Can Intralipids (lipid emulsion) be given intravenously (IV)?

Intralipid Administration: Intravenous Use Only

Intralipids should only be administered intravenously as either part of total parenteral nutrition or as a separate infusion. 1

Appropriate Administration Routes and Uses

• Intravenous lipid emulsions (ILEs) are an indispensable part of parenteral nutrition, serving as a non-carbohydrate source of energy delivered in an iso-osmolar solution 2
• ILEs provide essential fatty acids and help with the delivery of lipid-soluble vitamins A, D, E, and K 2
• 20% ILEs should be the first choice for treatment in infants and children requiring parenteral nutrition 2
• Intralipids are available in different concentrations (10%, 20%, 30%), with 20% emulsions being preferred for most patients 1

Dosing Guidelines

• In preterm infants, parenteral lipid intake should not exceed 4 g/kg/day 2
• In children, parenteral lipid intake should be limited to a maximum of 3 g/kg/day 2
• For long-term home parenteral nutrition (>6 months), the provision of intravenous lipid should not exceed 1 g/kg/day 2
• To prevent essential fatty acid deficiency in preterm infants, a minimum linoleic acid intake of 0.25 g/kg/day is recommended 2
• For term infants and children, a minimum linoleic acid intake of 0.1 g/kg/day is sufficient to prevent essential fatty acid deficiency 2

Monitoring and Safety Considerations

• Markers of liver integrity and function, and triglyceride concentrations should be monitored regularly in patients receiving ILEs 2
• More frequent monitoring is recommended for patients at higher risk for hyperlipidemia (e.g., those with high lipid or glucose dosage, sepsis, catabolism, extremely low birth weight infants) 2
• Reduction of ILE dosage should be considered if serum triglyceride concentrations during infusion exceed 3 mmol/L (265 mg/dL) in infants or 4.5 mmol/L (400 mg/dL) in older children 2
• Fat overload syndrome is a potential complication characterized by headaches, fever, jaundice, hepatosplenomegaly, respiratory distress, and spontaneous hemorrhage 1

Special Therapeutic Applications

• Beyond nutritional support, ILEs have been used as an antidote for drug toxicity, particularly in cases of local anesthetic systemic toxicity and other lipophilic drug overdoses 1, 3
• When used for toxicity treatment, intralipid emulsions are administered intravenously, never via other routes 1
• Caution should be exercised when using ILEs in patients requiring renal replacement therapy, as lipemic blood can obstruct filters in continuous venovenous hemofiltration 3

Formulation Considerations

• Pure soybean oil (SO) ILEs have been widely used for decades, but composite ILEs with or without fish oil are now preferred for parenteral nutrition lasting longer than a few days 2
• Lipid emulsions based on olive oil appear to be equally safe as those based on soybean oil 2
• MCT/LCT (medium-chain triglycerides/long-chain triglycerides) and fish oil emulsions have also proven safe, though data for long-term use is more limited 2

ILEs are metabolized following the same pathway as natural chylomicrons, with the triglyceride portion hydrolyzed by endothelial lipoprotein lipase 2. The rate of hydrolysis varies according to the type of triglyceride substrate and can be influenced by factors such as prematurity, malnutrition, hypoalbuminemia, metabolic acidosis, and high plasma lipid concentrations 2.