#2-5. Basic IV solutions and the non-covered “all-in-one” IV solution

BCAA is a better choice in patients with a liver disease. There are three types of BCAA; valine, leucine, and isoleucine. They are converted into energy directly in the muscles without hepatic metabolism and can improve hepatic coma in liver cirrhosis. On the other hand, BCAA is contraindicated in renal failure. BCAA’s main function is to generate energy, thereby increasing blood urea and exacerbate renal toxicity. Therefore, EAA is a better choice in patients with renal dysfunction. Histidine, in particular, is recommended as it promotes protein synthesis.

Lipid IV therapy can be used without concern for osmotic pressure. Lipids generate about 9kcal per gram, which is 2.25 times higher than glucose or amino acids. It also provides various essential fatty acids. The types of fatty acids delivered are determined by the lipid ingredients and it is important to check for the source of lipids. Let’s take a look at lipids to better our understanding of lipid IV therapy. Lipids can be largely divided into fatty acids, neutral fat, phospholipids, and cholesterol. Among these, we should focus on fatty acids, neutral fat and phospholipid. We will discuss neutral fat and phospholipid in greater detail in the future article on lipid emulsion. In this article, let’s briefly go over fatty acids.

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Fatty acids are one of the most basic components of lipids. The chemical structure of a fatty acid is a carbon chain with base methyl group on one end and acidic carboxyl group on the other end of its molecule. The carbon chain in the middle forms single bonds in saturated fatty acids and at least one double bond in unsaturated fatty acids. The number of carbon atoms is important in saturated fatty acid. Fatty acid with 6-12 carbon atoms is called medium chain fatty acid and the neutral fat composed of these fatty acids is called medium chain triglyceride (MCT). MCT is of particular interest. It is a saturated fatty acid with high energy conversion and does not cause weight gain as it is hardly stored in adipocytes. MCT is rich in coconut oil. The fatty acid commonly used in lipid IV therapy in the past was long chain triglycerides (LCT) which has lower energy conversion compared to MCT.

Unsaturated fatty acids make up the majority of essential fatty acids and can be divided into omega 3, 5, 6, and 9, based on how far the double bond is along the carbon chain from methyl group. The chain with only one double bond is called monounsaturated fatty acid and oleic acid (omega 9) is a well-known example. Omega 3 and omega 6 are both polyunsaturated fatty acids. (Figure 4).