olive oil, refined + soya bean oil, refined: clinical use

Prescribing considerations

• Use within a specialist parenteral-nutrition plan based on nutritional requirements, clinical condition and lipid clearance.
• Provide the other necessary macronutrients and micronutrients; the lipid emulsion alone is not complete nutrition.
• Correct severe fluid, electrolyte or metabolic disturbances before starting.
• Consider refeeding risk in severely undernourished patients.
• Use strict aseptic technique for catheter care and preparation, and confirm admixture compatibility.
• Use cautiously with hepatic impairment, anaemia, coagulation disorders, oliguria or anuria, pulmonary oedema, heart failure or impaired lipid metabolism.

Contraindications and cautions

• Hypersensitivity to egg, soya or peanut protein, the active ingredients or excipients
• Severe hyperlipidaemia or severe lipid-metabolism disorders characterised by hypertriglyceridaemia
• Lipoid nephrosis, or acute pancreatitis accompanied by hyperlipaemia

Monitoring

• Clinical tolerance and evidence of hypersensitivity or fat overload
• Triglycerides, blood glucose, electrolytes and liver function
• Fluid balance and cardiorespiratory status
• Full blood count and coagulation parameters when clinically relevant
• Catheter site and systemic signs of infection or thrombophlebitis
• Biochemical changes associated with refeeding

Clinical pharmacology

The olive–soya triglycerides are hydrolysed and cleared similarly to natural chylomicrons. Released fatty acids are oxidised for energy, stored in adipose tissue or incorporated into cell membranes.

Formulation and product differences

• The selected product contains approximately 80% refined olive oil and 20% refined soya-bean oil within its lipid component.
• It is a sterile oil-in-water emulsion containing egg phospholipids, glycerol and sodium oleate.
• It may form the lipid component of a complete admixture or, rarely, be infused separately as complementary nutritional support.
• The route may be central or peripheral depending on the osmolarity of the final admixture.
• Containers are single use; the bulk one-litre container is intended for pharmacy use rather than direct infusion.