Use of Fish Oil Emulsion in Parenteral Nutrition A Review of 20 Cases

Background. Parenteral nutrition provides nutritional support when the gastrointestinal tract is nonfunctional, but it may lead to intestinal failure-associated liver disease (IFALD). Substituting the soybean oil-based lipid emulsion (SOLE) with fish oil-based lipid emulsion (FOLE) has been associated with improvement of IFALD. Materials and methods. Medical records of patients who received parenteral FOLE for ≥1 month were reviewed for total and direct bilirubin, alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) levels. Results. Twenty patients were included. They were between 0.5 and 131.3 months at initiation of FOLE. They had been on parenteral nutrition with SOLE for a median of 46 days before the initiation of FOLE. Fifteen patients received a mixture of the 2 lipid emulsions, among them, only the 5 patients who received FOLE for >20 weeks showed an improvement in their bilirubin levels. One patient received SOLE and was then switched to FOLE monotherapy at which point his bilirubin level normalized. Four patients received a mixture of both lipid emulsions followed by FOLE monotherapy. Their bilirubin levels improved only after SOLE was discontinued. Changes in ALT and GGT were not significant. Conclusion. FOLE monotherapy was more effective than a mixture of SOLE and FOLE when treating preexisting IFALD, and the improvement in bilirubin was seen earlier with FOLE monotherapy treatment.