Fish oil triglycerides are used for providing total parenteral nutrition delivering energy and fatty acids directly into the bloodstream in patients who cannot take food or other supplements by mouth for medical reasons.
It is a mixture of highly refined fish oil containing omega-3 fatty acids such as eicosapentenoic acid (EPA) and docosahexenoic acid (DHA) with alpha-tocopherol, a form of vitamin E known for its antioxidant property.
Fish oil triglycerides are used to provide parenteral nutrition in patients who suffer from Parenteral Nutrition Associated Cholestasis (PNAC).
Fish oil triglycerides should not be used in patients with -
Allergic to fish oil or egg protein
High levels of fat (cholesterol and triglycerides) in the blood
Certain conditions like diabetes, stroke, occurrence of clots or fat deposits in blood vessels, and a sudden drop in blood flow or shock.
Fish oil triglycerides should not be used for preventing PNAC.
Fish oil triglycerides should not be given to premature infants, newborns, infants, children below 11 years, and patients with liver or kidney dysfunction as their safety and effectiveness have not been studied in these groups.
The recommended daily dose of fish oil triglycerides in pediatric patients is 1g/kg body weight.
The dose of fish oil triglycerides infusion can be reduced to 0.5g to 0.75g/kg body weight if the fat levels (triglycerides) are high and can be increased to a maximum 1g/kg body weight if the levels (triglycerides) are normal.
The initial rate of infusion given within half an hour should be 0.05mL/min and can be increased to 1.5 mL/kg body weight/ in an hour if the patient is able to tolerate fish oil triglycerides without any side effects.
The treatment with fish oil triglycerides can be stopped temporarily if any severe side effects or increased levels of triglycerides are seen in the blood.
Choosing the correct dose of fish oil triglycerides depends on the individual patients energy requirements, age, body weight, tolerance level, lab values of triglycerides level, co-administration of dextrose, amino acids, and vitamin E.
Fish oil triglycerides are available as an injectable emulsion which should be given directly into the central or peripheral vein either alone or mixed with another parenteral nutrition mixture.
The parenteral nutrition should be mixed in the parenteral container only in aseptic conditions to avoid microbial contamination.
Mixing of fish oil triglycerides injection with other intravenous solutions should be carefully done to avoid chemical reactions among the infusion solutions.
The dose of dextrose and amino acids can be modified based on the contents of the fish oil triglycerides solution.
Make sure that the parenteral mixture is free from precipitate before administration. If separation of the mixture or yellowish coloration of the solution occurs, discard the solution immediately.
Dextrose and amino acid solution can be simultaneously added to the parenteral nutrition container followed by the fish oil triglycerides solution. The mixture can be gently shaken to make the solution uniform.
Once the solutions are mixed, it should be given to the patient as soon as possible by using a Y-connector.
If the mixture cannot be administered immediately, it should be stored in a refrigerator at a temperature between 2°C and 8°C for up to 24 hours or up to a maximum of 6 hours at room temperature (below 25°C).
The infusion should be given within 24 hours from the time it is removed from its respective storage.
Patients should be monitored for symptoms and signs of early infection such as fever or chills as lipid emulsions such as fish oil triglycerides can cause microbial growth.
To avoid such complications, it is necessary to mix the fish oil triglycerides contents only in a sterile condition. Also, checking lab values to know the infection status is advised.
The infusion site should frequently be checked for redness, swelling or fluid discharge.
Administration of fish oil triglycerides may lead to the rise of refeeding syndrome or fat overload syndrome as it may result in sudden deterioration of patients health. Therefore, patients should be carefully monitored for liver function, blood abnormalities, and changes in electrolyte levels, thiamine deficiency, and fluid accumulation.
The levels of triglycerides should be measured at regular intervals during the treatment with fish oil triglycerides infusion. If the levels are high, treatment with fish oil triglycerides can be stopped temporarily and can be started again according to subsequently obtained lab values.
Aluminum accumulation can occur which may cause brain and bone toxicity in patients who receive fish oil triglycerides infusion for long-term particularly in patients with kidney dysfunction.
Monitor patients for the symptoms and signs of fluid accumulation around the lungs or heart during the treatment with fish oil triglycerides infusion.
Gastrointestinal: Nausea, vomiting, loss of appetite, pain in the stomach
Nervous system: Fever, chills, headache, abnormal weakness
Respiratory: Breathing difficulty, chest pain
Lab abnormalities: Alteration in the levels of liver parameters, triglycerides, blood glucose, hemoglobin, platelets, bleeding time, prothrombin time
Others: Back pain, bone pain, bluish coloration of the skin or cyanosis, prolonged erection of the penis, infusion site reactions (swelling, redness), changes in blood pressure
Patients should be routinely monitored for fat content in blood, liver and kidney function, electrolyte levels, fatty acid levels along with complete blood count during the treatment with fish oil triglycerides infusion.
Lipid levels may interfere with other lab tests and blood for any diagnostic purpose should be withdrawn only 6 hours after stopping the infusion as lipid levels will take time to get cleared completely from the bloodstream.
Patients may experience bleeding episodes or prolonged bleeding time when fish oil triglycerides infusion is given to patients taking blood thinners. So caution is required in such cases.
The doctor should be informed about any medications such as prescription or non-prescription drugs taken by the patient to avoid dangerous side effects caused by the drugs.
Store the emulsion at room temperature between 15°C and 25°C.
Do not keep in a freezer.
Store the mixture of fish oil triglycerides and other parenteral solutions at a cold storage in a refrigerator between 2°C, and 8°C and use within 24 hours.
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