Journal of Medical Toxicology

, Volume 9, Issue 3, pp 231–234 | Cite as

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

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

Intralipid Intravenous fat emulsion Lipid resuscitation therapy Poison center Antidote 

Supplementary material

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

References

  1. 1.
    Weinberg G, VadeBoncouer T, Ramaraju G, Garcia-Amaro M, Cwik M (1998) Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology 88:1071–1075PubMedCrossRefGoogle Scholar
  2. 2.
    Rosenblatt M, Abel M, Fischer G, Itzkovich C, Eisenkraft J (2006) Successful use of a 20 % lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology 105:217–218PubMedCrossRefGoogle Scholar
  3. 3.
    Sirianni A, Osterhoudt K, Calello D, Muller A, Waterhouse M, Goodkin M, Weinberg G et al (2008) Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine. Ann Emerg Med 51(4):412–415, 415.e1PubMedCrossRefGoogle Scholar
  4. 4.
    Young A, Velez L, Kleinschmidt K (2009) Intravenous fat emulsion therapy for intentional sustained-release verapamil overdose. Resuscitation 80(5):591–593PubMedCrossRefGoogle Scholar
  5. 5.
    French D, Armenian P, Ruan W, Wong A, Drasner K, Olson K, Wu A (2011) Serum verapamil concentrations before and after Intralipid® therapy during treatment of an overdose. Clin Toxicol 49(4):340–344CrossRefGoogle Scholar
  6. 6.
    Finn S, Uncles D, Willers J, Sable N (2009) Early treatment of a quetiapine and sertraline overdose with Intralipid. Anesthesia 64(2):191–194CrossRefGoogle Scholar
  7. 7.
    Hillyard S, Barrera-Groba C, Tighe R (2010) Intralipid reverses coma associated with zopiclone and venlafaxine overdose. Eur J Anaesthesiol 27(6):582–583PubMedGoogle Scholar
  8. 8.
    Jovic-Stosic J, Gligic, Putic V, Brajkovic G, Spasic R (2011) Severe propranolol and ethanol overdose with wide complex tachycardia treated with intravenous lipid emulsion: a case report. Clin Toxicol 49(5):426–430CrossRefGoogle Scholar
  9. 9.
    Montiel V, Gougnard T, Hantson P (2011) Diltiazem poisoning treated with hyperinsulinemic euglycemia therapy and intravenous lipid emulsion. Eur J Emerg Med 18(2):121–123PubMedCrossRefGoogle Scholar
  10. 10.
    Cave G, Harvey M (2009) Intravenous lipid emulsion as antidote beyond local anesthetic toxicity: a systematic review. Acad Emerg Med 16(9):815–824PubMedCrossRefGoogle Scholar
  11. 11.
    American College of Medical Toxicology (ACMT) National Office. Interim guidance for the use of lipid resuscitation therapy. Available at http://www.acmt.net/cgi/page.cgi/zine_service.html?aid=3384&zine=show. Accessed 4 March 2013
  12. 12.
    Bronstein A, Spyker D, Cantilena L, Rumack B, Dart R (2012) 2011 Annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 29th Annual Report. Clin Tox 50(10):911–1164CrossRefGoogle Scholar
  13. 13.
    Darracq M, Thornton S, Do H, Bok D, Clark R, Cantrell F (2013) Utilization of hyperinsulinemia euglycemia and intravenous fat emulsion following Poison Center recommendations. J Med Toxicol. doi:10.1007/s13181-013-0290-2
  14. 14.
    Wax P, Kleinschmidt K, Brent J (2011) The Toxicology Investigators Consortium (ToxIC) Registry. J Med Tox 7(4):259–265CrossRefGoogle Scholar
  15. 15.
    Geib A, Liebelt E, Manini F, Toxicology Investigator’s Consortium (ToxIC) (2012) Clinical experience with intravenous lipid emulsion for drug-induced cardiovascular collapse. J Med Tox 8(1):10–14CrossRefGoogle Scholar

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

Personalised recommendations