Clinical Update: Lipid Shortage and Restrictions

An important message from Kathy Chessman, PharmD

We have been notified that some method of Intralipid allocation from the manufacturer could be in place for the next 7 months.  We received only a partial delivery of our “allotment” on Friday.  We do not know when the remainder, or how much of the remainder, will be received.  In order to avoid wasting as much as possible, we have changed some of our procedures.

Based on the amount of Intralipid 20% that we received today, the following restrictions/procedures will be implemented, which represent a less severe restriction in our tiniest neonates/infants:

Lipid ordering restrictions:

No 3-in-1 Adolescent or Pediatric PNs until further notice.  All lipids will be administered as a separate infusion y-sited into PN infusions.  Orders for Intralipids should be written as a separate physician order in the chart.

Rationale:  Prevents the pharmacy from having to spike two lipid bulk bags in one 24-hr period.  All doses of lipids for the day can be drawn from one bag.  Once the bag is spiked, the lipids should be infused for 24 hr.  We have been unable to find any data to support a longer beyond use date.

For all neonates and infants < 6 months of age:  Daily lipid will be provided with no dose restrictions; however, practitioners should limit the amount of lipid to the least amount felt to be clinical necessary.  A dose of 0.5 g / kg / day will prevent essential fatty acid deficiency (EFAD) in most patients.   

Rationale:  These are our patients must vulnerable to the development of essential fatty acid deficiency (EFAD).  Extremely premature neonates are actually born with biochemical EFAD and can begin to show clinical signs as early as 72 hours.

For all patients 6 months of age and older: 

1) High risk patients (those on PN without significant enteral intake for 2 weeks or more, critically ill or severely malnourished) can receive 1.5 g/kg on Mon, Wed, and Fri, a dose sufficient to prevent EFAD, as long as the lipid supply is sufficient to provide this volume.  Additionally, if there is any remaining lipid after all lipid syringes have been prepared for neonates and infants < 6 months of age, then additional lipid may be given, if needed.  Kathy Chessman will coordinate with the pharmacy and other clinicians to allocate any remaining volume of lipids.

2) Low risk patients (those on PN without any enteral intake for < 2 weeks) may receive lipids only from any volume remaining in the bag opened daily (to prevent wasting lipids that will expire in 24 hr).  Kathy Chessman will coordinate with the pharmacy and other clinicians to allocate any remaining volume of lipids.

Rationale for 1 and 2 above:  since there is a critical shortage, we do not want to just throw away lipid remaining after all neonatal / infant doses have been drawn up for the next 24 hours.  We may be able to administer lipids to older patients on various days during the week using the lipid left after preparing the needed syringes for neonates and infants < 6 months of age.