Abstract
The use of intravenous lipid emulsion (ILE) as an antidote has prompted significant academic and clinical interest. Between August 2009 and August 2012, data from cases of ILE use in intoxicated patients in different hospitals on different continents were voluntarily entered into a registry based on the world wide web (www.lipidregistry.org). Here, we report data from this project. Participating centers were given access to the registry following institutional subscription. Specifically sought were details of the individual patients’ presenting condition, indications for ILE use, ILE administration regimen, potential complications, and of clinical outcome. Forty-eight uses of ILE were reported from 61 participating centers. Ten cases of local anesthetic systemic toxicity were reported; all (10/10) survived. Thirty-eight cases of intoxication by other agents were reported [30 decreased conscious state, 8 cardiovascular collapse (3 deaths)]. There was an elevation in GCS (p < 0.0001) and increased systolic blood pressure (p = 0.012) from immediately prior to ILE administration to 30 min after use. One serious and two minor adverse effects of ILE use were recorded in 48 reported cases (one case of bronchospastic reaction, one case of hyperamylasemia and one case of interference with laboratory testing). In this series of cases reported to the registry, improvements were seen for GCS in patients with central nervous system toxicity and in systolic blood pressure in shocked patients over a short time frame after the injection of ILE. Few adverse effects were recorded. Clinical trials and the reporting of drug concentrations after ILE use are necessary to further elucidate the role of ILE in clinical toxicology.
Similar content being viewed by others
References
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. Anaesthesiology 88:1071–1075
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. Anaestheiology 105:217–218
Litz R, Popp M, Stehr S, Koch T (2006) Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion. Anaesthesia 61:800–801
McCutchen T, Gerancher J (2008) Early intralipid may have prevented bupivacaine associated cardiac arrest. Reg Anaesth Pain Med 33:178–180
Foxall G, McCahon R, Lamb J, Hardman J, Bedforth N (2007) Levobupivacaine-induced seizures and cardiovascular collapse treated with Intralipid. Anaesthesia 62:516–518
Guidelines for the management of severe local-anaesthetic toxicity: the Association of Anaesthestists of Great Britain and Ireland. Avaliable at: http://www.aagbi.org/publications/guidelines/docs/latoxicity07.pdf. Accessed 25 January 2009
Neal JM, Bernards CM, Butterworth JF et al (2010) ASRA practice advisory on local anesthetic systemic toxicity. Reg Anaesth Pain Med 35:152–161
Weinberg G (2006) Lipid rescue resuscitation from local anaesthetic cardiac toxicity. Toxicol Rev 25:139–145
Harvey M, Cave G (2009) Correlation of plasma and peritoneal diasylate clomipramine concentration with hemodynamic recovery after intralipid infusion in rabbits. Acad Emerg Med 16:151–156
Partownavid P, Umar S, Li J, Rahman S, Eghbali M (2012) Fatty-acid oxidation and calcium homeostasis are involved in the rescue of bupicavaine-induced cardiotoxicity by lipid emulsion in rats. Crit Care Med 40:2431–2437
Huang J, Xian H, Bacaner M (1992) Long-chain fatty acids activate calcium channels in ventricular myocytes. Proc Natl Acad Sci U S A 89:6452–6456
Fettiplace M, Ripper R, Lis K et al (2013) Rapid cardiotonic effects of lipid emulsion infusion. Crit Care Med 41:e156–e162
Harvey M, Cave G (2007) Intralipid outperforms sodium bicarbonate in a rabbit model of clomipramine toxicity. Ann Emerg Med 49:178–185
Tebbutt S, Harvey M, Nicholson T, Cave G (2006) Intralipid prolongs survival in a rat model of verapamil toxicity. Acad Emerg Med 13:134–139
Bania T, Chu J, Perez E (2007) Hemodynamic effects of intravenous fat emulsion in an animal model of severe verapamil toxicity resuscitated with atropine, calcium, and saline. Acad Emerg Med 14:105–111
Harvey M, Cave G (2008) Intralipid infusion ameliorates propranolol induced hypotension in rabbits. J Med Toxicol 4:71–76
Bania T, Chu J (2006) Hemodynamic effect of intralipid in amitriptyline toxicity. Acad Emerg Med 13(S1):117
Sirianni A, Osterhoudt K, Calello D et al (2007) Use of intralipid in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine. Ann Emerg Med 51:412–415
Finn S, Uncles D, Willers J, Sable N (2009) Early treatment of a quetiapine and sertraline overdose with intralipid. Anaesthesia 64:191–194
Dolcourt B, Aaron C (2008) Intravenous fat emulsion for refractory verapamil and atenolol induced shock: a human case report. Clin Toxicol 46:619–620
Harvey M, Cave G (2012) Case report: successful lipid resuscitation in multi-drug overdose with predominant tricyclic antidepressant toxidrome. Int J Emerg Med 5:5–8
Haesendonck R, de Winter S, Vereist S, Sabbe M (2012) Intravenous lipid emulsion for intentional chloroquine poisoning. Clin Toxicol 50:223
Castanaeres-Zapatero D, Wittebole X, Huberlant V, Morunglav M, Hantson P (2012) Lipid emulsion as rescue therapy in lamotrigine overdose. J Emerg Med 42:48–51
Megarbane B, Jacobs F (2012) Lipid emulsion in acute poisonings: still no convincing demonstration for its use in non-local anesthetic drug poisoning without life-threatening presentation. Eur Rev Med Pharmacol Sci 16:990
Perichon D, Turfus S, Gerostamoulos D, Graudins A (2013) An assessment of the in vivo effects of intravenous lipid emulsion on blood drug concentration and haemodynamics following oro-gastric amitriptyline overdose. Clin Toxicol 51:208–215
Harvey M, Cave G, Shaw T (2013) Effect of intravenous lipid emulsion and octreotide on enteric thiopentone absorption; a pilot study. Clin Toxicol 51:117–118
Gieb A, Liebelt E, Manini A (2012) Clinical experience with intravenous lipid emulsion for drug-induced cardiovascular collapse. Journal of Med Toxicol; 10–14
Shi K, Xia Y, Wang Q et al (2013) The effect of lipid emulsion on pharmacokinetics and tissue distribution of bupivacaine in rats. Anesth Analg 116:804–809
Heinonen J, Litonius E (2013) Backmann, Neuvonen P, Rosenberg P. Intravenous lipid emulsion entraps amitriptyline into plasma and can lower its brain concentration—an experimental intoxication study in pigs. Basic Clin Pharmacol Toxicol 113:193–200
Fulton J, Greller H, Hoffman R (2005) GCS and AVPU. The alphabet soup doesn’t spell coma in toxicology. Annals EMerg Med 45:224–225
French D, Armenian P, Ruan W (2011) Serum verapamil concentrations before and after intralipid therapy during treatment of an overdose. Clinical Toxicol 49:340–344
Jamaty C, Bailey B, Larocque A, Notebaert E, Sanogo K, Chauny J (2010) Lipid emulsions in the treatment of acute poisoning: a systematic review of human and animal studies. Clin Toxicol 48:1–27
Kearns W II (2007) Mangement of β-adrenergic blocker and calcium channel antagonist toxicity. Emerg Med Clin N Am 25:309–331
Engebretsen K, Kaczmarek K, Morgan J, Holger J (2011) High-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning. Clin Toxicol 49:277–283
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Esm 1
(PDF 376 kb)
Rights and permissions
About this article
Cite this article
Cave, G., Harvey, M., Willers, J. et al. LIPAEMIC Report: Results of Clinical Use of Intravenous Lipid Emulsion in Drug Toxicity Reported to an Online Lipid Registry. J. Med. Toxicol. 10, 133–142 (2014). https://doi.org/10.1007/s13181-013-0375-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13181-013-0375-y