fat ee-MUL-shun

Therapeutic Classification: caloric sources

• Provision of nonprotein calories to patients whose total caloric needs cannot be met by carbohydrates (glucose) alone, usually as part of parenteral nutrition.
• Treatment and prevention of essential fatty acid deficiency in patients receiving long-term parenteral nutrition (provides linoleic acid).

• Acts as a nonprotein calorie source.

• Provision of essential fatty acids and nonprotein calories.

Absorption: IV administration results in complete bioavailability.

Distribution: Distributes into intravascular space.

Metabolism/Excretion: Cleared by conversion to triglycerides, then to free fatty acids and glycerol by lipoprotein lipase. Free fatty acids are transported to tissues, where they may be oxidized as an energy source or re-stored as triglycerides.

Half-life: 30–60 min.

Contraindicated in:

• Hyperlipidemias
• Lipoid nephrosis
• Pancreatitis accompanied by lipemia
• Hypersensitivity to egg products (emulsifier is egg yolk phospholipid), legumes, soybeans, or fat emulsions.

Use Cautiously in:

• Thromboembolic disorders
• Severe liver or pulmonary disease
• Anemia or bleeding disorders
• Patients who are at risk for fat embolism.

Exercise Extreme Caution in:

• Preterm infants (↓ ability to clear fat emulsion).

Seen only with long-term use.†

CV: chest pain.

Endo: hypertriglyceridemia.

GI: hepatomegaly†, jaundice†, nausea, pancreatitis, vomiting.

Local: phlebitis at IV site.

Resp: INTRAVASCULAR FAT ACCUMULATION(PRETERM INFANTS ONLY).
Misc: fever, infection, chills, hypersensitivity reactions.

Drug-Drug:

• Concurrent use withpropofol may ↑ risk of hypertriglyceridemia.

Total Parenteral Nutrition

• IV (Adults): Initial dose: 1 g/kg/day, increase by 0.5–1 g/kg/day to a maximum of 2.5 g/kg/day.
• IV (Children 1 mo): Initial dose: 0.5–1 g/kg/day, increase by 0.5 g/kg/day to amaximum of 3 g /kg/day.
• IV (Neonates premature): Initial dose: 0.25–0.5 g/kg/day, increase by 0.25–0.5 g/kg/day to a maximum of 3 g/kg/day.

Essential Fatty Acid Deficiency

• IV (Adults and Children): Provide 8–10% of caloric intake as fat, infuse once or twice weekly.

• Emulsion for IV Use: 10%; 20%; 30%;

• Monitor weight every other day in adults and daily in infants and children receiving fat emulsion to assist in meeting caloric requirements.
• Assess patient for allergy to eggs prior to therapy. Acute hypersensitivity reaction with pruritic urticaria may occur in patients allergic to eggs.

• Monitor triglyceride and fatty acid levels routinely to determine patient’s capacity to eliminate infused fat from the circulation. Lipemia must clear between daily infusions.
  • Monitor hemoglobin, blood coagulation, and platelet count weekly, especially during continuous therapy. Report abnormalities promptly. Therapy may be discontinued.
  • Monitor serum bilirubin, cholesterol, and hepatic function weekly, especially in premature infants to prevent hyperlipidemia.

• If signs of overloading syndrome (focal seizures, fever, leukocytosis, splenomegaly, shock) or elevated triglyceride or free fatty acid levels occur, infusion should be stopped and the patient re-evaluated prior to reinstituting therapy.

IV Administration:

• Fat emulsion should comprise no more than 60% of patient’s total caloric intake. The remaining 40% should consist of carbohydrates and amino acids.
  • Fat emulsion may be administered via peripheral or central venous catheter. Monitor peripheral sites for phlebitis.
  • Infuse fat emulsion via Y-site near the infusion site. Because of the lower specific gravity, the fat emulsion solution must be hung higher than the amino acid and dextrose solutions to prevent the fat emulsion from backing up into the amino acid and dextrose line.
  • Manufacturer does not recommend use of filters during administration, but 1.2-micron filters have been used.
  • Use tubing provided by the manufacturer. Change IV tubing after each dose of fat emulsion.
• Intermittent Infusion: Emulsions that appear oily or that have separated should not be used.30% emulsions must not be infused directly.
  • Pedi: Avoid use of 10% emulsion in preterm infants; a greater accumulation of plasma lipids occurs due to the greater phospholipid load of the 10% emulsion.
  • Maximum hang times for fat emulsion alone or for admixtures with dextrose and amino acids is 24 hr. Discard all unused portions.
• Rate: For adults, the initial infusion rate should be 1 mL/min for the 10% solution and 0.5 mL/min for the 20% solution for the first 15–30 min. If no adverse reactions occur, the rate may be increased to infuse 50 mL/hr for the 20% solution or 100 mL/hr for the 10% solution.
  • No more than 500 mL of the 10% solution or 250 mL of 20% solution should be infused at one time.
  • Pedi: For children, the initial infusion rate should be 0.1 mL/min of the 10% solution and 0.05 mL/min for the 20% solution for the first 10–15 min. If no adverse reactions occur, the rate may be increased to a maximum of 0.25 g/kg/hr.
  • Administer via infusion pump to ensure accurate rate.
• Y-Site Compatibility:
  • ampicillin
  • cefazolin
  • cefoxitin
  • clindamycin
  • digoxin
  • dopamine
  • erythromycin lactobionate
  • furosemide
  • gentamicin
  • isoproterenol
  • lidocaine
  • norepinephrine
  • oxacillin
  • penicillin G potassium
  • tobramycin
• Y-Site Incompatibility:
  • amikacin
• Additive Compatibility:
  • Fat emulsion may be admixed (“3-in-1,” all-in-one, triple mix total nutrient admixture [TNA]) or administered simultaneously with amino acid and dextrose solutions
  • Intralipid is compatible with FreAmine II 8.5%
  • Travasol without electrolytes 8.5% and 10%
  • Veinamine 8%
  • cimetidine
  • famotidine
  • hydrocortisone
  • multivitamins
  • nizatidine
  • dextrose 10% and 70%
  • While not generally recommended, heparin may be added in a concentration of 1–2 units/mL prior to administration to increase clearance rate of lipemia, minimize risks associated with hypercoagulability, and prevent catheter thrombosis
• Additive Incompatibility: Although compatibility studies have been done, manufacturer recommends that fat emulsion not be admixed with any other medication.

• Explain the purpose of fat emulsion to the patient prior to administration.

• Weight gain.
  • Maintenance of normal serum triglyceride and fatty acid levels.

Intralipid, Liposyn III