FAT EMULSION, INTRAVENOUS

FAT EMULSION, INTRAVENOUS
(fat e-mul'sion)
Intralipid, Liposyn II, Soyacal
Classifications: caloric agent; lipid emulsion;
Therapeutic: nutritional supplement
; lipid emulsion
Pregnancy Category: B for Soyacal 10%; C for all others

Availability

10%, 20%, 30% emulsion

Action

Soybean oil in water emulsion containing egg yolk phospholipids and glycerin. Liposyn 10% is a safflower oil in water emulsion containing egg phosphatides and glycerin.

Therapeutic Effect

Used as a nutritional supplement. Fat emulsions contain a mixture of neutral triglycerides, and mostly unsaturated fatty acids.

Uses

Fatty acid deficiency. Also to supply fatty acids and calories in high-density form to patients receiving prolonged TPN therapy who cannot tolerate high dextrose concentrations or when fluid intake must be restricted as in renal failure, CHF, ascites.

Contraindications

Hyperlipemia; bone marrow dyscrasias; impaired fat metabolism as in pathological hyperlipemia, lipoid nephrosis, acute pancreatitis accompanied by hyperlipemia; pregnancy (category C).

Cautious Use

Severe hepatic or pulmonary disease; coagulation disorders; anemia; newborns, premature neonates, infants with hyperbilirubinemia; when danger of fat embolism exists; diabetes mellitus; thrombocytopenia; history of gastric ulcer.

Route & Dosage

Prevention of Essential Fatty Acid Deficiency
Adult: IV 500 mL of 10% or 250 mL of 20% solution twice/wk (max: rate of 100 mL/h)
Child: IV 5–10 mL/kg/d twice/wk (max: 3–4 g/kg/d; max: rate of 100 mL/h)

Calorie Source in Fluid-Restricted Patients
Adult: IV Up to 2.5 g/kg or 60% of nonprotein calories daily (max: rate of 100 mL/h)
Child: IV Up to 4 g/kg or 60% of nonprotein calories daily (max: rate of 100 mL/h)
Premature Neonate: IV 0.25–0.5 g/kg/d, increase by 0.25–0.5 g/kg/d (max: 3–4 g/kg/d; max: infusion 0.15 g/kg/h)

Administration

Intravenous
  • Do not use if oil appears to be separating out of the emulsion.

PREPARE: IV Infusion: Allow preparations that have been refrigerated to stand at room temperature for about 30 min before using whenever possible. Check with a pharmacist before mixing fat emulsions with electrolytes, vitamins, drugs, or other nutrient solutions.  

ADMINISTER: IV Infusion for Adult: ?? 10% emulsion: Infuse at 1 mL/min for first 15–30 min; increase to 2 mL/min if no adverse reactions.?? 20% emulsion: Infuse at 0.5 mL/min for first 15–30 min; increase to 2 mL/min if no adverse reactions occur. IV Infusion for Child: ?? 10% emulsion: Infuse at 0.1 mL/min for first 10–15 min; increase to 1 g/kg in 4 h if no adverse reactions occur.??Do not exceed 100 mL/h.?? 20% emulsion: Infuse at 0.05 mL/min for first 10–15 min; increase to 1 g/kg in 4 h if no adverse reactions occur.??Do not exceed 50 mL/h. IV Infusion for Premature Neonate: ??Infuse at rate not to exceed 0.15 g/kg/h. IV Infussion for All Patients: ??Give fat emulsions via a separate peripheral site or by piggyback into same vein receiving amino acid injection and dextrose mixtures or give by piggyback through a Y-connector near infusion site so that the two solutions mix only in a short piece of tubing proximal to needle.??Must hang fat emulsions higher than hyperalimentation solution bottle to prevent backup of fat emulsion into primary line.??Do not use an in-line filter because size of fat particles is larger than pore size.??Control flow rate of each solution by separate infusion pumps.??Use a constant rate over 20–24 h to reduce risk of hyperlipemia in neonates and prematures because they tend to metabolize fat slowly. 

INCOMPATIBILITIES Solution/additive: Aminophylline, amphotericin B, ampicillin, calcium chloride, calcium gluconate, dextrose 10%, gentamicin, hetastarch, magnesium chloride, penicillin G, phenytoin, ranitidine, vitamin B complex. Y-site: Acyclovir, albumin, amphotericin B, cyclosporine, doxorubicin, doxycycline, droperidol, ganciclovir, haloperidol, heparin, hetastarch, hydromorphone, levorphanol, lorazepam, midazolam, minocycline, nalbuphine, ondansetron, pentobarbital, phenobarbital, potassium phosphate, sodium phosphate.

  • Discard contents of partly used containers.
  • Store, unless otherwise directed by manufacturer, Intralipid 10% and Liposyn 10% at room temperature [25° C (77° F) or below]; refrigerate Intralipid 20%. Do not freeze.

Adverse Effects (≥1%)

Body as a Whole: Hypersensitivity reactions (to egg protein), irritation at infusion site. Hematologic: Hypercoagulability, thrombocytopenia in neonates. GI: Transient increases in liver function tests, hyperlipemia. [Long-Term Administration] Sepsis, jaundice (cholestasis), hepatomegaly, kernicterus (infants with hyperbilirubinemia), shock (rare).

Diagnostic Test Interference

Blood samples drawn during or shortly after fat emulsion infusion may produce abnormally high hemoglobin MCH and MCHC values. Fat emulsions may cause transient abnormalities in liver function tests and may interfere with estimations of serum bilirubin (especially in infants).

Interactions

Drug: No clinically significant interactions established.

Nursing Implications

Assessment & Drug Effects

  • Observe patient closely. Acute reactions tend to occur within the first 2? h of therapy.
  • Lab tests: Determine baseline values for hemoglobin, platelet count, blood coagulation, liver function, plasma lipid profile (especially serum triglycerides and cholesterol, free fatty acids in plasma). Repeat 1 or 2 times weekly during therapy in adults; more frequently in children. Report significant deviations promptly.
  • Lab tests: Obtain daily platelet counts in neonates during first week of therapy, then every other day during second week, and 3 times a week thereafter because newborns are prone to develop thrombocytopenia.
  • Note: Lipemia must clear after each daily infusion. Degree of lipemia is measured by serum triglycerides and cholesterol levels 4–6 h after infusion has ceased.

Patient & Family Education

  • Report difficulty breathing, nausea, vomiting, or headache to physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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