The Theoretical Background of the Intravenous Nutrition with Fat Emulsions

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Abstract
By giving fat emulsions intravenously large amount of calories can be given parenterally in conditions with impaired intestinal absorption. There is no risk of thrombophlebitis, and the administered calories are not accompanied by a large water volume. The artificial emulsions can be removed from the blood by uptake as intact particles in the liver parenchymal cells and/or the reticuloendothelial cells. Intravascular hydrolysis to fatty acids and partial glycerides may play a role and also aggregation of the fat particles. The infused fat is utilized for energy purposes. The effects on blood pressure and respiration are documented with the low-molecular triglycerides tributyrin and trinorvalerin. Certain phospholipid preparations may also cause circulatory effects. The current preparations for intravenous use lack such effects. Sludging of blood cells may cause impaired microcirculation. The hyperlipemia may cause an impaired oxygenation of the tissues. Colloidal and pyrogenic effects were reported but seem largely to be eliminated. Some emulsions have a tendency to cause "overloading syndrome" and liver injury when given during longer periods. Other emulsions do not produce these chronic effects. The same can be said about the anemia after intravenous fat therapy. Some emulsions can cover in the dog 100% of the caloric need for long periods without causing organ damage.