Lipid Dosing Types of Formulas & Calculations

name of 4 oil emulsion

SMOFlipid

SMOFlipid components and function

• S = Soybean oil (30%)

• M = Medium-chain triglycerides (MCTs) (30%)

• O = Olive oil (25%)

• F = Fish oil (15%)

• 30% soybean oil

  • Provides essential fatty acids (linoleic acid, α-linolenic acid)

• 30% medium-chain triglycerides (MCTs)

  • Rapidly oxidized for energy

  • Less likely to accumulate

• 25% olive oil

  • Rich in monounsaturated fats (oleic acid)

  • Relatively neutral inflammatory profile

• 15% fish oil

  • EPA

  • DHA

  • Anti-inflammatory effects

1 oil emulsions

Intralipid and Omegaven

SMOFlipid omega-3 content

Contains EPA & DHA
Contains 15% omega-3 fatty acids from fish oil, providing essential fatty acids that support various physiological processes.

does intralipid have omega-3s

No, intralipid does not contain omega-3 fatty acids. It's primarily composed of soybean oil and lacks the specific omega-3 supplements found in products like Omegaven.

does intralipid have MCTs

no

does SMOFlipid have MCTs

yes

which has higher phytosterol content intralipid or smoflipid?

intralipid

which has higher Vitamin E content intralipid or SMOFlipid?

SMOFlipid

which has higher pro-inflammatory potential intralipid or SMOFlipid?

Intralipid has a higher pro-inflammatory potential compared to SMOFlipid. High omega-6 content in intralipid leads to increased production of arachidonic acid-derived eicosanoids, which tend to promote inflammation. Lower omega-6 plus fish oil in SMOFlipid shifts eicosanoid production toward a less inflammatory profile.

which is higher in omega-6 content intralipid or SMOFlipid?

intralipid

intralipid content and functions

• 100% soybean oil

• Rich in:

  • Linoleic acid (omega-6)

  • Some α-linolenic acid (omega-3 precursor)

• Does not provide meaningful amounts of EPA or DHA.

standard lipid concentration for intralipid and smoflipid for calculations

20%

volume relationship for calculations for intralipid or SMOFlipid

5 mL/g lipid

energy density in kcal/mL for intralipid/SMOFlipid

2 kcal/mL

energy density in kcal/g for intralipid/SMOFlipid

10 kcal/g

omegaven lipid concentration

10%

omegaven volume relationship mL/g lipid

10 mL/g lipid

omegaven kcal/mL

1.1 kcal/mL

omegaven in kcal/g

11 kcal/g

MCT oil kcal/mL

7.7 kcal/mL

lipid in g/d formula

lipid in g/d = dose in g/kg/d x weight in kg

lipid in mL/d formula

lipid in mL/d = lipid g/d x mL/g

lipid kcal/d

lipid kcal/d = lipid mL/d x kcal/mL

lipid infusion rate

(lipid mL/d)/ infusion hours

A 20% lipid emulsion means how many grams lipid per mL

20 g lipid per 100 mL

A 10% lipid emulsion means how many grams lipid per mL

10 g lipid per 100 mL

what % of total kcal should be avoided in lipid dosing and why?

60% of total kcal due to risk of ketosis

what is the maximum infusion rate and why should this cap be followed?

Do not exceed infusion rate >0.15 gm/kg/hr. To avoid ketosis

why does ketosis happen secondary to excessive lipid administration

• triglycerides are hydrolyzed

• Fatty acids undergo β-oxidation

• The TCA cycle becomes limited

  • For acetyl-CoA to enter the TCA cycle, it must combine with oxaloacetate.

    Acetyl-CoA + Oxaloacetate → Citrate

    However, if oxaloacetate is relatively unavailable, acetyl-CoA accumulates.

    This occurs when:

    • Carbohydrate intake is inadequate

    • Insulin levels are low

    • Gluconeogenesis consumes oxaloacetate

    • The liver receives an excessive fatty acid load relative to its oxidative capacity

• Excess acetyl-CoA is diverted to ketogenesis

  • When acetyl-CoA accumulates:

    2 Acetyl-CoA
    ↓
    Acetoacetyl-CoA
    ↓
    HMG-CoA
    ↓
    Acetoacetate
    ↓
    β-hydroxybutyrate + acetone

    These are the ketone bodies.

Does excessive lipid alone cause ketosis?

Usually no, especially in patients receiving adequate dextrose.

In PN, sufficient dextrose stimulates insulin, which:

• suppresses lipolysis,

• promotes carbohydrate oxidation,

• maintains oxaloacetate availability, and

• reduces hepatic ketogenesis.

Therefore, excessive lipid administration by itself does not commonly produce clinically significant ketosis if carbohydrate provision is adequate.

When can lipid administration contribute to ketosis?

It is more likely when excessive lipid administration occurs along with:

• inadequate dextrose intake,

• prolonged fasting,

• insulin deficiency (e.g., diabetes),

• severe illness or stress with increased counter-regulatory hormones,

• inborn errors of carbohydrate metabolism.

In these settings, the liver receives a large fatty acid supply while carbohydrate oxidation is insufficient, favoring ketone production.

Omegaven content

highly purified fish oil triglycerides, rich in omega-3s EPA & DHA, added in tocopherol

Omegaven indication

• consider if SBS or IF and PN expected > 4 weeks

• PNAC in absence of other etiologies for cholestasis

• cautionary use for transient cholestasis

• not indicated for PNAC prevention