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Hepatic dysfunction in patients receiving intravenous lipid emulsions.

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Newer intravenous lipid emulsions (ILEs) containing fish oil (FO) may help reverse liver disease (IFALD) in patients. While soybean oil (SO) ILEs can cause IFALD, FO-based options show promise in treatment.

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Area of Science:

  • Hepatology
  • Parenteral Nutrition
  • Pediatric Gastroenterology

Background:

  • Intravenous lipid emulsions (ILEs) historically used soybean oil (SO), but can lead to intestinal failure-associated liver disease (IFALD).
  • IFALD presents as cholestasis in infants and steatosis in older patients.
  • Emerging ILE formulations aim to mitigate or reverse IFALD.

Approach:

  • Review of recent developments in ILEs and their impact on IFALD.
  • Evaluation of alternative ILEs, including SMOF (soybean oil, medium-chain triglycerides, olive oil, fish oil) and fish oil (FO) only ILEs.
  • Analysis of clinical data on the efficacy of different ILEs in managing IFALD.

Key Points:

  • SMOF and FO ILEs are investigated as alternatives to SO ILEs.
  • FO ILEs have shown potential in reversing IFALD in adults, despite initial pediatric approval.
  • IFALD appears to be dose-related, with excessive caloric or macronutrient intake potentially contributing to liver injury.

Conclusions:

  • Transitioning from SO to SMOF may not always resolve IFALD.
  • Partial or complete replacement with FO-based ILEs can halt and reverse IFALD.
  • Further research into the dose-dependent effects of macronutrients on ILE-induced liver injury is warranted.