Adequacy of Lipid Emulsion Administration Prescription Rate in a Single Center

Abstract

Purpose: IV-lipid emulsion can be a nutritional supplement to provide essential fatty acids and energy for patients who need total parenteral nutrition support. The recommended administration dose of lipid emulsion is less than 2.5 g/kg/d and the rate should not exceed 0.15 g/kg/h for adult patients. The purpose of this study is to evaluate the adequacy of the currently prescribed administration rate of IV-lipid emulsion in a single center. Methods: We analyzed 1,739 lipid emulsion administration prescriptions in 1,095 patients over 18 years old at Ajou University Hospital from January 1, 2014 to March 31. Results: The median prescription rate of total lipid emulsion was 0.134 (0.012∼1.125) g/kg/h, and the exceeding portion of maximum recommended infusion rate was 36.9%. The median administration prescription rate of lipid emulsion was faster in 500 mL emulsions, compared to 250 mL emulsion (0.146 g/kg/h vs. 0.075 g/kg/h; P＜0.001) and at emergency room (ER), compared to general ward (0.154 g/kg/h vs. 0.123; P＜0.001). The exceeding portion of maximum recommended infusion rate of lipid emulsion was also higher in 500 mL emulsion, compared to 250 mL emulsion (52.2% vs. 30.4%; P＜0.001) and at ER, compared to general ward (52.1% vs. 30.4%; P＜0.001). Triglyceride level was higher in exceeding recommended infusion rate compared to less, but not statistically significant (119 mg/dL vs. 261 mg/dL; P=0.202). Conclusion: Administration prescription rate of lipid emulsion exceeded the recommended rate and this feature was dominant in 500 mL emulsion and at ER. Education and monitoring of lipid emulsion prescription is needed for appropriate lipid administration and prevention of fat overload syndrome.