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© 2019 ASPEN | American Society for Parenteral and Enteral Nutrition. All Rights Reserved. Clinical Outcomes: Alternative ILE – Home PN

• In long-term PN patients, higher risk of complications related to PN1:

o Infection risk
o Lipid abnormalities
o Hepatic dysfunction → Parenteral Nutrition Associated Liver Disease (PNALD)

• Possible role for alternative ILE1,2

o Mundi (2018)1: n=9, long-term home PN, received 4-oil ILE

- Patients receiving 4-oil ILE tolerated higher ILE dose and had trend toward improvement in
alkaline phosphatase

o Klek (2018)2: n=67, long-term home PN, randomized to different ILE x 12 mos

- Liver parameters stabilized in all groups
- Lower Tbili and GGT with Olive-oil supplemented ILE

1. Mundi MS. Nutr Clin Pract. 2018;33(6):851-857. 77
2. Klek S. Nutrition. 2018;55-56:45-50.

Minimizing Risks from ILE

© 2019 ASPEN | American Society for Parenteral and Enteral Nutrition. All Rights Reserved. • If using SO-ILE

o Limit dose to < 1g/kg/day1
o Cycling PN infusions over <24 hours in long-term patients may be protective2

• Monitor for lipid clearance

o Triglyceride levels <400 mg/dL

• Consider use of alternative ILE:

o In critically ill patients requiring PN
o When there is liver dysfunction
o When intolerance to soybean oil limits energy provision

1. ASPEN. Appropriate Dosing for Parenteral Nutrition: ASPEN Recommendations. January 2019.

http://www.nutritioncare.org/PNDosing 78
2. Hwang TL. Hepatogastroenterology.(2000);47:1347–50.

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