General & History
Year of introduction of SMOFLipid to Market?
2004
Which of the below results was NOT found to be statistically significant?
- Dec Infx risk by 40%
- Dec sepsis risk by 56%
- red 30 day mortality by 16%
- red ICU LOS ~1.95 days
- red Hospital LOS ~ 2.14 days
Reduced 30 day mortality P value 0.15
In patients on long-term PN (>6 months), soybean ILE doses should not exceed _______ to prevent liver complications.
1 g/kg/day
Which IVLE is considered a risk factor for IF associated with liver diseases?
Pure Soy Bean Oil
Each 1000ml contains how many grams (g) of EACH of the following:
- Soya Oil
- MCTs
- Olive Oil
- Fish Oil
- Soya Oil 60g
- MCTs 60g
- Olive Oil 50g
- Fish Oil 30g
Name of 1st lipid emulsion (1957, USA) that was withdrawn due to side effects?
Lipomul
Note: Intralipid was invented in 1962 by Swedish research Arvid Wretlind
Number of studies included in the meta-analysis that used FK FO (either Omegaven or SMOF)
37 of 49
29 Omegaven
8 SMOF
Which study observed sig lower trig levels after 2 and 5 days of PN in adult postop surg pts compared to OO/SO emulsion?
Piper SN, Schade I, Beschmann RB et al. 2009
Complete the sentence : _ _ _ _ can be effective in resolving cholestasis
Pure Fish Oil Emulsion
The concentration (in mmol/L) that triglycerides should not exceed during infusion of SMOF
3mmol/L
“Feeding entirely by vein is impossible; even if it were possible, it would be impractical; and even if it were practical, it would be unaffordable.”
This was the prevailing belief at this time. What decade?
1960s
Primary Outcome Measures? (Hint there are 2)
1) Risk of Infection
2) Mortality
Recommendation 33 of 2018 ESPEN Guidelines in the ICU refers to the provision of FO enriched PN. What does is recommended?
0.1-0.2g/kg/day FO
Full Rec: Parenteral Lipid emulsions enriched with EPA +DHA (FO dose 0.1-0.2g/kg/d) can be provided in pts receiving PN.
What is the only method to improve liver function and either prevent or treat IF associated with liver disease while providing sufficient energy?
Administration of a FO containing 3rd gen IVLE
Rec daily dose of Fat in g/kg/day not to exceed?
(bonus for 0 extra points - corresponding volume of SMOFlipid in ml/kg/day)
3g fat/kg/day
Corresponds to 15ml SMOFLipid/kg/day
P:E ratio (g:kcal) of SMOFKabiven AND SMOFKabiven NTense
SMOFKabiven 1.5:32
SMOFKabiven NTense 1.5:20
No of patients (to the nearest hundred) included?
3600
Actual answer (3641)
Since SMOFlipid has been marketed, how many spontaneous reports of an adverse drug reactions have been reported?
1
a case of non-serious erythema in a 75-year-old female patient.
Aim of the Study?
to...."expand observations from the 12 month study... by comparing the effect of three different IVLEs on liver Fx and clinical status of HPN patients during a 5 year observation
What should govern the dosage and infusion rate of SMOFlipid?
The patient's ability to eliminate fat
Name 5 of the 7 components of lipid emulsions
1. Tryglycerides/oils
2. Emulsifier
3. Glycerol
4. Water
5. Vitamins
6. Sodium Hydroxide
7. Sodium Oleate
There were significant benefits found in 10/24 lab parameters.
Name 6 of these.
AST, ALT, GGT (3)
alpha tocopherol (1)
EPA & DHA (2)
LBT5, LBT5/LBT4 (2)
PTT (1)
TNF alpha (1)
What is the approx PH of SmoFlipid AND Smofkabiven
+/- 0.5 accepted
Smoflipid: approx. 8
Smofkabiven: approx. 5.6
Take home message?
Bilirubin concentrations at 5y sig lower in FO containing IVLE vs Non-FOIVLE
or
FO containing IVLEs may be advantageous in preserving liver Fx during long-term PN
The fat emulsion has a particle size and biological properties similar to those of endogenous................
Chylomicrons