Must only be administered through a central vein. Hypersensitivity or anaphylactic reaction The infusion must be stopped immediately if any signs or symptoms of an allergic reaction (such as fever, shivering, rash or dyspnea) develop.
Finomel contains soya-bean oil, fish oil and egg phospholipids, which may rarely cause allergic reactions. Cross allergic reaction has been observed between soybean and peanut. 3). Pulmonary vascular precipitates Pulmonary vascular precipitates causing pulmonary vascular emboli and pulmonary distress have been reported in patients receiving parenteral nutrition.
In some cases, fatal outcomes have occurred. Excessive addition of calcium and phosphate increases the risk of the formation of calcium phosphate precipitates. Precipitates have been reported even in the absence of phosphate salt in the solution.
Suspected in vivo precipitate formation has also been reported. In addition to inspection of the solution, the infusion set and catheter should also periodically be checked for precipitates. If signs of pulmonary distress occur, the infusion should be stopped and medical evaluation initiated.
Infection and sepsis Since an increased risk of infection is associated with the use of any vein, strict aseptic precautions should be taken to avoid any contamination during catheter insertion and manipulation. Fat overload syndrome “Fat overload syndrome” has been reported with similar products.
, overdose and/or infusion rate higher than recommended); however, the signs and symptoms of this syndrome may also occur when the product is administered according to instructions. The reduced or limited ability to metabolize the lipids contained in Finomel accompanied by prolonged plasma clearance may result in a fat overload syndrome.
, coma). The syndrome is usually reversible when the infusion of the lipid emulsion is stopped. Use in patients with impaired lipid metabolism. Monitor the patient’s capacity to eliminate lipids by checking the triglyceride levels. 6 mmol/l during infusion.
Use with caution in conditions of impaired lipid metabolism, which may occur in patients with renal failure, diabetes mellitus, pancreatitis, impaired liver function, hypothyroidism and sepsis. Serum glucose, electrolytes and osmolarity as well as fluid balance, acid-base status and liver enzyme tests should be monitored.
Refeeding syndrome Refeeding severely undernourished patients may result in the refeeding syndrome that is characterized by the shift of potassium, phosphorus, and magnesium intracellularly as the patient becomes anabolic. Thiamine deficiency and fluid retention may also develop.
Careful monitoring and slowly increasing nutrient intakes while avoiding overfeeding can prevent these complications. This syndrome has been reported with similar products. In malnourished patients, initiation of parenteral nutrition can precipitate fluid shifts resulting in pulmonary oedema and congestive heart failure as well as a decrease in the serum concentration of potassium, phosphorus, magnesium and water soluble vitamins.