lipid emulsion, injectable

General

Pronunciation:
lip-id ee-mull-shun

Trade Name(s)

• Clinolipid

Ther. Class.
parenteral nutrition

Pharm. Class.
lipid calorie sources

Indications

To provide a source of calories and essential fatty acids when oral/enteral nutrition is not possible.

Action

Provision of calories and fatty acids which act as substrates for energy production (beta oxidation of fatty acids), also provide membrane structure/function, provide precursor for bioactive molecules and gene expression.

Therapeutic Effect(s):

Maintenance of lipid homeostasis during parenteral nutrition.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability; fatty acids are converted to other fatty acids by the liver.

Distribution: Unknown.

Metabolism and Excretion: Metabolized by cell to CO₂ and water, which are converted to energy in the form to adenosine triphosphate (ATP). Storage forms allow continual turnover. Excess CO₂ is expired via lungs and water is eliminated in urine, skin and other tissue surfaces. Additional lipids may undergo biliary excretion.

Half-life: Unknown.

TIME/ACTION PROFILE

Contraindication/Precautions

Contraindicated in:

• Known hypersensitivity to egg or soybean proteins, lipid emulsion or other contents of product
• Severe hyperlipidemia or dyslipidemia.

Use Cautiously in:

• Hepatic impairment
• Severe fluid/electrolyteolic/metab disorders (correct prior to use)
• ↑ triglyceride levels (initiate at lower dose, advance in small increments)
• Geri: Elderly patients may be sensitive to effects;
• OB: Use during pregnancy only if clearly needed;
• Lactation:Use cautiously if breastfeeding;
• Pedi: Pre-term/low birth weight infants have poor lipid clearance (deaths have occurred); does not contain sufficient amounts of essential fatty acids for routine use in children.

Adverse Reactions/Side Effects

GI: ↑ liver enzymes, nausea, PARENTERAL NUTRITION-ASSOCIATED LIVER DISEASE, vomiting

Endo: hyperglycemia

Metabolic: fat overload syndrome, hypoproteinemia, refeeding syndrome, ↑ triglycerides

Misc: HYPERSENSITIVITY REACTIONS INCLUDING ANAPHYLAXIS

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

May ↓ anticoagulant effect of warfarin (due to soybean oil Vitmain K₁ content).

Route/Dosage

IV: (Adults) Usual dose– 1–1.5 g/kg/day (not to exceed 2.5 g/kg/day); dose depends on multiple considerations including energy expenditure, clinical status, body weight, tolerance, metabolic status and other energy sources.

Availability

Emulsion for intravenous infusion: 20% lipid emulsion (contains 0.2 g lipids/mL)

Assessment

• Monitor for signs and symptoms of hypersensitivity or allergic reactions (tachypnea, dyspnea, hypoxia, bronchospasm, tachycardia, hypotension, cyanosis, vomiting, nausea, headache, sweating, dizziness, altered mentation, flushing, rash, urticaria, erythema, pyrexia, chills) during infusion. Stop infusion immediately and treat symptomatically if symptoms occur.
• Monitor for signs and symptoms of infections (fever, chills, leukocytosis, hyperglycemia) during therapy. Check parenteral access device frequently.
• Monitor for signs and symptoms of fat overload syndrome (sudden deterioration in patient condition, fever, anemia, leukopenia, thrombocytopenia, coagulation disorders, hyperlipidemia, liver fatty infiltration or hepatomegaly, deteriorating liver function, coma) during therapy. Usually reversible when lipid infusion is discontinued but may occur when lipid dose exceeded.
• Carefully monitor severely undernourished patients for signs and symptoms of refeeding syndrome (intracellular shift of potassium, phosphorous, and magnesium as anabolism develops. Thiamine deficiency and fluid retention may develop). Avoid overfeeding and slowly increase nutrient intake to prevent syndrome.
• Monitor fluid status in patients with pulmonary edema or HF.

Lab Test Considerations: Obtain serum triglyceride levels to establish baseline value prior to administering lipids. If triglyceride values are ↑ initiate lipid infusion at a lower dose, advance in smaller increments, and check triglyceride levels before each adjustment.

• Monitor serum triglycerides, fluid and electrolyte status, serum osmolarity, blood glucose, liver and kidney function, CBC with platelets and coagulation parameters periodically during therapy. Reduce dose of lipid infusion in patients with serum triglycerides >400 mg/dL.
• Monitor for essential fatty acid deficiency (EFAD) using serum fatty acid levels.
• May interfere with anticoagulant activity due to content of Vitamin K.
• May cause aluminum toxicity in premature infants and patients with impaired kidney function who receive aluminum levels >4 to 5 mcg/kg/day. Clinolipid contains no >25 mcg/L of aluminum.

Potential Diagnoses

• Imbalanced nutrition: less than body requirements (Indications)

Implementation

• Correct severe water and electrolyte disorders, severe fluid overload states, and severe metabolic disorders before infusion of lipids.

Patient/Family Teaching

• Explain purpose of lipid infusion to patient.
• If patient is trained to self-administer lipid infusion at home instruct patient to inspect bag for particulate matter and evenly distributed liquid, ensure in-line filter is used, and emphasize need for periodic lab tests. Advise patient to notify health care professional immediately if signs and symptoms of infection or allergic reaction occur.
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
• Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Maintenance of lipid homeostasis.