The use and indications for ILE in pediatrics is somewhat different from adults therefore, the safety considerations will be presented in 2 papers, beginning with background and adult considerations (Part 1) and followed by a neonate/pediatric considerations paper (Part 2). 8 The purpose of this paper is to provide information on all ILE products in the US, outline appropriate indications and dosing, and suggest ways to prevent potential errors with these products. The 2017 ASPEN ILE gap analysis survey demonstrated concerns with current ILE practices having a potential to further increase the risk for ILE errors in prescribing, compounding, and administration of ILE products. 7 Currently, 5 ILE products are available with 4 different formulations, each with different dosing, clinical, and safety issues. Since the Vanek paper in 2012, ASPEN has encouraged the pharmaceutical industry to bring new ILE products into the US market. 5 Supply shortages have also led to errors with PN product dosing, including ILEs, an issue recently addressed by the American Society for Parenteral and Enteral Nutrition (ASPEN). This concern has been exacerbated by the frequent and long-standing problems with product inventory shortages. 3, 4 It has long been a concern of nutrition support clinicians in the US that having only 1 source of ILE creates a challenge to meet the needs of all patients. Guidelines for ILE use suggest advantages of the other ILE products for specific patients requiring PN. 2 Multiple ILE products using soybean oil (SO) as well as other oils to improve the safety and efficacy of ILE have been developed and used in other countries. A review of soybean-based ILE described safety issues related to total daily dose, infusion rate, and duration. 1 Since ILE were first made available to the US market, the source oil (soybean) has been scrutinized for its use as an energy source. As an emulsion, ILEs have physical-chemical characteristics influencing compatibility and stability that are distinctly different from other intravenous nutrients and fluids. Issues associated with ILE use are distinctly different from oral fat and arise from emulsion stability, dose, and infusion tolerance. Lipid injectable emulsions (ILEs) are complex pharmaceutical formulations intended as a source of energy and fatty acids (FAs) for parenteral nutrition (PN) therapy. This paper (Part 1) will focus on ILE background, information, and recommendations for adult patients, whereas Part 2 of this series will focus on neonatal and pediatric patient–specific information. This paper provides information on appropriate indications, dosing, and methods to avoid potential errors with ILE products in the US. Gaps in ILE best practices create a risk for ILE safety errors in prescribing, compounding, and administration of these products. Partly because of safety concerns with the soybean-based ILE and frequent and long-standing problems with product inventory shortages, new ILE products have become available. Since 1975, soybean oil has been the consistent source oil used in ILE formulations in the US. Lipid injectable emulsions (ILEs) are complex pharmaceutical formulations used as a source of energy and essential fatty acids in parenteral nutrition.
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