Nourish-E

Uses

Soybean oil is an oil used as a source of calories and essential fatty acids in selected patients for total parenteral nutrition (TPN) therapy and prevention of essential fatty acid deficiency.

Indicated for parenteral nutrition as a source of calories and essential fatty acids when oral or enteral nutrition is not possible, insufficient, or contraindicated.

Nourish-E is also used to associated treatment for these conditions: Essential Fatty Acid Deficiency (EFAD), Nutritional supplementation, Parenteral Nutrition, Total parenteral nutrition therapy

How Nourish-E works

Fatty acids serve as an important substrate for energy production. The most common mechanism of action for energy production derived from fatty acid metabolism is beta oxidation. Fatty acids are also important for membrane structure and function, precursors for bioactive molecules (such as prostaglandins), and as regulators of gene expression. Soybean oil-based lipid emulsion may also cause an increase in heat production, decrease in respiratory quotient, and increase in oxygen consumption following its administration . Soybean oil contents prevent abnormally high triacylglycerol synthesis and its accumulation as lipid droplets in the liver by regulating hepatic lipogenesis and lipolysis. In vitro, soybean oil is shown to prevent downregulation of CYP2C2, CYP2C11 and CYP3A2 mRNA thus maintaining hepatic drug oxidation capabilities. Soybean oil is broken down into free fatty acids that activate PPAR-alpha, which regulate hepatic CYP4A1 that hydroxylate saturated and unsaturated fatty acids. Soybean oil is also shown to prevent up/downregulation of efflux transporters and maintain mRNA levels of hepatic antioxidant enzymes in vitro rat studies .

Toxicity

The most frequent adverse effects were nausea, vomiting and muscle spasm. Soybean oil-based lipid emulsions can cause hypersensitivity reactions and risks of catheter-related infections. Fat overload syndrome is a rare condition that has been reported with intravenous lipid emulsions, due to a reduced or limited ability to metabolize lipids accompanied by prolonged plasma clearance. Worsensing conditions of the patients can be seen including hematological effects, declined hepatic function and central nervous system manifestations. Hypertriglyceridema may occur. Preterm and small-for-gestational-age infants have poor clearance of intravenous lipid emulsion and increased free fatty acid plasma levels following lipid emulsion infusion, leading to accumulation in lungs. It is advised not to exceed 0.75 mL/kg/hour.

Volume of Distribution

After triglycerides are hydrolyzed, fatty acids can enter the tissues where they may be oxidized or resynthesized into triglcerides and stored.

Elimination Route

Following infusion, there is a transient increase in plasma triglycerides.

Clearance

The elimination rate of lipid emulsions depends on particle size, fatty acid composition, apolipoprotein content of the lipid globules, lipoprotein lipase activity, and hepatic lipase activity .

Elimination Route

Converted carbon dioxide from smaller fatty acid units are excreted by the lungs.

Innovators Monograph

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