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The ideal composition of intravenous lipid emulsion

The body responds to a diverse range of insults, such as surgery, infection and injury by the activation of a wide range of cell types of the immune system, creating a number of potent cellular actions and mediators.// The inflammatory response, although essential for fighting infection, may damage the host. Its strength depends on pro- and anti-inflammatory mediators, cytokines and lipid mediators being the key mediators.

Recently, Robert Grimble, from the Institute of Human Nutrition, School of Medicine, University of Southampton, UK has reviewed the fatty acid profile of modern lipid emulsions, and the scientific considerations for creating the ideal composition.

In his report published in volume 1 of Clinical Nutrition Supplements, he states that in some types of patients, the lack of a correctly functioning gut precludes complete oral or enteral nutrient provision. As a consequence, the intravenous route assumes a greater importance for the provision of energy substrates, amino acids and micronutrients. Reliance on glucose as the main provider of energy to patients requiring intravenous nutrition led to metabolic complications. These include insulin insensitivity and metabolic acidosis due to the need to dispose of a large amount of metabolic breakdown products in the form of carbon dioxide.

Intravenous nutrition has been a life-saving technique in the treatment of severely ill patients, particularly in those where normal gut function is absent. However, the inability to provide sufficient energy to patients, in the form of glucose, led to the development of intravenous lipid emulsions.

These products were a major breakthrough in clinical nutrition particularly as insulin insensitivity is a major feature in the metabolism of severely ill patients. Previous studies have indicated that the use of lipid emulsions in clinical nutrition is not without limitations, but the inclusion of ù-3 fatty acids and fats rich in MUFAs a
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