Indications for: NUTRILIPID
To provide a source of calories and essential fatty acids for parenteral nutrition and as a source of essential fatty acids when a deficiency occurs when oral or enteral nutrition is not possible, insufficient, or contraindicated.
Adults and Children:
Individualize. Dose based on patient’s energy requirements, body wt, tolerance, clinical status, age-related growth rate in children, and ability to eliminate and metabolize fat. Administer by IV infusion via peripheral or central line. Preterm and term infants to 10yrs: initially 1–2g/kg/day; max 3g/kg/day. Initiate rate at 0.05mL/min for the first 10–15mins; increase gradually to required rate after 15mins (max 0.75mL/kg/hr). 11–<17yrs: initially 1g/kg/day; max 2.5g/kg/day. Initiate rate at 0.05mL/min for the first 10–15mins; increase gradually to required rate after 15mins (max 0.5mL/kg/hr). ≥17yrs: initially 1–1.5g/kg/day; max 2.5g/kg/day. Initiate rate at 0.5mL/min for the first 15–30mins; increase gradually to required rate after 30mins (max 0.5mL/kg/hr). Usual infusion duration: 12–24 hours; may continue treatment based on patient’s clinical status. If serum triglycerides (>400mg/dL): initiate at a lower dose and increase in smaller increments; check levels before each adjustment. For complete parenteral nutrition: supplement with amino acids, carbohydrates, electrolytes, vitamins and trace elements.
Egg, soybean, or peanut allergy. Severe disorders of lipid metabolism characterized by hypertriglyceridemia (serum triglyceride >1000mg/dL).
Clinical decompensation with rapid IV infusion in neonates/infants. Risk of parenteral nutrition-associated liver disease (eg, cholestasis or hepatic steatosis), other hepatobiliary disorders (eg, cholecystitis and cholelithiasis); monitor liver function and consider discontinuation or dose reduction if abnormalities occur. Correct severe fluid and electrolyte disorders, fluid overload states, and metabolic disorders prior to initiating. Measure serum triglycerides at baseline, with each dose increase, and regularly during therapy. Monitor overall energy intake, other sources of fat and glucose, drugs that may interfere with lipid and glucose metabolism. Discontinue and treat if hypersensitivity reactions occur. Monitor for signs/symptoms of infection and essential fatty acid deficiency (EFAD). Severely undernourished: avoid overfeeding. Pulmonary edema or heart failure: monitor fluid status closely. Monitor fluids, electrolytes, serum osmolarity, blood glucose, liver and kidney function, CBCs, platelets, coagulation parameters throughout treatment. Hepatic impairment. Elderly. Neonates: risk of thrombocytopenia; monitor platelets frequently. Pregnancy. Nursing mothers.
Vitamin K content may antagonize anticoagulants (eg, coumarin, warfarin); monitor. High lipid levels in plasma may interfere with the results of certain blood tests.
Hyperlipidemia, hypercoagulability, thrombophlebitis, thrombocytopenia; hypersensitivity reactions, infections, refeeding syndrome, PNALD, hypertriglyceridemia, aluminum toxicity (esp. preterm infants, renal impairment); rare: fat overload syndrome.
Generic Drug Availability:
Emulsion (250mL, 500mL)—1