert ML, Farraj M, Hwang LT. The incidence and clinical significance of intravenous fat emulsion contamination during infusion. JPEN J Parenter Enter Nutr 1987 11 42-45. 

Fats have the lowest RQ, but administration of intravenous fat emulsions to mechanically ventilated patients may have the potential to adversely affect pulmonary gas exchange in some clinical conditions. ... 

The development of an amphotericin B microcmulsion for the treatment of ocular mycosis was reported in 1996 by Cohen et al. (39). The vehicle was prepared with Intralipid 20%. an intravenous fat emulsion marketed by Pharmacia and Upjohn, containing soybean oil and egg yolk phospholipids. The emulsion. 

Table 7. Composition of intravenous fat emulsions. (Shenkin and Wretlind 1978)...

These have thus far included studies of the following systems proteins, microemulsions, colloids, copolymers, micelles, liposomes, fibrinogen, internal molecular motions, liquid interfaces, fatty acids, viruses, bacteria, vesicles, viscosity, lipids, motile cells, enzymes, lipoprotein, polyelectrolytes, spores, liquid crystals, glass transmissions, sols, microgels, soot, blood plasma, nanoparticles, swelling latex, gene delivery, and intravenous fat emulsions. 

Two infants with intestinal failure and parenteral nutrition-associated liver disease were given an intravenous fat emulsion containing primarily omega-3 fatty acids instead of the conventional emulsion [30 ]. Biochemical tests of liver function improved significantly. One child was removed from the liver transplantation list because of improved hepatic function, and the second child had complete resolution of cholestasis while solely on parenteral nutrition. 

With the development of stable, energy dense, isotonic lipid emulsions for intravenous use (Table IV), the use of concentrated glucose solutions which have to be infused through large calibre central veins has decreased. Administration of nutrients by peripheral vein eliminates the complications associated with central catheter placement and use (Jako-bowski et al., 1979). Intravenous fat emulsions are manufactured from either soyabean or safflower oil, stabilized with 1.2% egg phospholipid, and made isotonic with 2.5% glycerol. Formulations are rich in essential fatty acids, yield 1.1 kcal/ml, and have a metabolic fate which is similar to that of naturally occurring chylomicrons. Liposyn, however, has only trace amounts of linolenic acid compared to the two other emulsions. In addition, carnitine is absent from all of the lipid emulsions. 

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