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- Title
ANTIDOTAL USE OF INTRAVENOUS LIPID EMULSION.
- Authors
Jovic-Stosic, Jasmina; Putic, Vesna; Vukcevic, Natasa; Vucinic, Slavica; Ercegovic, Gordana
- Abstract
INTRODUCTION: Intravenous lipid emulsion (ILE) has a long history of safe use in parenteral nutrition. In recent years, ILE has been investigated as a potential antidote in case of poisoning by liposoluble substances, including local anaesthetics, analgesics, calcium channel blockers, betablockers, antidepressants, antipsychotics and pesticides. The beneficial effect of lipid emulsion is primarily explained by the possibility that a lipophilic drug may be sequestered from tissue receptors and captured by an extended lipid compartment in the blood (lipid sink theory). Alternate mechanism of ILE effects includes recover cardiac contractility by increasing the fatty acid content and calcium level in cardiomyocytes. Knowledge on ILE antidotal effects is based on animal studies and human case reports, so systematic clinical experience is lacking. OBJECTIVE: To assess the efficacy and complications of intravenous lipid emulsion (ILE) antidotal use in acute human poisoning. METHODS: Prospective clinical study on ILE (Intralipid 20%) effects given as fast intravenous infusion in total dose of 500-1000 ml. The main criteria for administration were cardiocirculatory failure caused by liposoluble agents and poor response to vasopressors. Effects on blood pressure (BP), ECG, and patients survival were assessed. RESULTS: A total of 11 patients were treated with ILE. Poisonings were caused by glyphosate herbicide (1 patient), organophosphate insecticide (2 patients), verapamil and benzodiazepines (3 patients), propranolol combined with alcohol or psychoactive drugs (2 patients) and mixed ingestion of various drugs including carbamazepine, lamotrigin, sertraline, risperidone, amytriptiline, clozapine, haloperidol, valproic acid/valproate and chlorpromazine (3 patients). Significant increase of BP leading to vasopressor therapy reduction was noted in all patients after the initial dose of 500 ml, but in some cases this effect was transient and additional dose of Intralipid was necessary. The most prominent effect was on wide complex tachycardia which developed in two patients (ingested glyphosate or propranol/alcohol) as sinus rhythm was regained before the end of Intralipid infusion. ECG changes in others included slight widening of QRS or QT prolongation. There was no rapid normalisation that could be attributed to ILE. All patient survived except for those poisoned by organophosptates. The only complication which may be connected with ILE treatment was ARDS in case of severe verapamil intoxication. DISCUSSION: Though limited by the small number of patients, our experience revealed that the most invariable effect of ILE was the increase of BP. The most impressive was the fast reversal of wide complex tachycardia due to sodium channel blockade. The same mechanism of toxicity is attributed to local anaesthetics (bupivacaine, mepivacaine, ropivacaine) for which reports have indicated similar clinical efficacy of ILE in treating refractory cardiac arrest. CONCLUSION: ILE (Intralipid 20%) is recently included in guidelines for the treatment of refractory cardiac arrest caused by local anaesthetics. From military medicine point of view, it could be recommended to include ILE in medical supply for all units performing regional or general anaesthesia.
- Publication
Balkan Military Medical Review, 2013, Vol 16, p117
- ISSN
1107-6275
- Publication type
Article