MEDIUM CHAIN TRIGLYCERIDES hydrolyze faster, are eliminated from the bloodstream and undergo complete oxidation than long chain triglycerides. Consequently, they are the preferred energy substrate, particularly when there are disturbances cleavage and / or utilization of long-chain triglycerides, such as deficiency of lipoprotein lipase deficiency cofactors lipoprotein lipase deficiency of carnitine and disorders of the carnitine-dependent transport systems.
Only the long chain triglycerides anadrol 50mg contain unsaturated fatty acids, so they are primarily intended for the treatment and prevention of essential fatty acid deficiency and only secondarily as a source of energy.
phosphatides, in addition to their ability to emulsify triglycerides are components of cell membranes and provide their biological functions, including the exchange of the water.
Glycerol, which is added in order to make the emulsion isotonic is a physiological mediator in the metabolism of glucose and lipids: it is metabolized in the glycolytic energy release or utilized during glucose synthesis, glycogen and triglycerides.
ɑ-Tocopherol added Lipofundin MCT / LCT 20% to avoid peroxidation of polyunsaturated fatty acids.
. Lipofundin MCT / LCT 20% is administered intravenously, so its bioavailability is 100% of its
half-life Lipofundin MCT / LCT 20% from plasma is approximately 9 minutes.
The affinity of the medium chain fatty acid to albumin is less than the long-chain fatty acids; Nevertheless, when administered in accordance with the instruction and both are completely bound to plasma albumin and therefore do not penetrate the blood-brain barrier; therefore, they do not fall into the cerebrospinal fluid.
Currently, information about the penetration of the placenta or breast milk is not available.
renal excretion of triglycerides or free fatty acids occurs. Forced diuresis or hemodialysis did not lead to the removal of lipofundina MCT / LCT.
Indications for use:
Lipofundin MCT / LCT is shown:
- as an energy source,
- to provide the body essential fatty acids and fluid during parenteral nutrition.
Lipofundin MCT / LCT is contraindicated in the following conditions:
- expressed violations of blood coagulation,
- shock and collapse,
- acute thromboembolism,
- fat embolism,
- severe septicemia accompanied by acidosis and hypoxia,
- in the acute phase of myocardial infarction and stroke,
- ketoatsidoticheskaya coma
- decompensated metabolism in diabetes or unstable metabolism,
- hypersensitivity to ingredients included in the composition of the preparation,
- acidosis of different etiology,
- violations of water-electrolyte balance (such as hypotonic dehydration, hypokalaemia, hyperhydration)
- intrahepatic cholestasis,
- under conditions involving accumulation of serum triglycerides, such as:
- disorders of lipid metabolism,
- liver disease,
- disorders of the reticuloendothelial system,
- hemorrhagic necrotizing pancreatitis.
Use during pregnancy and lactation
Due to the fact that the safety of the drug Lipofundin MCT / LCT 20% during pregnancy and lactation has not been studied, do not use it in these times, especially in the first trimester of pregnancy, except in situations where the potential benefit to the mother outweighs the potential risk to the fetus.
Dosage and administration
Intravenous infusion. Before the introduction of fat emulsion should have a body temperature!
The fat emulsion suitable for administration via a peripheral vein. The fat emulsions may be administered separately therethrough during total parenteral nutrition.
Infusion system with filters having a diameter less than 5 microns are used for the introduction of fat emulsions, as emulsion does not pass through them.
In those situations where fat emulsions are administered simultaneously with carbohydrates and solutions of amino acids, Y-shaped, or bypass adapter must be in close proximity to the site of infusion administration. This condition allows you to enter the solutions together with the drug Lipofundin MCT / LCT through the same catheter.
It is necessary to closely monitor the compatibility, if Lipofundin MCT / LCT is administered simultaneously through the Y-shaped adapter with bypass or solutions containing other drugs. Particular caution should be exercised with simultaneous introduction of solutions containing divalent cations (eg, Ca 2+, Mg 2+). If you suspect the presence of the patient’s fat metabolism disorders, defined by the concentration of fasting serum triglycerides, to avoid hyperlipidemia (concentration of serum triglycerides more than 3 mmol / l in adults and more than 1.7 mmol / l in children). When a patient is fasting hyperlipidemia assignment fatliquors contraindicated. hyperlipidemia after 12 hours after stopping the infusion of lipid disorders also shows lipid metabolism.
For adults and children over 6 years of
daily requirement for fat is 1-2 g fat / kg / day, which corresponds to 5 – 10 ml of the drug Lipofundin MCT / LCT 20% per kg body weight per day. For newborns daily requirement for fat is 2 g -3 (maximum 4 g) fat / kg / day, which corresponds to 10-15 ml (20 ml) of the preparation anadrol 50mgMCT / LCT 20% per kg of body weight per day. The ability to eliminate fats in this group of patients still insufficiently developed, this applies especially to premature babies and children born with low birth weight. Therefore, a maximum dose of fat in these patients is not appointed, conduct close monitoring of serum triglycerides and fatty acids, and see to it that there was no hyperlipidemia at the end of the interval between the daily infusions. For children up to 1 year (excluding newborns) and from 1 to 6 years The daily requirement of fats in fat 3.1 g / kg body weight / day, which corresponds to 5-15 ml of the preparation Lipofundin MCT / LCT 20% per kg of body weight per day.
The rate of infusion
of principle the introduction of lipid emulsions is the fact that they must be entered as slowly as possible. During the first 15 minutes of the infusion rate should not exceed 0.05-0.1 g fat / kg / h, which corresponds to 0.25-0.05 ml emulsion per kg / hr. The maximum infusion rate: 0.15 g fat / kg body weight per hour, corresponding to 0.75 ml of the preparation Lipofundin MCT / LCT 20% per kg of body weight per hour. Thus, the drip mode should not exceed 0.25 drop per kg body weight per minute. This means 70 kg of the maximum infusion rate may be approximately 50 ml / hr or 18 drops per minute for a patient weight. The infusion rate should be reduced in patients with cachexia, as well as children. It is recommended to choose such an infusion rate at which the calculated daily dose was administered at least 24 hours, but not less than 16 hours.
Duration of use
Within TPN fatliquor assigned primarily for 1-2 weeks. If parenteral nutrition with lipid emulsions is shown in the future, during the corresponding laboratory control, may be extended and for longer periods of time.
In very rare cases there may be acute reactions, manifested as shortness of breath, cyanosis, allergic reactions, hyperlipidemia, can be marked hyperglycaemia, hypercoagulability, nausea, vomiting, headache, facial flushing, pyrexia, decreased or increased blood pressure, sweating, chills, lethargy, chest pain, and lower back during lipid infusion.
in these cases, the infusion should be stopped after the disappearance of symptoms and normalization of triglycerides (or haze serum induced hyperlipidemia) infusion can be continued at a lower speed and / or at a lower dose . In such situations, the patient should be installed close monitoring, especially at the initial stage, and the concentration levels of triglycerides (or serum turbidity) should be controlled.
Overdose symptoms: pyrexia, headache, abdominal pain, fatigue, hyperlipidemia, hepatomegaly with jaundice or without it, splenomegaly, elevated liver enzymes, anemia, decrease in the number of platelets, reducing the number of white blood cells, hemorrhage, decrease in blood clotting factors (pathological values of bleeding time, coagulation time, prothrombin time etc.) Urgent measures, antidotesmust stop the infusion. Further treatment is determined based on the specific symptoms and their severity; in some situations, you may need a blood transfusion or its components.
The interaction with other drugs and other interactions
Lipofundin MCT / LCT should not be used as a solvent for the concentrate of electrolytes or other drugs.
It should not be mixed with other infusion solutions, because in this case can not be guaranteed adequate stability of the fat emulsion for a long interval time. Combining parenteral nutrition preparation mode is used only when the pharmaceutical compatible solutions can be monitored and guaranteed.
In no case can not allow mixing with alcohol-containing injection or infusion solutions.
Heparin increases lipolysis as the exogenously entered and endogenous lipids, and thus causes increasing the concentration in serum free fatty acids. Despite the fact that the use of heparin accelerates the elimination of fats in the case of hypertriglyceridemia it can not be recommended because, firstly, the rapid elimination of fats is not combined with an equivalent increase in lipid metabolism and, secondly, due to increased levels of free fatty acids in serum the displacement of metabolites and drugs from their association with albumin. Furthermore, due to prolonged high doses of heparin was observed paradoxical deterioration elimination of fats.
With daily appointment of the drug in high doses necessary to control the level of serum triglycerides, and after the first day of infusion of glucose control in the blood, acid-base balance and electrolyte balance.
It is necessary to control the water balance and / or the patient’s body weight daily.
Since the change in the blood picture may be a symptom of overdose, it is recommended to control the picture of peripheral blood. In cases of hyperglycemia is necessary to stop the introduction of the fat emulsion.
Using fat emulsions as the sole power source may provoke metabolic acidosis. Co-administration of carbohydrate solution prevents the development of this complication. Thus, infusion of a fat emulsion should always be combined with the administration of the carbohydrate solution in sufficient quantities. Part of the vitamin E formulation affects the effectiveness of vitamin K is involved in the synthesis of blood clotting factors. Therefore, patients receiving oral anticoagulants and in the presence of suspected deficits have vitamin K, it is recommended to carry out monitoring of the coagulation status.
If lipids are introduced every day in the high doses necessary to control triglyceride levels in serum and, if necessary, blood glucose, acid basic and electrolyte balance in the first day of infusion and then at regular intervals.
The water balance and / or body weight should be monitored daily. If during the infusion concentration of triglycerides in the blood reaches a value in children 3 mmol / l, is necessary anadrol 50mg to reduce or stop the injection.
With increasing glucose concentration in the blood is also necessary to adjust the volume of the infusion.
In case of accidental freezing vials should be destroyed. Unused amounts of the drug are not saved for later use and should be discarded.
Do not use vials in which the separation of the emulsion occurs (deposition of fat).
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