Journal of Medical Toxicology

, Volume 9, Issue 3, pp 231–234

Lipid Rescue 911: Are Poison Centers Recommending Intravenous Fat Emulsion Therapy for Severe Poisoning?

  • Michael R. Christian
  • Erin M. Pallasch
  • Michael Wahl
  • Mark B. Mycyk
Toxicology Investigation

DOI: 10.1007/s13181-013-0302-2

Cite this article as:
Christian, M.R., Pallasch, E.M., Wahl, M. et al. J. Med. Toxicol. (2013) 9: 231. doi:10.1007/s13181-013-0302-2

Abstract

Intravenous fat emulsion (IFE) therapy is a novel treatment that has been used to reverse the acute toxicity of some xenobiotics with varied success. We sought to determine how US Poison Control Centers (PCCs) have incorporated IFE as a treatment strategy for poisoning. A closed-format multiple-choice survey instrument was developed, piloted, revised, and then sent electronically to every medical director of an accredited US PCC in March 2011. Addresses were obtained from the American Association of Poison Control Centers listserv, and participation was voluntary and remained anonymous. Data were analyzed using descriptive statistics. The majority of PCC medical directors completed the survey (45 out of 57; 79 %). Of the 45 respondents, all felt that IFE therapy played a role in the acute overdose setting. Most PCCs (30 out of 45; 67 %) have a protocol for IFE therapy. In a scenario with “cardiac arrest” due to a single xenobiotic, directors stated that their center would “always” or “often” recommend IFE after overdose of bupivacaine (43 out of 45; 96 %), verapamil (36 out of 45; 80 %), amitriptyline (31 out of 45; 69 %), or an unknown xenobiotic (12 out of 45; 27 %). In a scenario with “shock” due to a single xenobiotic, directors stated that their PCC would “always” or “often” recommend IFE after overdose of bupivacaine (40 out of 45; 89 %), verapamil (28 out of 45; 62 %), amitriptyline (25 out of 45; 56 %), or an unknown xenobiotic (8 out of 45; 18 %). IFE therapy is being recommended by US PCCs; protocols and dosing regimens are nearly uniform. Most directors feel that IFE is safe but are more likely to recommend IFE in patients with cardiac arrest than in patients with severe hemodynamic compromise.

Keywords

IntralipidIntravenous fat emulsionLipid resuscitation therapyPoison centerAntidote

Supplementary material

13181_2013_302_MOESM1_ESM.pdf (215 kb)
ESM 1(PDF 216 kb)

Copyright information

© American College of Medical Toxicology 2013

Authors and Affiliations

  • Michael R. Christian
    • 3
    • 4
  • Erin M. Pallasch
    • 1
  • Michael Wahl
    • 1
  • Mark B. Mycyk
    • 2
  1. 1.The Illinois Poison CenterChicagoUSA
  2. 2.Cook County Hospital (Stroger)ChicagoUSA
  3. 3.Division of Clinical Pharmacology and Medical ToxicologyChildren’s Mercy Hospital and ClinicsKansas CityUSA
  4. 4.Truman Medical Center, Department of Emergency MedicineUniversity of Missouri—Kansas City, School of MedicineKansas CityUSA