Guidance for Meeting Essential Fatty Acids Requirements in Adult Patients During Limited Supply of Lipid Injectable Emulsions

• Lipid injectable emulsions (ILEs) for use in the United States are in limited supply.
  
• ASPEN has developed product shortage recommendations to help clinicians manage parenteral
  nutrition therapy during times of ILE shortages.
• The ASPEN 2017 Lipid Injectable Emulsion Product Shortage Considerations include specific
  recommendations for conserving and rationing ILEs with detailed guidance for prioritizing the
  supply of soybean oil-based ILEs and providing adequate essential fatty acids (EFAs) to prevent
  EFA deficiency (EFAD).
• The guidance provides information for using alternative ILEs. However, there is no specific
  information on meeting essential fatty acids (EFAs) needs.
• During times when ILEs are in short supply and rationing and conservation strategies are
  implemented clinicians should:
  • perform calculations, refer to product specific information and/or directly communicate
    with manufacturers to confirm that the minimum doses of EFAs are provided and
  • closely monitor patients receiving PN for developing EFAD including EFA profiles to
    ensure deficiencies do not occur.
• Daily dosing of adult ILEs to prevent EFA deficiency is provided in the table below.
  

From Mirtallo JM, Ayers P, Boullata J, et al. ASPEN lipid injectable emulsion safety recommendations, part 1: background and adult considerations. Nutr Clin Pract. 2020; 35(5):769-782.