President’s Welcome
GASPEN has had a very busy summer! In August, we hosted our second summer meeting at Emory Saint Joseph’s Hospital with presentations on ethics, acid-base, pediatric and neonatal nutrition, volume-based feedings, nutrition support teams, enteral nutrition nightmares, nutrition support in critically ill adult patients, and micronutrient deficiencies! In November, we co-hosted a CE program with the Southeast Chapter of Critical Care Medicine (SCCM). Dr. Jayshil Patel gave a wonderful presentation on the topic of early exclusive and supplemental parenteral nutrition in the critical care setting. The live meeting was hosted at Northside Hospital in Atlanta
but was broadcasted at 7 different locations! All meetings were well-attended and well-received. I would like to thank our wonderful active GASPEN board members for all of their hard work preparing for these meetings. You can read recaps of the meetings in our newsletter.
While GASPEN has been very busy planning continuing education activities, there are also many ASPEN activities available. ASPEN continues to offer a robust selection of webinars. Don’t forget to sign up for ASPEN’s Nutrition Science and Practice Conference 2019 in Phoenix, Arizona! If you are a pharmacy resident or dietetic intern interested in nutrition support, stay tuned! We would like to send one resident or intern to ASPEN 2019. We will post the criteria for consideration for the scholarship on our Facebook page in the upcoming months. We welcome any suggestions and comments from GASPEN members for CE programs, newsletter articles and any other ways that we can benefit our members. Do you have an interesting case that you would like to present? Would you like to share a research project or quality improvement initiative?
Consider sharing with other members by publishing in our newsletter. We also would like to welcome any GASPEN members who would like to become involved on our board. I look forward to another wonderful year with GASPEN!
Khatija Jivani, PharmD, BCPS
GASPEN President
Alternative Fish Oil-Containing Lipid Injectable Emulsions in Critical Illness
Maria Sheridan, PharmD, BCNSP
Lipids are an integral component of parenteral nutrition (PN). They provide the body with a source of fuel and fatty acids (FAs), which are necessary for the formation of cell membranes and biochemical mediators. Introduced in 1961, the first successful lipid injectable emulsion (ILE) was made from soybean oil (SO) and provided a breakthrough in PN.
This first-generation ILE was made available in the US in 1975, and initially used to prevent essential fatty acid deficiency (EFAD). Clinical practice has since evolved to include lipids as an energy source, due to the dangers of excessive dextrose provision, such as hyperglycemia and hepatic steatosis.
However, complications such as exaggerated inflammatory response in the critically ill, reticuloendothelial system suppression, and liver dysfunction were identified and attributed to the high ω-6 FA content in SO.
Omega-6 FAs are precursors to pro-inflammatory eicosanoids and may promote their
overproduction and increase oxidative stress in sepsis and trauma. Subsequent generations of
ILEs utilize alternative oil sources to reduce ω-6 FA content and provide FAs that exert more
favorable effects on immune function and inflammatory status.
Alternative ILEs have been utilized in Europe for over 30 years, but remained unavailable in the US until recently. Oil sources in these products include medium chain triglyceride (MCT) oil, olive oil (OO), and/or fish oil (FO). MCT oil provides a source of FAs that are readily oxidizable for energy and lack pro-inflammatory properties.
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