Lipid Emulsions

PN regimens include lipid emulsions as the source for fat calories and essential fatty acids. In the United States, commercially available intravenous lipid products contain largely n-6 long-chain fatty acids derived from vegetable oils. Long-chain lipid emulsions provide the most concentrated source of calories in PN (9 kcal/g). Other lipid-containing products are currently available in Europe, including lipid emulsions containing medium-chain fatty acids and structured triglycerides. The latter are custom synthesized triglycerides that contain both long-chain and medium-chain fatty acids on the same glycerol moiety. These lipid substrates may offer certain metabolic and immune tolerance advantages.

Controversy surrounds the use of intravenous lipid emulsions (IVLEs) due to early reports of adverse immune function and pulmonary effects in critically ill patients. These early reports of alterations in immune function were associated with excessive infusion rates or doses of IVLEs in comparison with today's standard dosing regimens. Concerns have also been raised that n-6 fatty acids may fuel inflammatory eicosanoid pathways. Lipids are contraindicated in patients with significant hypertri-glyceridemia. When lipids are restricted, modest doses of lipids (30-40 g twice weekly) should be provided to prevent essential fatty acid deficiency (EFAD). Linoleic acid (18:3n6) and a-linolenic acid (18:3n3) are required to prevent EFAD. To prevent EFAD, 2-4% of calories should be provided as linoleic acid and 0.5% as a-linolenic acid.

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