Caution should be exercised in cases of increased serum osmolarity.
As for all large-volume infusion solutions Nutriflex-Lipid Peri/Nutriflex Omega Special should be administered with caution to patients with impaired cardiac or renal function. Disturbances of the fluid, electrolyte or acid-base balance, e.g. hyperhydration (for Nutriflex-Lipid Peri), hypertonic dehydration (for Nutriflex Omega Special), hyperkalaemia, acidosis, should be corrected before the start of infusion.
Too rapid infusion can lead to fluid overload with pathological serum electrolyte concentrations, hyperhydration and pulmonary oedema.
The serum triglyceride concentration should be monitored when infusing Nutriflex-Lipid Peri/Nutriflex Omega Special. Fasting lipaemia should be excluded in patients with suspected disturbances of lipid metabolism before starting infusion.
The administration of lipids is contra-indicated if there is fasting lipaemia. The presence of hypertriglyceridaemia 12 hours after lipid administration also indicates a disturbance of lipid metabolism.
Nutriflex-Lipid Peri/Nutriflex Omega Special should be administered cautiously to patients with disturbances of lipid metabolism, e.g. renal insufficiency, diabetes mellitus, pancreatitis, impaired hepatic function, hypothyroidism (with hypertriglyceridaemia), pulmonary disease (for Nutriflex Omega Special only) and sepsis. If Nutriflex-Lipid Peri/Nutriflex Omega Special is given to patients with these conditions, close monitoring of serum triglycerides is mandatory.
Any sign or symptom of anaphylactic reaction (such as fever, shivering, rash or dyspnoea) should lead to immediate interruption of the infusion.
Depending on the patient's metabolic condition, occasional hypertriglyceridaemia or increases of the blood glucose concentration may occur. If the plasma triglyceride concentration rises to more than 3 mmol/l during administration of lipid it is recommended that the infusion rate should be reduced. Should the plasma triglyceride concentration remain above 3 mmol/l the administration should be stopped until the level normalizes.
As with all solutions containing carbohydrates the administration of Nutriflex-Lipid Peri/Nutriflex Omega Special can lead to hyperglycaemia. The blood glucose level should be monitored. If there is hyperglycaemia the rate of infusion should be reduced or insulin should be administered.
A dose reduction or interruption of administration is also indicated if the blood glucose concentration rises to more than 14 mmol/l (250 mg/dl) when administering the lipid/product.
Intravenous infusion of amino acids is accompanied by increased urinary excretion of the trace elements, especially copper and, in particular, zinc. This should be considered in the dosing of trace elements, especially during long-term intravenous nutrition.
Nutriflex-Lipid Peri/Nutriflex Omega Special should not be given simultaneously with blood in the same infusion set due to the risk of pseudoagglutination.
Moreover controls of the serum electrolyte levels, the water balance, the acid-base balance and - during long-term administration - of blood cell counts, coagulation status and hepatic function are necessary.
The fat content may interfere with certain laboratory measurements (e.g. bilirubin, lactate dehydrogenase, oxygen saturation) if blood is sampled before fat has been adequately cleared from the blood stream.
Substitution of electrolytes, vitamins and trace elements may be necessary as required.
As Nutriflex-Lipid Peri/Nutriflex Omega Special contains zinc and magnesium, care should be taken when it is co-administered with solutions containing these elements.
As with all intravenous solutions strict aseptic precautions are necessary for the infusion of Nutriflex-Lipid Peri/Nutriflex Omega Special.
Nutriflex-Lipid Peri/Nutriflex Omega Special is a preparation of complex composition. It is, therefore, strongly advisable not to add other solutions.
Nutriflex Omega Special: There is as yet no clinical experience of the use of Nutriflex Omega special in children and adolescents.
There is only limited experience of its use in patients with diabetes mellitus or renal failure.
Vitamin E can interfere with the effect of vitamin K in clotting factor synthesis. This should be considered in patients with blood coagulation disorders or suspected vitamin K deficiency.