TPR Podcast Episode #7: Interview with Guy Weinberg about lipid rescue therapy
January 14, 2015, 5:12 pm
NOTE: The audio quality of this recording is understandable but definitely choppy and sub-optimal. However, the concepts discussed are so important that we are uploading the file for those who want to listen. We will also post a transcript of the discussion in the next few days.
In this episode the TPR team interviews Dr. Guy Weinberg from the Department of Anesthesia at the University of Illinois Medical Center in Chicago. Dr. Weinberg, among his many other accomplishments, was instrumental in developing the modality of lipid rescue therapy in treating cardiotoxicity caused by parenteral injection of local anesthetics such as bupivacaine. He also runs the website LipidRescue™ Resuscitation.
The discussion is worth listening to (or reading) in its entirety. The following are summaries of some of Dr. Weinberg’s key take-home points:
- Although the recipe for administering 20% Intralipid in cases of parenteral local anesthetic has been well worked out, the optimal dose for treating oral ingestion of lipophilic cardiotoxic or neurotoxic agents has not. With parenteral local anesthetic injection serum levels peak quickly and fall rapidly. With oral ingestions — especially of sustained-release products — levels are more sustained and may even increase for a period of time. These 2 different scenarios may very well have to be treated differently.
- The clinician should avoid administering too much lipid emulsion, as this can cause adverse effects from fat overload.
- As a reasonable schedule in oral overdose, Dr. Weinberg suggested: 20% Intralipid 1.5 ml/kg (lean body mass) bolus, followed by infusion 0.25 ml/kg/min; if an upper limit of 10-12 ml/kg is reached and more lipid emulsion is indicated, dial back the infusion to 100 ml/h (adult dose.)
- Since in toxicology cases intravenous lipid emulsion (ILE) therapy is at this time usually used as a last resort, case reports may be biased towards poor outcomes.
- If pancreatitis after ILE is suspected, the diagnostic should not be made on the basis of laboratory tests such as amylase or lipase alone, but should be confirmed with imaging.
This episode’s Quizzler: In the 1984 film Ghostbusters, what is the real identity of the Stay Puft Marshmallow Man? Submit answers by e-mail to: firstname.lastname@example.org. First correct response wins a $10 Amazon gift certificate and a TPR t-shirt.