Indications
This is a sterile 20% fat (lipid) emulsion made from purified soybean oil, used in intravenous (IV) nutrition. It provides a concentrated source of energy and essential fatty acids for patients who cannot eat or absorb enough food through the gut, such as after major surgery, in severe illness, bowel failure, or in premature and sick newborn babies. It is usually given with amino acids, glucose, electrolytes and vitamins as part of a full parenteral nutrition plan, and is also used in some ready-mixed multi-chamber nutrition bags.
How It Works
The emulsion contains tiny droplets of soybean oil stabilised with egg phospholipids, with glycerol added. Once in the blood, the droplets are handled like natural dietary fat: they are broken down and used by the body for energy, while the essential fatty acids (linoleic and alpha-linolenic acid) are used to build cell membranes and important body chemicals. Fat provides more energy in a small volume than sugar, which helps meet energy needs without giving too much fluid or glucose.
Dosage and Administration
Given only in hospital by doctors and nurses. The dose and infusion rate are calculated according to body weight, age, condition and blood fat (triglyceride) levels, and given as prescribed. It is infused slowly into a vein, often over 12 to 24 hours, either alone through a separate line or as part of a mixed nutrition bag. In newborns and infants, the rate is strictly controlled and the line protected from light.
Interactions
It contains vitamin K from soybean oil, which can reduce the effect of Warfarin. Heparin given with the infusion may temporarily increase fat clearance. Other medicines should not be added unless known to be compatible, as they may break the emulsion. Very high blood fat levels can interfere with some laboratory tests, so blood is usually taken after the infusion has cleared.
Contraindications
Not used in people with severe allergy to egg, soybean or peanut protein (cross-reactions can occur), severe hyperlipidaemia (very high blood fats), severe liver failure, severe blood clotting disorders, shock or unstable circulation, acute heart attack or stroke, severe sepsis with acidosis, or fat embolism.
Side Effects
Possible effects include a slight rise in body temperature, chills, flushing, nausea, vomiting, headache, back or chest pain, and shortness of breath, mostly at the start or if infused too fast. Allergic reactions can occur. Long-term use may affect the liver. Too fast or too much infusion can cause fat overload syndrome, with fever, liver enlargement, low platelets, bleeding and organ problems.
Tell the nurse or doctor straight away about breathing difficulty, chest pain, rash or swelling of the face, high fever, yellowing of the skin, unusual bleeding or bruising, or pain at the drip site, as these need urgent medical attention.
Pregnancy and Lactation
It may be used in pregnancy and breastfeeding when the doctor decides that IV nutrition is needed, with monitoring.
Precautions and Warnings
- Blood triglycerides, liver function, platelets and blood sugar are monitored during treatment.
- Use with care in liver or kidney disease, diabetes, pancreatitis, low thyroid function, sepsis and blood clotting problems.
- In premature babies the infusion rate is strictly limited, as fat can build up in the lungs.
- Shake gently and use only if the emulsion is evenly milky; do not use if oil drops or layers have separated.
- Strict sterile technique is needed; use promptly after opening.
Overdose
An overdose or too-fast infusion can cause fat overload syndrome. The infusion is stopped, and the condition usually improves; supportive treatment is given and blood tests monitored.
Therapeutic Class
Parenteral nutrition, lipid (fat) emulsion for intravenous use
Storage
Store below 25°C, do not freeze, and keep in the outer carton or overpouch. Discard if frozen or if the emulsion has separated. Hospital use only; keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.