Early treatment of a quetiapine and sertraline overdose with Intralipid<sup>®</sup>*

Finn, S. D. H.; Uncles, D. R.; Willers, Johann; Sable, Nilesh

doi:10.1111/j.1365-2044.2008.05744.x

Cited by 114 publications

(86 citation statements)

References 25 publications

(22 reference statements)

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“…Since then, use in local anesthetic systemic toxicity, and more recently use in toxidromes from drugs other than local anesthetics, has been increasingly reported [18][19][20][21][22][23]. Systematic reporting of outcomes following ILE infusion for such indications has been lacking with only single case reports, and short case series [27] appearing in literature to date.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical use of ILE in non-local anesthetic poisoning has similarly been associated with successful resuscitation outcome in numerous case reports of overdose with pharmacologically disparate agents [18][19][20][21][22][23]. However, given the variability of drugs taken in overdose and the range of both generic and specific antidotes utilized to treat cardiovascular toxicity in concert with administered ILE therapy in these cases, the magnitude of any benefit attributable to ILE administration remains unclear [24].…”

Section: Introductionmentioning

confidence: 99%

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LIPAEMIC Report: Results of Clinical Use of Intravenous Lipid Emulsion in Drug Toxicity Reported to an Online Lipid Registry

et al. 2014

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The use of intravenous lipid emulsion (ILE) as an antidote has prompted significant academic and clinical interest. Between August 2009 and August 2012, data from cases of ILE use in intoxicated patients in different hospitals on different continents were voluntarily entered into a registry based on the world wide web (www.lipidregistry.org). Here, we report data from this project. Participating centers were given access to the registry following institutional subscription. Specifically sought were details of the individual patients' presenting condition, indications for ILE use, ILE administration regimen, potential complications, and of clinical outcome. Forty-eight uses of ILE were reported from 61 participating centers. Ten cases of local anesthetic systemic toxicity were reported; all (10/10) survived. Thirtyeight cases of intoxication by other agents were reported [30 decreased conscious state, 8 cardiovascular collapse (3 deaths)]. There was an elevation in GCS (p<0.0001) and increased systolic blood pressure (p=0.012) from immediately prior to ILE administration to 30 min after use. One serious and two minor adverse effects of ILE use were recorded in 48 reported cases (one case of bronchospastic reaction, one case of hyperamylasemia and one case of interference with laboratory testing). In this series of cases reported to the registry, improvements were seen for GCS in patients with central nervous system toxicity and in systolic blood pressure in shocked patients over a short time frame after the injection of ILE. Few adverse effects were recorded. Clinical trials and the reporting of drug concentrations after ILE use are necessary to further elucidate the role of ILE in clinical toxicology.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

LIPAEMIC Report: Results of Clinical Use of Intravenous Lipid Emulsion in Drug Toxicity Reported to an Online Lipid Registry

et al. 2014

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“…The American College of Medical Toxicology currently recommends the use of ILE for patients who experience hemodynamic instability or other refractory complications that are unresponsive to other standard resuscitation therapies and are presumed to be a consequence of lipophilic drug toxicity [1]. ILE therapy is utilized in the treatment for systemic local anesthetic toxicity and has been used as an early treatment after intentional drug overdose as well, although it is generally not recommended as a first-line agent in that circumstance [2]. While there are many reports of successful outcomes after administration of ILE, the potential adverse effects of this therapy are rarely published.…”

Section: Introductionmentioning

confidence: 99%

Prolonged Laboratory Interference After Administration of Intravenous Lipid Emulsion Therapy

2014

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Background Pancreatitis and laboratory interference are rarely reported complications of intravenous lipid emulsion (ILE) therapy. We report a case of significant laboratory interference after ILE administration. Case Report A 43-year-old female was admitted to the hospital after an unwitnessed ingestion of propranolol, tramadol, zolpidem, and alprazolam. She was intubated and treated with intravenous normal saline, insulin/glucose, and norepinephrine infusions due to hypotension. Two bolus doses and one maintenance dose of 20 % ILE were administered. Beginning approximately 2 h after ILE administration, laboratory assays were unable to be performed due to the presence of lipemia. The patient developed refractory hypotension and was transferred to a tertiary care center. Upon admission to the ICU, the patient received one additional bolus of 20 % ILE. Laboratory assays were again attempted but were unable to be adequately performed due to a pinkish-white discoloration of the patient's blood. Percutaneous femoral extracorporeal membrane oxygenation (ECMO) was initiated, but laboratory interference noted with the arterial blood gas analyzer prevented the analysis of oxygenation. The patient's hemodynamic condition did not improve; she expired 31 h after initial admission. Case Discussion In one previous report, centrifugation was effective in removing more than 90 % of glycerol-banked triglycerides, thus minimizing lipid interference with laboratory assays. We noted persistent laboratory interference for more than 20 h after ILE administration, despite ultracentrifugation of specimens. Conclusion Clinicians should be aware that ILE administration may cause significant and prolonged interference with laboratory assays, which may affect the monitoring of critically ill patients.

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“…Rosenblatt et al published the first human case report of IFE use in bupivacaine-induced cardiac arrest, marking the transition from bench to bedside [2]. IFE has since been used successfully in numerous case reports for toxicity from a variety of xenobiotics including bupropion [3], verapamil [4,5], quetiapine [6], venlafaxine [7], propranolol [8], and diltiazem [9]. IFE has been used with varied success in several animal models as well [10].…”

Section: Introductionmentioning

confidence: 99%

Lipid Rescue 911: Are Poison Centers Recommending Intravenous Fat Emulsion Therapy for Severe Poisoning?

et al. 2013

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Intravenous fat emulsion (IFE) therapy is a novel treatment that has been used to reverse the acute toxicity of some xenobiotics with varied success. We sought to determine how US Poison Control Centers (PCCs) have incorporated IFE as a treatment strategy for poisoning. A closed-format multiplechoice survey instrument was developed, piloted, revised, and then sent electronically to every medical director of an accredited US PCC in March 2011. Addresses were obtained from the American Association of Poison Control Centers listserv, and participation was voluntary and remained anonymous. Data were analyzed using descriptive statistics. The majority of PCC medical directors completed the survey (45 out of 57; 79 %). Of the 45 respondents, all felt that IFE therapy played a role in the acute overdose setting. Most PCCs (30 out of 45; 67 %) have a protocol for IFE therapy. In a scenario with "cardiac arrest" due to a single xenobiotic, directors stated that their center would "always" or "often" recommend IFE after overdose of bupivacaine (43 out of 45; 96 %), verapamil (36 out of 45; 80 %), amitriptyline (31 out of 45; 69 %), or an unknown xenobiotic (12 out of 45; 27 %). In a scenario with "shock" due to a single xenobiotic, directors stated that their PCC would "always" or "often" recommend IFE after overdose of bupivacaine (40 out of 45; 89 %), verapamil (28 out of 45; 62 %), amitriptyline (25 out of 45; 56 %), or an unknown xenobiotic (8 out of 45; 18 %). IFE therapy is being recommended by US PCCs; protocols and dosing regimens are nearly uniform. Most directors feel that IFE is safe but are more likely to recommend IFE in patients with cardiac arrest than in patients with severe hemodynamic compromise.

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Early treatment of a quetiapine and sertraline overdose with Intralipid^®*

Cited by 114 publications

References 25 publications

LIPAEMIC Report: Results of Clinical Use of Intravenous Lipid Emulsion in Drug Toxicity Reported to an Online Lipid Registry

LIPAEMIC Report: Results of Clinical Use of Intravenous Lipid Emulsion in Drug Toxicity Reported to an Online Lipid Registry

Prolonged Laboratory Interference After Administration of Intravenous Lipid Emulsion Therapy

Lipid Rescue 911: Are Poison Centers Recommending Intravenous Fat Emulsion Therapy for Severe Poisoning?

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Early treatment of a quetiapine and sertraline overdose with Intralipid®*

Cited by 114 publications

References 25 publications

LIPAEMIC Report: Results of Clinical Use of Intravenous Lipid Emulsion in Drug Toxicity Reported to an Online Lipid Registry

LIPAEMIC Report: Results of Clinical Use of Intravenous Lipid Emulsion in Drug Toxicity Reported to an Online Lipid Registry

Prolonged Laboratory Interference After Administration of Intravenous Lipid Emulsion Therapy

Lipid Rescue 911: Are Poison Centers Recommending Intravenous Fat Emulsion Therapy for Severe Poisoning?

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Early treatment of a quetiapine and sertraline overdose with Intralipid^®*