title: Use of a fish oil-based lipid emulsion to treat essential fatty acid deficiency in a soy allergic patient receiving parenteral nutrition.
abstract: The treatment of essential fatty acid deficiency (EFAD) in a 17-year-old male following allogeneic bone marrow transplantation is described. His transplant was complicated by gastrointestinal bleeding that precluded the use of enteral feedings. Due to a severe soy allergy, he could not tolerate any intravenous fat emulsions marketed in the US. After months of receiving fat-free parenteral nutrition and intermittent use of enteral feeds, he developed signs and symptoms consistent with EFAD, including a rash and an elevated plasma triene:tetraene ratio of 0.231 (0.013-0.05). After receiving FDA approval, a parenteral fish oil emulsion was administered to provide fat calories and sufficient alpha-linolenic and linoleic acid to correct his EFAD. Therapy was initiated at 0.2 g/kg/day and advanced to 0.67 g/kg/day, providing approximately 45 mg/kg/day of linoleic acid. After 10 days of therapy, his rash disappeared and his triene:tetraene ratio improved to 0.07. By day 17 the ratio normalized to 0.047. This suggests that using a fish oil emulsion with minimal linoleic acid may be safely used as the sole source of fat calories and may be an option to prevent or treat EFAD in subjects allergic to soy that require a parenteral source of fat.
authors: Department of Pharmacy, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA. kathleen.gura@childrens.harvard.edu
authors: Kathleen M
authors: KM
authors: Gura
authors: Susan K
authors: SK
authors: Parsons
authors: Lori J
authors: LJ
authors: Bechard
authors: Tara
authors: T
authors: Henderson
authors: Morna
authors: M
authors: Dorsey
authors: Wanda
authors: W
authors: Phipatanakul
authors: Christopher
authors: C
authors: Duggan
authors: Mark
authors: M
authors: Puder
authors: Carine
authors: C
authors: Lenders
mesh_terms: D000293:Adolescent; D016026:Bone Marrow Transplantation; D002149:Energy Intake; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects / Q000737:chemistry*; D005228:Fatty Acids, Essential / Q000097:blood / Q000172:deficiency*; D005395:Fish Oils / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000628:therapy; D006801:Humans; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods; D012449:Safety; D016896:Treatment Outcome
chemical_list: D005217:Fat Emulsions, Intravenous; D005228:Fatty Acids, Essential; D005395:Fish Oils