Formulation, stability, and administration of parenteral nutrition with new lipid emulsions.
Intravenous lipid emulsions (IVLE) are an important source of energy and essential fatty acids and their incorporation into pediatric and adult parenteral nutrition (PN) regimens has revolutionized nutrition therapy. However, their clinical use has not been without risk, and will continue to remain so because of the intravenous route of administration. Pharmaceutical and microbiological concerns are centered around the methods of compounding all-in-one (AIO) admixtures, but these can be largely minimized with today's technologies and advanced understanding of aseptic principles. Modern lipid products, based on olive, coconut, and/or fish oils, have demonstrable formulation and clinical benefits over traditional soybean and safflower IVLE and, when combined in the new multi-chamber bags, can also offer improvements in stability and safety. This review outlines the rationale for different lipid formulations in PN admixtures, reviews the factors influencing stability and efficacy of lipid-based AIO regimens and evaluates some technologies for minimizing peroxidation and maximizing stability of AIO admixtures.
Hardy
Gil
G
Faculty of Medical and Health Sciences, University of Auckland, Boyle Crescent, Auckland PB 92019, New Zealand. g.hardy@auckland.ac.nz
Puzovic
Marko
M
D000328:Adult; D002648:Child; D000074263:Coconut Oil; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005395:Fish Oils / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D015227:Lipid Peroxidation; D000069463:Olive Oil; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods*; D010938:Plant Oils / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012450:Safflower Oil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D013024:Soybean Oil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D000069463:Olive Oil; D010938:Plant Oils; D013024:Soybean Oil; D012450:Safflower Oil; D000074263:Coconut Oil