IV Lipid Infusions in Patients with Infection

Rationale for Using IV Lipids During Infection

IV lipids are an integral part of parenteral nutrition (PN) regimens, providing essential fatty acids and energy while allowing lower carbohydrate provision, which facilitates better glucose control in patients with infection 1
When infused at appropriate rates (1-2 g/kg/day), lipid emulsions are generally safe and well-tolerated even during critical illness, providing a concentrated energy source and helping prevent essential fatty acid deficiency 1
Lipids are important in critically ill patients with infection as they provide a concentrated energy source and help prevent essential fatty acid deficiency, with lipid metabolism and turnover increased as fatty acids are used as a primary fuel source 3
In critically ill patients, lipid metabolism and turnover are increased as fatty acids are used as a primary fuel source, according to the American Society for Parenteral and Enteral Nutrition 2

In patients with infection or sepsis, close monitoring of plasma triglycerides is essential, with adjustment of lipid infusion rate if necessary, to keep triglyceride values below 12 mmol/L (approximately 1,000 mg/dL), as recommended by the American College of Clinical Nutrition 2
Triglyceride values should be kept below 12 mmol/L (approximately 1,000 mg/dL), but ideally within normal ranges, to prevent fat overload syndrome, which can include thrombocytopenia, leukopenia, coagulopathy, hepatosplenomegaly, and respiratory distress 4
During acute infection, lipid clearance may be reduced due to decreased activity of lipoprotein lipase, requiring close monitoring of plasma triglycerides, as suggested by the European Society for Clinical Nutrition and Metabolism 2

Composite lipid emulsions containing fish oil may have less pro-inflammatory effects and more antioxidant effects than pure soybean oil emulsions, and may attenuate the hyperinflammatory state in severe sepsis and acute lung injury, according to the American College of Chest Physicians 2
Fish oil-containing emulsions may attenuate the hyperinflammatory state in severe sepsis and acute lung injury, providing a potential benefit in critically ill patients with infection 2

If severe unexplained thrombocytopenia occurs, consider monitoring serum triglyceride concentrations and potentially reducing parenteral lipid dosage, as recommended by the American Society of Hematology 5
In patients with acute respiratory failure, it might be prudent to limit lipid intake during the acute phase, especially when using pure soybean oil emulsions, to prevent worsening of respiratory function, as suggested by the Society of Critical Care Medicine 2
If persistent hypertriglyceridemia (>12 mmol/L for >72 hours) occurs, temporarily discontinue lipid infusion, to prevent fat overload syndrome and other complications, as recommended by the American College of Gastroenterology 4

For patients requiring long-term parenteral nutrition who develop infection, consider using mixed LCT/MCT (long-chain/medium-chain triglyceride) formulations, which may have fewer immunosuppressive effects than pure LCT emulsions, according to the European Society for Parenteral and Enteral Nutrition 7