Lipid emulsion therapy for poisonings: a review
July 30, 2012, 11:29 pm
Intravenous Lipid Emulsion for the Treatment of Drug Toxicity. Ozcan MS, Weinberg G. J Intensive Care Med 2012 Jun 24 [Epub ahead of print]
This article reviews the history of intravenous lipid emulsion (ILE) as a treatment for poisoning, proposed mechanisms, laboratory and clinical evidence relating to ILE, dosing, and potential side effects.
Interest in ILE as therapy for poisoning began with the serendipitous discovery that pretreatment with lipid emulsion protected animals from the effects of systemic bupivacaine toxicity. Although the exact mechanism responsible for this protective effect, possibly explanations include: the “lipid sink” or portioning mechanism, increased levels of myocardial fatty acid fuel, and direct isotopic effect. Multiple mechanisms may be active.
Although laboratory data to date are not totally conclusive — and case reports are difficult to interpret because of numerous confounding variables — available evidence suggests that ILE may be beneficial in refractory severe toxicity due to local anesthetics, beta blockers, calcium channel blockers, tricyclic antidepressants, bupropion, haloperidol, and quetiapine. The authors note that: “No major adverse effect of ILE for treatment of drug overdose has yet been reported.”
The discussion and reference list are complete and current through the later part of 2011. A PubMed search reveals that more recently case reports have been published describing the use of ILE in overdose from diltiazem, olanzapine, chloroquine, tricyclic antidepressants (2 reports), and cocaine.
One of the co-authors, Guy Weinberg, did much of the original work on ILE as a treatment for local anesthetic toxicity, and maintains the educational website LipidRescue.
This review article is worth keeping on file as an up-to-date reference on ILE.