[Fat emulsions: principles of pathophysiologic effects and clinical applications]

Modern fat emulsions are being applied with increasing frequently in clinical nutrition. The adverse reactions observed at the beginning of the development of fat emulsions had a strong negative influence on the use of such preparations. In this study, modern fat emulsions are presented and characterized on the basis of the huge amount of experimental and clinical data and knowledge gained to date. The profile of applications has changed drastically during the last few years, especially due to the results of membrane studies, because fatty acid derivatives have been discovered to be important parts of such structures. This knowledge has enhanced the area of indications which before were determined by the energetical aspects and the essentiality of fatty acids only. As a remarkable development we discuss the changed basis of indications, which moved from the simple presence of a specific nosological entity such as renal failure or sepsis to criteria of blood substrate composition for proving and selecting indications. Pharmacokinetic studies are presented which have provided data for physiological dosages. As influencing factors apart from hormonal constellations and pathophysiological functions of posttraumatic metabolism, body weight is discussed in respect to concentrations of triglycerides in plasma. On the basis of our clinical studies on applications of fat emulsions in intensive-care patients, preconditions are defined which must be considered before the use of fat. Finally, pathophysiological interactions between carbohydrate- and fat metabolism result in an analytical control system which is proposed for the surveillance of fat applications especially in destabilized intensive-care patients.