At presentation, he had hypotension and bradycardia that was unresponsive to treatment with intravenous saline, calcium, glucagon, and vasopressors. Isolated reports of pulmonary edema or severe lipemia exist as a complication of therapy.Ī 26-year-old hypertensive, male, kidney transplant recipient presented to an outside emergency department (ED) after an intentional overdose of his medications (ie, amlodipine, metoprolol, lisinopril). Lipid non-local anesthetics systematic review.Intralipid emulsion (ILE) is a nutritional fatty acid supplementation that is emerging as a potential therapy for local anesthetic systemic toxicity and is also being considered as a therapy for other lipophilic medication intoxications. Intravenous lipid emulsion therapy was used in the management of overdose with 65 unique substances.ĭespite the use of ILE for multiple substances in the treatment of patients with poisoning and overdose, the effect of ILE in various non-local anesthetic poisonings is heterogenous, and the quality of evidence remains low to very low. In addition, 137 human case reports or case series were identified. One observational study examined ILE in glyphosate overdose. There were three human randomized control trials (RCT): one RCT examined ILE in TCA overdose, one RCT examined ILE in various overdoses, and one study examined ILE in reversal of sedation after therapeutic administration of inhaled anesthesia. These include 40 animal experiments and 22 case reports involving animal toxicity. The final analysis included 203 articles: 141 for humans and 62 for animals. Agreement of at least two members of the subgroup was required before an article could be excluded. Articles involving pre-treatment experiments, pharmacokinetic studies not involving toxicity, and studies not addressing antidotal use of ILE met pre-defined exclusion criteria. Relevant articles were determined based upon a predefined methodology. The aim of this group is to review the available evidence regarding the effect of ILE in non-LA drug poisoning and develop consensus-based recommendations on the use of this therapy.Ī systematic review of the literature was performed to capture articles through 15 December 2014. The American Academy of Clinical Toxicology established a lipid emulsion workgroup. Furthermore, many case reports describe ILE use for substances in which no clear efficacy data exists. Despite this, the evidence for its effect in non-local anesthetic toxicity remains sparse. The use of intravenous lipid emulsion (ILE) therapy for the treatment of lipophilic drug toxicity is increasing. 9 i Department of Emergency Medicine, McGill University Health Centre & Department of Medicine, McGill University, Montreal, Canada.8 h Schulich Library of Science and Engineering, McGill University, Montreal, Canada and.7 g Department of Emergency Medicine, Regions Hospital, Saint Paul, MN, USA.6 f Department of Emergency Medicine, University of Calgary, Poison and Drug Information Service, Calgary, Canada.5 e Department of Medicine, School of Clinical Sciences at Monash Health, Clinical Toxicology Service at Monash Health and Monash Emergency Translational Research Group, Monash University, Clayton, Victoria, Australia.4 d Department of Emergency Medicine, Upstate Medical University, New York and Upstate New York Poison Center, New York, NY, USA.3 c Department of Medical Biology, Sacré-Coeur Hospital, University of Montreal, Montreal, Canada.Perelman Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA 2 b Division of Medical Toxicology, Ronald O.1 a Department of Emergency Medicine, Section of Medical Toxicology, University of Southern California, Los Angeles, CA, USA.
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