Indications
Lipids here means an intravenous fat (lipid) emulsion used as part of parenteral nutrition, which is feeding directly into a vein. It supplies energy and essential fatty acids to patients who cannot eat or absorb enough food through the gut, for example after major surgery, in severe illness or with bowel failure. It is often supplied in multi-chamber bags together with amino acids and glucose.
How It Works
The emulsion contains tiny droplets of oils (such as soybean oil, medium-chain triglycerides, olive oil and fish oil) stabilised with egg phospholipids. Once in the bloodstream the body breaks the droplets down like dietary fat and uses the fatty acids for energy and to build cell membranes. Omega-3 and omega-6 fatty acids prevent essential fatty acid deficiency.
Dosage and Administration
It is given as a slow infusion into a vein (usually a central vein for mixed bags) by a doctor or nurse, in hospital or under specialist home care. The amount and rate are as prescribed and are based on body weight, energy needs and blood tests such as triglyceride levels.
Interactions
- Heparin given with it may briefly affect how fats are cleared from the blood.
- The Vitamin K in some oils may reduce the effect of Warfarin; clotting tests are monitored.
- Other medicines should not be added to the bag unless compatibility is confirmed by a pharmacist.
Contraindications
- Allergy to egg, fish, soy or peanut protein, or any ingredient.
- Very high blood fat levels (severe hyperlipidaemia) or severe disorders of fat metabolism.
- Severe liver failure, severe blood clotting disorders, and unstable conditions such as shock or severe acidosis.
Side Effects
Possible effects include a slight rise in temperature, chills, nausea, vomiting, headache, raised blood fat levels and changes in liver tests. If given too fast, it can cause breathlessness, flushing and back or chest pain. With long-term use, liver problems and fat overload syndrome (fever, enlarged liver and spleen, low platelets) can occur. Infection of the IV line is a risk with any parenteral nutrition.
Get urgent medical help (tell the nurse at once) if there is difficulty breathing, chest pain, swelling of the face, rash, high fever with shivering, or redness and pain at the line site.
Pregnancy and Lactation
It may be used in pregnancy and breastfeeding when nutrition through a vein is needed, under close medical supervision.
Precautions and Warnings
- Blood triglycerides, glucose, salts and liver tests are checked regularly.
- Given with extra care in premature babies, liver or kidney disease, and infections.
- Strict hygiene is needed when handling the line to prevent infection.
- Do not use if the emulsion has separated or the bag is damaged.
Overdose
Too much or too fast can cause fat overload syndrome with fever, breathing difficulty and organ problems. The infusion is stopped and the patient is treated; symptoms usually improve once it is stopped.
Therapeutic Class
Parenteral nutrition, intravenous lipid emulsion.
Storage
Hospital product: store as directed on the pack, usually below 25°C; do not freeze. 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.