The emerging use of ILE administration in clinical toxicology warrants careful attention to its potential adverse effects. The dosing regimen and context of administration leading to the adverse events documented in this review are not generalizable to all clinical toxicology scenarios. Adverse effects seem to be proportional to the rate of infusion as well as total dose received. Further safety studies in humans and reporting of adverse events associated with ILE administration at the doses advocated in current clinical toxicology literature are needed.
of their professional time to nutrition support activities. These activities may include direct patient care, research relevant to nutrition support therapy, teaching, and administrative responsibilities. These standards are not intended for the pharmacist who occasionally provides nutrition support to patients, but rather to those who by virtue of education, training, experience, and personal interest wish to be identified as an NSP and provide expertise in collaboration with other healthcare professionals. 2. Level of Care: These Standards of Practice represent a range of competencies that should be provided by any NSP within or outside the context of a formal nutrition support service or team. The application of standards in any individual case should be determined by the best judgment of the NSP, as well as their position and practice environment. The Standards are presented in the most generic terms possible. Details of patient care are left to the discretion of the individual NSP, healthcare professionals, and nutrition support services or teams. The Standards aim to provide a basis for sound and efficient nutrition care for patients in all healthcare settings in need of nutrition support therapy. Terminology to be included in each standard are specified as: a. "Shall": indicates standards to be followed strictly. b. "Should": indicates that among several possibilities one is particularly suitable, without mentioning or excluding others, or that a certain course of action is preferred but not necessarily required. c. "May": indicates a course of action which is permissible within the limits of recommended practice.
Intravenous lipid emulsion (ILE) therapy is a novel treatment that was discovered in the last decade. Despite unclear understanding of its mechanisms of action, numerous and diverse publications attested to its clinical use. However, current evidence supporting its use is unclear and recommendations are inconsistent. To assist clinicians in decision-making, the American Academy of Clinical Toxicology created a workgroup composed of international experts from various clinical specialties, which includes representatives of major clinical toxicology associations. Rigorous methodology using the Appraisal of Guidelines for Research and Evaluation or AGREE II instrument was developed to provide a framework for the systematic reviews for this project and to formulate evidence-based recommendations on the use of ILE in poisoning. Systematic reviews on the efficacy of ILE in local anesthetic toxicity and non-local anesthetic poisonings as well as adverse effects of ILE are planned. A comprehensive review of lipid analytical interferences and a survey of ILE costs will be developed. The evidence will be appraised using the GRADE system. A thorough and transparent process for consensus statements will be performed to provide recommendations, using a modified Delphi method with two rounds of voting. This process will allow for the production of useful practice recommendations for this therapy.
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