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Preparing the Malnourished Patient for Parenteral Nutrition (PN)
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Nonetheless, it should not be forgotten that overfeeding during parenteral nutrition administration is likely to result in fat accumulation and steatosis and could cause elevated liver enzymes. This is particularly true of excess carbohydrate as the liver will need to convert it to triglycerides for storage. The type of lipid emulsion may also be a factor. Early lipid products were composed primarily of soybean oil triglycerides. Recently, products with a more diverse source of fats have become available and were shown to have lower incidences of PNALD (Raman et al. 2017).
Care of the Premature and Ill Neonate
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Ting Ting Fu, Kera McNelis, Carrie Smith, Jae H. Kim
The type of lipid emulsion should be considered as well (Chapter 9). Soybean oil emulsions, which contain both omega-6 (linoleic acid) and omega-3 (-linolenic acid) fatty acids, have been used traditionally, but metabolites of linoleic acid may induce inflammation and toxic effects. Fish oil-containing emulsions such as SMOFlipid® (soy, medium-chain triglycerides, olive, and fish oils) and Omegaven® contain predominantly omega-3 fatty acids, which may be more hepatoprotective. Smaller studies have shown reduced cholestasis when fish oil-containing emulsions are used preemptively, but this has not been demonstrated by larger studies. Currently, there is insufficient evidence to support its routine use to prevent or reduce neonatal morbidities. Omegaven is typically reserved for patients with liver compromise.
Pharmacology of Local Anesthetics
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
The main goals of treatment of LAST are to prevent cerebral and myocardial hypoxia, so oxygenation and ventilation are first priorities (Neal et al, 2018). Airway management reduces hypoxia, hypercapnia, and acidosis, factors which potentiate LAST. However, the discovery of lipid emulsion as a “sink” for local anesthetics (and other lipophilic toxins) has revolutionized the treatment of LAST (Fettiplace & Weinberg, 2018). Current guidelines by the American Society of Regional Anesthesia (ASRA) and by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) recommend the administration of IV lipid emulsion therapy at the first signs of LAST but following airway management including ventilation (Neal et al, 2018; AAGBI, 2010). A 100-mL bolus of 20% lipid emulsion given over two to three minutes if patient is over 70 kg and 1.5 mL/kg if the patient weighs below 70 kg is recommended. Subsequent infusion of lipid emulsion should be continued for at least ten minutes after circulatory stability is achieved with a maximum recommended dose of 12 mL/kg. In case of failure of all resuscitative measures, cardiopulmonary bypass should be considered, if available. Useful online checklists are provided by the AAGBI (http://www.aagbi.org/sites/default/files/la_toxicity_2010_0.pdf) and the ASRA (https://www.asra.com/guidelines-articles/guidelines/guideline-item/guidelines/2020/11/01/checklist-for-treatment-of-local-anesthetic-systemic-toxicity).
Comparative effectiveness of methylene blue versus intravenous lipid emulsion in a rodent model of amlodipine toxicity
Published in Clinical Toxicology, 2019
The present study had several limitations. First, the dose of lipid is much different from the antidotal dose used in humans. The dose of 24.8 mL/kg came from a study of Perez et al. [19], who reported the greatest benefit of that dose in normalizing hemodynamics in severe verapamil toxicity in a rodent model, although the authors used Intralipid® instead of SMOFlipid® used in our study. Long chain preparations of lipid emulsion (Intralipid®) were not currently available to use in the present study. Second, intraperitoneal amlodipine may have different pharmacokinetics than do oral overdoses of amlodipine in humans. Third, the study period may not provide sufficient time to assess the animals’ survival. Fourth, we did not test a combination of ILE and MB. Unfavorable outcomes appear more frequent among patients receiving ILE prior to MB than those receiving only MB although the mechanism of this interaction remains unknown [32].
Liposome supported peritoneal dialysis in rat amitriptyline exposure with and without intravenous lipid emulsion
Published in Journal of Liposome Research, 2019
Robin Chapman, Martyn Harvey, Paul Davies, Zimei Wu, Grant Cave
Animals were randomized to one of three treatment groups using a random number generator.Group A: Negative control (five subjects). Intravenous antidote-Sodium bicarbonate (NaHCO3) standard therapy (1 mEq/Kg of 150 mmol/L NaHCO3). Intraperitoneal dialysate - standard peritoneal dialysate (20 ml of a solution containing 150 mmol/L Na+, 120 mmol/l Cl−, 30 mmol/l HCO3, and 1.25% glucose). The concentration of glucose was chosen based on that most likely to maintain constant volume of dialysate in the peritoneal cavity.Group B: Positive control (five subjects). Intravenous antidote - NaHCO3 standard therapy(1 mEq/Kg of 150 mmol/L NaHCO3). Intraperitoneal dialysate - liposome supported peritoneal dialysate (50 mg lipid load in standard peritoneal dialysate).Group C: Treatment arm (six subjects). Intravenous antidote - Intravenous lipid emulsion(6.2 ml/kg of 20% Intralipid®). Intraperitoneal dialysate - Liposome supported peritoneal dialysate (50 mg lipid load in standard peritoneal dialysate).
Preparation and in vivo evaluation of an intravenous emulsion loaded with an aprepitant-phospholipid complex
Published in Drug Delivery, 2023
Yan Li, Hong Yin, Chensi Wu, Jia He, Chunyan Wang, Bo Ren, Heping Wang, Dandan Geng, Yirong Zhang, Ligang Zhao
Lipid emulsions with soybean oil as the oil phase and lecithin as a surfactant have been used clinically in the USA for more than 50 years (Zhang et al., 2018). Lipid emulsions have been used as carriers for the delivery of insoluble drugs such as anesthetics (etomidate, propofol) and cardiovascular medicine (nimodipine microemulsion), in the last year (Driscoll, 2006). Moreover, Lipid emulsion as a fresh and progressive drug delivery approach has the following advantages: (1) high bioavailability, fast onset and small individual differences; (2) high solubility and stability of water-insoluble drugs, and long-lasting pharmacological effects (Li et al., 2013); and (3) lessening the venous toxicity of lipophilic drugs (Carpentier & Dupont, 2000).