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Fat Emulsion Dosage

Applies to the following strengths: 30%; 10%; 20%; with fish oil 10%; with fish, medium chain, olive, and soy oil 20%

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Dietary Supplement

Usual dosage: 1 to 2 grams/kg/day, IV
-Initial infusion rate should be 0.5 mL/min for the first 15 to 30 minutes.
-May gradually increase rate after 30 minutes if tolerated.
-Maximum rate should not exceed 0.5 mL/kg/hour.
-Duration of infusion is from 12 to 24 hours, depending on clinical situation.
Maximum dose: 2.5 grams/kg/day

Comments:
-Recommended dosage depends on age, energy expenditure, clinical status, body weight, tolerance, ability to metabolize, and consideration of additional energy given to the patient.
-Take energy supplied by dextrose and amino acids, as well as enteral nutrition into account when determining dose.
-Correct severe fluid and electrolyte disorders prior to administration.
-The daily dose should not exceed 60% of total energy requirements.
-Obtain a baseline serum triglyceride level; if triglycerides are elevated, initiate at a lower dosage and advance in smaller increments, monitoring triglyceride levels with each adjustment.

Usual Pediatric Dose for Dietary Supplement

Preterm infants and term infants under 1 year:
Initial dose: 1 to 2 grams/kg/day
-Initial infusion rate is 0.05 mL/min for the first 10 to 15 minutes
-Gradually increase to required rate after 15 minutes
-Maximum infusion rate is 0.75 mL/kg/hour
Maximum dose: 3 grams/kg/day
-See precautions

1 to 10 years old:
Initial dose: 1 to 2 grams/kg/day
-Initial infusion rate is 0.05 mL/min for the first 10 to 15 minutes
-Gradually increase to required rate after 15 minutes
-Maximum infusion rate is 0.75 mL/kg/hour
Maximum dose: 3 grams/kg/day

11 to 17 years:
Initial dose: 1 gram/kg/day
-Initial infusion rate is 0.05 mL/min for the first 10 to 15 minutes
-Gradually increase to required rate after 15 minutes
-Maximum infusion rate is 0.5 mL/kg/hour
Maximum dose: 2.5 grams/kg/day

Comments:
-Recommended dosage depends on age, energy expenditure, clinical status, body weight, tolerance, ability to metabolize, and consideration of additional energy given to the patient.
-Take energy supplied by dextrose and amino acids, as well as enteral nutrition into account when determining dose.
-Correct severe fluid and electrolyte disorders prior to administration.
-The daily dose should not exceed 60% of total energy requirements.
-Obtain a baseline serum triglyceride level; if triglycerides are elevated, initiate at a lower dosage and advance in smaller increments, monitoring triglyceride levels with each adjustment.

Renal Dose Adjustments

Data not available
-Aluminum toxicity may develop in patients with impaired kidney function.

Liver Dose Adjustments

Use with caution.
-Monitor liver function closely, as hepatobiliary disorders are known to develop in some patients.

Precautions

US BOXED WARNING(S):
-Deaths have been reported after infusion of intravenous fat emulsion in preterm infants; autopsy findings included intravascular fat accumulation in the lungs.
-Premature and small for gestational age infants have poor clearance of intravenous fat emulsion and increased free fatty acid plasma levels following fat emulsion infusion.
Recommendations:
-Treatment of premature or low birth weight infants with this product must be based on a careful risk-benefit assessment.
-Strict adherence to the recommended total daily dose is mandatory; infusion rate should be as slow as possible and should in any case exceed 1 g fat/kg in 4 hours.
-Seriously consider administering less than the maximum recommended dose in premature or small for gestational age infants to reduce the risk of intravenous fat overload.
-Carefully monitor (e.g. serum triglycerides and/or plasma free fatty acid levels) infants ability to eliminate the infused fate from the circulation.
-Lipemia must clear between daily infusions.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-For intravenous infusion only into a peripheral or central vein.
-When given with dextrose and amino acids, the choice of central or peripheral administration should depend on the osmolarity of the final infusate.
-If osmolarity is 900 mOsm/L or higher it must be infused through a central vein.
-Use a dedicated line for parenteral nutrition.
-May be infused concurrently into the same vein as dextrose-amino acid solutions by a Y-connector located near the infusion site; control flow rates of each solution separately using an infusion pump.
-Use a 1.2 micron in-line filter.
-Use a non-vented infusion set or close the vent on a vented set to prevent air embolism, do not connect flexible bags in a series, fully evacuate residual gas in the bag prior to administration, do not pressurize the bag to increase flow rate, and if using a pump, turn the pump off before the bag runs dry.
-Do not use administration sets that contain di-2-ethylhexyl phthalate (DEHP); administration sets with polyvinyl chloride (PVC) component have DEHP as a plasticizer.
-Take into account vitamin E content of this product when determining the need for additional supplementation.

Monitoring:
-The lipids in this product may interfere with some blood tests (e.g. hemoglobin, lactate dehydrogenase, bilirubin, and oxygen saturation) if blood is sampled before lipids have cleared from the bloodstream.
-Lipids are normally cleared 5 to 6 hours after the lipid infusion is stopped.
-Monitor fluid status closely in patients with pulmonary edema or heart failure.
-Routinely monitor serum triglycerides, fluid and electrolyte status, blood glucose, liver and kidney function, blood count including platelets, and coagulation parameters throughout treatment.
-Monitoring for signs and symptoms of essential fatty acid deficiency (EFAD) is recommended.
-Consult reference values of serum fatty acid level tests to determine adequacy of essential fatty acid status.
-Increasing essential fatty acid intake (enterally or parenterally) is effective in treating EFAD.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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