UMEM Educational Pearls

Category: Toxicology

Title: Lipid Emulsion Therapy - Increasing Evidence

Keywords: intralipid, arrest, lipid (PubMed Search)

Posted: 5/23/2013 by Fermin Barrueto, MD (Updated: 2/18/2020)
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Utilizing 20% lipid emulsion at a dose of 1.5 mL/kg (100 mL Bolus) IV with repeat in 15 minutes in no response is being recommended in patients hemodynamic instabiity due to poisoning.

Probably more effective in lipophilic drugs is a current theory for the mechanism of action - the "lipid sink". The idea is that the lipids envelope the drug pulling it off its receptors or sequestering it in the intravascular space. A recent paper has added another mechanism - direct inotropic and lusiptropic effects.(1)

Also, if you think the therapy is experimental, think again. Another recent paper surveyed Poison Control Centers and found 30/45 Poison Centers in the US have a defined protocol for utilization of lipid emulsion therapy. The PCCs are recommending it more.(2)

What was once considered just a purely experimental therapy only used at the very end of code is becoming more mainstream. Comfort with its safety profile and anectodotal effiicacy continues to mount.

References

1. Fettiplace MR, Ripper R, Lis K, Lin B, Lang J, Zider B, Wang J,
Rubinstein I, Weinberg G. Rapid Cardiotonic Effects of Lipid Emulsion
Infusion. Crit Care Med. 2013 Mar 25. [Epub ahead of print]

2. Christian MR, Pallasch EM, Wahl M, Mycyk MB. Lipid Rescue 911: Are
Poison Centers Recommending Intravenous Fat Emulsion Therapy for
Severe Poisoning? J Med Toxicol. 2013 May 10. [Epub ahead of print]