A randomized, controlled clinical trial of intravenous lipid emulsion as an adjunctive treatment for permethrin toxicosis in cats

Peacock, Rachel; Hosgood, Giselle; Swindells, Katrin L.; Smart, Lisa

doi:10.1111/vec.12322

Cited by 31 publications

(50 citation statements)

References 58 publications

(125 reference statements)

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“…‐ 162 In particular, Intralipid has been used extensively to treat ivermectin 77 , 163 ‐ 166 and permethrin 167 ‐ 170 toxicity. In particular, Peacock et al 171 conducted a randomized trial of lipid emulsion in permethrin toxicosis in felines and found a robust rescue effect of the lipid emulsion in comparison to saline. Beyond that, a number of other overdoses with potential translational relevance have been reported as effectively managed with ILE, including moxidectin, 172 ibuprofen, 173 carbamazepine, 106 , 119 and baclofen 106 .…”

Section: Part Iii: Clinical Futurementioning

confidence: 99%

Past, Present, and Future of Lipid Resuscitation Therapy

Fettiplace

Weinberg

2015

J Parenter Enteral Nutr

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Lipid resuscitation therapy was identified in 1998 as an effective treatment for local anesthetic systemic toxicity in an animal model. Since the original observation, the field has progressed tremendously with successful clinical translation and expansion of use to treatment of other types of drug overdose. Recent work has expanded our understanding of the mechanism of this novel treatment, one that includes both a dynamic scavenging component and direct cardiotonic effect. In this review, we discuss the past, present, and future of lipid resuscitation therapy with a focus on our understanding of the mechanism and directions that the field is moving, both from a clinical and basic research side.

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Section: Part Iii: Clinical Futurementioning

confidence: 99%

Past, Present, and Future of Lipid Resuscitation Therapy

Fettiplace

Weinberg

2015

J Parenter Enteral Nutr

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“…Three animal experiments studied ILE for non-LA toxicity. [35,39,42] In one trial, 20 cats with 14 additional controls were exposed dermally to permethrin. ILE was administered to the treatment group at 15 mL/kg as a continuous intravenous infusion over 60 minutes.…”

Section: Non-local Anestheticsmentioning

confidence: 99%

“…A grading system for neurologic effects detected a decrease in the duration and severity of poisoning in the treatment group reported as a decrease in the duration and severity of poisoning in the treatment group. [39] Another randomized experiment in swine sought to determine a difference in mean arterial blood pressure (MAP), QRS duration and survival after diphenhydramine poisoning. Twenty-four animals were equally divided into two groups.…”

Section: Non-local Anestheticsmentioning

confidence: 99%

See 1 more Smart Citation

Evidence-based recommendations on the use of intravenous lipid emulsion therapy in poisoning

Gosselin

Hoffman

et al. 2016

Clinical Toxicology

131

104

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Background: Although intravenous lipid emulsion (ILE) was first used to treat life-threatening local anesthetic (LA) toxicity, its use has expanded to include both non-local anesthetic (non-LA) poisoning and less severe manifestations of toxicity. A collaborative workgroup appraised the literature and provides evidence-based recommendations for the use of ILE in poisoning. Methods: Following a systematic review of the literature, data were summarized in four publications: LA and non-LA poisoning efficacy, adverse effects, and analytical interferences. Twenty-two toxins or toxin categories and three clinical situations were selected for voting. Voting statements were proposed using a predetermined format. A two-round modified Delphi method was used to reach consensus on the voting statements. Disagreement was quantified using RAND/UCLA Appropriateness Method. Results: For the management of cardiac arrest, we recommend using ILE with bupivacaine toxicity, while our recommendations are neutral regarding its use for all other toxins. For the management of life-threatening toxicity, (1) as first line therapy, we suggest not to use ILE with toxicity from amitriptyline, non-lipid soluble beta receptor antagonists, bupropion, calcium channel blockers, cocaine, diphenhydramine, lamotrigine, malathion but are neutral for other toxins, (2) as part of treatment modalities, we suggest using ILE in bupivacaine toxicity if other therapies fail, but are neutral for other toxins, (3) if other therapies fail, we recommend ILE for bupivacaine toxicity and we suggest using ILE for toxicity due to other LAs, amitriptyline, and bupropion, but our recommendations are neutral for all other toxins. In the treatment of non-life-threatening toxicity, recommendations are variable according to the balance of expected risks and benefits for each toxin. For LA-toxicity we suggest the use of Intralipid V R 20% as it is the formulation the most often reported. There is no evidence to support a recommendation for the best formulation of ILE for non-LAs. The voting panel is neutral regarding ILE dosing and infusion duration due to insufficient data for non-LAs. All recommendations were based on very low quality of evidence. Conclusion: Clinical recommendations regarding the use of ILE in poisoning were only possible in a small number of scenarios and were based mainly on very low quality of evidence, balance of expected risks and benefits, adverse effects, laboratory interferences as well as related costs and resources. The workgroup emphasizes that dose-finding and controlled studies reflecting human poisoning scenarios are required to advance knowledge of limitations, indications, adverse effects, effectiveness, and best regimen for ILE treatment.

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“…In regard to investigating the effects and potential benefits of intravenous lipid therapy in cats with a similar toxin, permethrin, Peacock et al report the largest randomized controlled trial in cats. In this trial, investigators chose to evaluate the impact of intravenous lipid therapy on course of clinical signs associated with permethrin toxicity.…”

mentioning

confidence: 99%