Is lipid emulsion therapy effective in calcium-channel-blocker and beta-blocker overdose?

February 28, 2015, 1:12 am

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Role of intravenous lipid emulsions in the management of calcium channel blocker and β-blocker overdose: 3 years experience of a university hospital. Sebe A et al.  Postgrad Med 2015 Feb;127:119-124.

Abstract

The authors of this study, from Cukurova University School of Medicine in Turkey, retrospectively reviewed patients admitted to their hospital who were treated with lipid rescue therapy (LRT) for refractory hypotension, heart block, or cardiac arrest following overdose from a calcium-channel-blocker (CCB) or a beta-blocker (BB).

They identified 15 patients(9 CCB, 6 BB.) There were two cardiac arrests; one of those patients died, the other survived with hypoxic encephalopathy. One additional patient survived with hypoxic encephalopathy. Twelve patients were reported discharged without sequelae.

The authors’ stated goal was to “assess the efficacy of lipid emulsion as antidotal therapy in severe CCB and BB intoxications.” Unfortunately, their study has so many flaws that they don’t even come close to an answer.For one thing, their chart review has almost no methods. In addition, some key data are missing, such as the time interval between initial administration of LRT and reversal of hypotension and hypoperfusion.

One other observation:the paper states that the CCB patients were treated with hyperinsulinemic euglycemia before LRT was started. However, their protocol was to give 1 g/kg dextrose followed by 0.5 U/kg/hour insulin. Most recommendations include an initial bolus dose of  0.5-1 U/kg. If this had been given, at least some of these patients might have responded and not needed LRT in the first place.

Like the authors, I am a believer in LRT for the patient in refractory shock from overdose of many cardiotoxic drugs. Unfortunately, I can not use the data in this paper to argue the point.

Related posts:

Excellent review of lipid rescue therapy

TPR Podcast #7: Interview with Guy Weinberg about lipid rescue therapy

Acute respiratory distress syndrome following intralipid emulsion therapy 

Complications associated with lipid emulsion therapy

Lipid rescue therapy can interfere with critical lab values

Case report: cocaine cardiotoxicity treated with intravenous lipid infusion

Lipid emulsion therapy for poisonings: a review

Lipid emulsion overdose

2 Comments:

  1. Guy Weinberg Says:

    I agree with you, Leon, regarding this report. A few additional comments:

    Notwithstanding the authors’ significant methodologic flaws, I’m still encouraged to see that 12 of 15 patients in cardiogenic shock left the hospital intact. That’s a pretty good number.

    I appreciate your link to the Gilbert paper (see ‘no methods’ ) which offers a nice entre to an important body of literature…thanks!

    I’d like to offer more later on the topic of timing in general and lipid therapy in particular, In short, “How does one decide when to use a particular treatment during resuscitation’?

  2. Leon Says:

    Guy:

    Thanks for the comment. I agree that the numbers in the paper are encouraging. I just wish the authors had been clear enough about how the data were extracted and analyzed that I could have faith in their results.