Adult Dosing
Prevention of essential fatty acid deficiency
Note: 8-10% of calorie input as fat emulsion. Presence of stress may cause an increase in dose
Intralipid
- Start with 0.5 mL/minute infusion rate for 15-30 mins. If no adverse reactions occur increase to 1 mL/minute
Note:
- More than 500 mL of the drug should be infused on the first day of the treatment. Daily dosage should not exceed 2.5 g of fat/kg of body weight
Liposyn III 10%
- Initial infusion rate of 1.0 mL/minute for 15 mins, if no adverse reaction occurs the rate can be increased to 500 mL over 4-6 hrs
- Max: 3 g/kg/day
Liposyn III 20%
- Initial infusion rate of 0.5mL/minute for 15 mins, if no adverse reaction occurs the rate can be increased to 250 mL over 4-6 hrs
- Max: 3 g/kg/day
Clinolipid
- Usual dose: 1 to 1.5 g/kg/day. Max: 2.5 g of fat/kg of body weight
Note:
- Initial infusion rate should not exceed 0.1 g (equal to 0.5 mL) per minute for the first 15 - 30 minutes
Total parenteral nutrition
- Individualize doses based on caloric requirements. Daily dose should not exceed 2.5 g of fat/kg of body weight and should not exceed 60% of total daily caloric input
Tricyclic overdose[Non-FDA Approved]
- 100 mL over 1 minute, then 400 mL over 30 minute
Calcium Channel Blocker Overdose[Non-FDA Approved]
- 1.5 ml/kg IV bolus, can be repeated followed by a drip of 0.25 ml/kg/min. Maximum dose of 8 ml/kg
Pediatric Dosing
Prevention of essential fatty acid deficiency
Note: 8-10% of calorie input as fat emulsion. Presence of stress may cause an increase in dose
Intralipid
- In premature infants, initial infusion 0.5 g fat/kg body weight/24 hours
- In older pediatric patients initial infusion 0.05 mL/minute for the first 10 to 15 minutes. If no adverse reactions occur, increase to 0.5 mL/kg/hour
Note:
- The maximum dosage recommended by the American Academy of Pediatrics is 3 g fat/kg/24 hour
Liposyn III 10%
- Initial infusion rate 0.1 mL/minute for 15 mins, if no adverse reaction occurs increase to 100 mL/hour
- Max: 3 g/kg/day
Liposyn III 20%
- Initial infusion rate of 0.1 mL/minute for 15 mins, if no adverse reaction occurs increase to 50 mL/hour
- Max: 3 g/kg/day
[Outline]
- Product contains soybean oil, egg phospholipids, and glycerin. There have been case reports of allergy reaction in egg sensitive individuals
- Since the product contains aluminum, it may cause toxicity with prolonged parenteral administration and may lead to renal impairment
- Increased risk in premature neonates have been reported due to therapy, hence not recommended for use in pediatric patients
- Patient receiving parenteral levels of aluminum >4-5 mcg/kg/day and having impaired kidney function including premature neonates are at risk of aluminum accumulation at levels associated with central nervous system and bone toxicity
- Tissue loading has been reported with lower rates of infusion
- Check fat elimination by monitoring serum triglyceride levels
- Avoid overdose
- If signs or symptoms of a hypersensitivity reaction develops including tachypnea, dyspnea, hypoxia,bronchospasm, tachycardia, hypotension, cyanosis, vomiting, nausea, headache, sweating, dizziness, altered mentation, flushing, rash, urticaria, erythema, pyrexia and chills then immediately stop infusion
- Patients requiring parenteral nutrition are at high risk of infections, fat overload syndrome, and refeeding complications
- Frequent clinical and laboratory determinations are necessary in patients with pulmonary edema or heart failure
- Perform LFTs if therapy is recommended for prolong time, Consider discontinuation of therapy if impaired liver function. Measure platelet counts daily in neonatal patients receiving this therapy
Cautions: Use cautiously in
- Hepatic impairment
- Renal impairment
- Patient suffering from fat metabolism disorder
- Pathologic hyperlipemia
- Lipoid nephrosis
- Acute pancreatitis along with hyperlipemia
- Premature Infants
Pregnancy Category:C
Breastfeeding: Manufacturer advises caution