Intravenous Fat Emulsion Formulations for the Adult and Pediatric Patient: Understanding the Differences.
Intravenous Fat Emulsion Formulations for the Adult and Pediatric Patient: Understanding the Differences.
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DOI：
10.1177/0884533616662996
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发表时间：
2016-10
期刊：
影响因子：
--
通讯作者：
Gura KM
中科院分区：
文献类型：
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作者：
Anez-Bustillos L;Dao DT;Baker MA;Fell GL;Puder M;Gura KM
静脉注射脂质乳剂（IVLE）提供必需脂肪酸（FA），是肠外营养（PN）的密集能量来源。17世纪引入了静脉注射脂质，但一直受到副作用的困扰。脂质乳剂的配方后来使其成为一种相对安全的给药成分。许多成分对所有IVLE都是共同的，但是油源和它的百分比使它们彼此不同。所使用的油决定了IVLE如何被代谢并从体内清除。存在于每种油中的FA提供了独特的有益和有害的特性。这篇综述提供了IVLE的概述，并讨论了有助于临床医生为患者选择最佳产品的因素。随着时间的推移，阐明每种油源的特征导致了目前不同配方的演变。乳剂从单纯用大豆油制成，到与中链甘油三酯（如椰子油）、橄榄油以及最近的鱼油混合。不幸的是，在PN配方中的其他成分中，脂质与肝脏疾病的发展有关。因此，脂质保留或脂质减少策略被提出以避免这些并发症。理想的IVLE可以逆转或预防必需FA缺乏而不会导致并发症，同时提供能量以促进正常生长发育。对其成分、配方和剂量的修改使得IVLE单独或添加到PN配方中都是相对安全的成分。然而，理想的乳剂尚未开发出来。
Intravenous lipid emulsions (IVLE) provide essential fatty acids (FA) and are a dense source of energy in parenteral nutrition (PN). Parenterally administered lipid was introduced in the 17th century but plagued with side effects. The formulation of lipid emulsions later on made it a relatively safe component for administration to patients. Many ingredients are common to all IVLE, yet the oil source(s) and its (their) percentage(s) makes them different from each other. The oil used dictates how IVLE are metabolized and cleared from the body. The FA present in each type of oil provide unique beneficial and detrimental properties. This review provides an overview of IVLE and discuss factors that would help clinicians choose the optimal product for their patients. Elucidating the characteristics of each oil source over time has resulted in an evolution of the different formulations currently available. Emulsions have gone from being solely made with soybean oil, to being combined with medium-chain triglycerides (i.e., coconut oil), olive oil, and more recently, fish oil. Unfortunately, the lipid, among other constituents in PN formulations, has been associated with the development of liver disease. Lipid-sparing or lipid-reduction strategies have therefore been proposed to avoid these complications. The ideal IVLE would reverse or prevent essential FA deficiency without leading to complications, while simultaneously providing energy to facilitate normal growth and development. Modifications in their ingredients, formulation, and dosing have made IVLE a relatively safe component alone or when added to PN formulations. The ideal emulsion, however, has yet to be developed.