Intravenous Fat Emulsion Formulations for the Adult and Pediatric Patient

Abstract

Intravenous lipid emulsions (IVLE) provide essential fatty acids (FA) and are a dense source of energy in parenteral nutrition (PN). Parenterally administered lipid was introduced in the 17th century but plagued with side effects. The formulation of lipid emulsions later on made it a relatively safe component for administration to patients. Many ingredients are common to all IVLE, yet the oil source(s) and its (their) percentage(s) makes them different from each other. The oil used dictates how IVLE are metabolized and cleared from the body. The FA present in each type of oil provide unique beneficial and detrimental properties. This review provides an overview of IVLE and discuss factors that would help clinicians choose the optimal product for their patients. Elucidating the characteristics of each oil source over time has resulted in an evolution of the different formulations currently available. Emulsions have gone from being solely made with soybean oil, to being combined with medium-chain triglycerides (i.e., coconut oil), olive oil, and more recently, fish oil. Unfortunately, the lipid, among other constituents in PN formulations, has been associated with the development of liver disease. Lipid-sparing or lipid-reduction strategies have therefore been proposed to avoid these complications. The ideal IVLE would reverse or prevent essential FA deficiency without leading to complications, while simultaneously providing energy to facilitate normal growth and development. Modifications in their ingredients, formulation, and dosing have made IVLE a relatively safe component alone or when added to PN formulations. The ideal emulsion, however, has yet to be developed.

Metabolic Complications of Home Parenteral Nutrition

“…A new IV fat emulsion product containing a combination of soybean oil, olive oil, fish oil, and medium‐chain triglycerides has been approved by the Food and Drug Administration (FDA) for use in the United States. Although its use is currently limited, clinical studies have shown this IV fat emulsion to have less inflammatory properties, high antioxidant content, and decreased risk of cholestasis in HPN‐dependent patients 61 …”

Innovative Discharge Process for Families with Pediatric Short Bowel Syndrome: A Prospective Nonrandomized Trial

“…Another limitation to generalizability was that many patients used an investigational lipid emulsion Omegaven (Fresenius Kabi AG, Bad Homburg vdh, Germany). Omegaven requires specific administration techniques as it is dispensed in 100 ml bottles and is not available as a total nutrient admixture, thus requiring the use of an additional infusion pump and a different administration set with a vented spike . A final limitation is that it is difficult to control for all non‐HPN factors that contribute to postdischarge adverse events such as readmission.…”

Emergence of Mixed‐Oil Fat Emulsions for Use in Parenteral Nutrition

“…In Europe, work by Schubert and Wretlind 12 showed that the use of SO stabilized with egg yolk phosphatides in 2.5% glycerol solution caused no significant reactions, leading to the introduction and acceptance of Intralipid (produced by Fresenius Kabi [Bad Homburg, Germany] and sold by Baxter [Deerfield, IL] in the United States) in the United Kingdom, France, and Scandinavia in 1961. In the United States, Intralipid did not receive Food and Drug Administration (FDA) approval until 1972, leading to the continued use of high‐dextrose, lipid‐free PN 13 . Subsequent reports began to link this PN formulation to hyperosmolar hyperglycemic nonketotic diabetic coma, hepatic enzyme elevations, fatty liver, and EFAD, especially in children 14 – 19 .…”