Formulation, stability, and administration of parenteral nutrition with new lipid emulsions

Nutr Clin Pract. 2009 Oct-Nov;24(5):616-25. doi: 10.1177/0884533609342445.

Abstract

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.

Publication types

  • Review

MeSH terms

  • Adult
  • Child
  • Coconut Oil
  • Fat Emulsions, Intravenous / administration & dosage
  • Fat Emulsions, Intravenous / adverse effects
  • Fat Emulsions, Intravenous / therapeutic use*
  • Fish Oils / administration & dosage
  • Fish Oils / adverse effects
  • Fish Oils / therapeutic use
  • Humans
  • Infant, Newborn
  • Lipid Peroxidation
  • Olive Oil
  • Parenteral Nutrition / adverse effects
  • Parenteral Nutrition / methods*
  • Plant Oils / administration & dosage
  • Plant Oils / adverse effects
  • Plant Oils / therapeutic use
  • Safflower Oil / administration & dosage
  • Safflower Oil / adverse effects
  • Safflower Oil / therapeutic use
  • Soybean Oil / administration & dosage
  • Soybean Oil / adverse effects
  • Soybean Oil / therapeutic use

Substances

  • Fat Emulsions, Intravenous
  • Fish Oils
  • Olive Oil
  • Plant Oils
  • Soybean Oil
  • Safflower Oil
  • Coconut Oil