Approximately 35% of all ICU patients have chronic kidney disease (CKD). Depending on the degree of the renal damage, this occurrence is associated with an increase in in-hospital mortality from 20.9 percent to 56.8%. Sepsis is the most common cause of AKI in severely unwell patients. Additionally, septic individuals are at a higher risk of having severe renal failure.
N-3 polyunsaturated fatty acids are abundant in fish oils (PUFAs). Long-chain n-3 PUFAs, particularly eicosapentaenoic acid (EPA, C20:5) and docosahexaenoic acid (DHA, C22:6), found in oily fish and fish oil, have been demonstrated to have a number of immunomodulatory and anti-inflammatory characteristics.
In terms of renal damage, n-3 PUFAs have been demonstrated to offer some potential advantages in terms of slowing the course of chronic kidney disease in humans, as well as preserving renal function and improving survival in ischemia/reperfusion-induced AKI.
Injectable Lipid Emulsions
For decades, injectable lipid emulsions have been utilized in clinical settings to provide vital fatty acids and vitamins to hospitalized patients.
Components
1. Lipids –
- Lipids (LCTs and MCTs) authorized by regulatory bodies are often the primary choice for producing medication emulsions, either alone or in combination.
- Triolein, soybean oil, safflower oil, sesame oil, and castor oil are examples of LCTs that have been licensed for clinical usage.
- Fractionated coconut oil, Miglyol® 810, 812, Neobee® M5, and Captex® 300 are all approved MCTs.
2. Emulsifiers –
- Emulsions are thermodynamically unstable systems that will undergo physical changes over time (such as aggregation, creaming, and droplet development).
- Emulsifiers help to keep emulsions stable by lowering the system’s interfacial tension and supplying adequate surface charge for droplet–droplet repulsion.
- The toxicological profile, desired location of administration, and stabilizing capacity of an emulsifier all influence its selection.
3. Aqueous Phase –
- The aqueous phase frequently contains additives such as tonicity modifiers, antioxidants, and preservatives (water for injection).
- Glycerin, sorbitol, or Xylitol can be used to modify tonicity. Because it interacts with lecithin and causes emulsion discolouration, dextrose is seldom used to regulate tonicity.
Fish oil may be present in three types of injectable nutrition emulsions right now:
1. Omegaven® (pure fish oil emulsion)
2. Lipoplus® (50 MCT: 40 soybean oil: 10 fish oil)
3. SMOFlipid® (30 MCT: 30 soybean oil: 25 olive oil: 15 fish oil)
What is Omegaven and how is it used?
Omegaven (fish oil triglycerides) is a lipid (fat) combination used to provide calories and fatty acids to children and individuals who receive intravenous nourishment.
What are side effects of Omegaven?
The following are some of the most common Omegaven side effects:
- Vomiting, agitation, slowed heart rate, and breathing problems (apnea),
- Infection with a virus,
- Skin irritation,
- White blood cell count is low (neutropenia),
- Muscle rigidity and redness at the incision location
What is Smoflipid and how is it used?
- Smoflipid is a prescription drug that is given as an intravenous infusion when oral or enteral nourishment is not possible. Smoflipid can be used on its own or in combination with other drugs.
- Smoflipid is a kind of fatty acid that belongs to the Fatty Acids medication family.
- Smoflipid’s safety and effectiveness in youngsters are unknown.
- SMOFLIPID 20 percent lipid injectable emulsion (100 mL, 250 mL, and 500 mL) from Fresenius Kabi is a four-oil intravenous (IV) lipid emulsion for adult patients (quite new to the US market). Soybean oil, medium chain triglycerides, olive oil, and fish oil are all found in Smoflipid. We’ve received concerns concerning the visual similarities between Smoflipid 20 percent and INTRALIPID 20 percent, another Fresenius Kabi medication that exclusively includes soybean oil.
What are the possible side effects of Smoflipid?
Smoflipid has the potential to induce major adverse effects, such as:
- Hives,
- Breathing problems,
- Bulging of your face, lips, tongue, or throat,
- Extreme dizziness,
- Thirst increases,
- Repeated urination,
- Fatigue,
- Breathing problems,
- stomach ache,
- Fruity odor on the breath,
- Mouth is dry,
- Blood pressure that is too high (hypertension),
- Infection that is severe,
- You may feel discomfort or a burning feeling when urinating.
- Anemia,
- Fever, Chills,
- Quick heartbeat,
- Weakness and Fatigue
The following are the most prevalent Smoflipid adverse effects:
- Nausea, vomiting, gas, fever, stomach discomfort, elevated blood triglycerides, and indigestion are among symptoms that might occur.
Advantages
As drug delivery vehicles, injectable emulsions have a variety of potential advantages:
- Pain, discomfort, and thrombophlebitis are all reduced.
- Toxicity is reduced.
- Stability and solubility have improved.
- Drug delivery that is precise.
Disadvantages
Despite the fact that injectable emulsions have a variety of potential benefits, the number of authorized medicines is limited. The following are some of the primary obstacles to a wider use of emulsions in medication delivery:
- LCT and MCT, which have been authorized by regulatory bodies, are not always effective solvents for lipophilic medicines.
- Even if the medication has a decent oil solubility, the oil phase in the emulsion system is often less than 30%, posing drug-loading issues for medicines with high dosage needs. Extensive toxicity studies would be required for the development of new oils with better medication solubility.
- During storage, included medications may make the emulsion physically unstable, making formulation difficult. The management of droplet size in injectable emulsions is subject to stringent regulatory constraints.
- The pharmaceutical scientist’s ability to overcome formulation issues and build emulsion systems with the required target product profile is limited due to the limited number of certified safe emulsifiers for stabilizing the emulsion system.