Hemodynamic Effects of Intravenous Fat Emulsion in an Animal Model of Severe Verapamil Toxicity Resuscitated with Atropine, Calcium, and Saline

Abstract

Standard resuscitation and IFE increase MAP and survival in an animal model of severe verapamil toxicity compared with standard resuscitation alone.

Review article: Intravenous lipid emulsion as antidote: A summary of published human experience

“…16 The 'lipid sink' theory might conceptually be applied to any lipophilic toxin. Consistent with this, ILE has been trialled in animal models of amitriptyline, 17 atenolol, 18 bupivacaine, 5,6 chlorpromazine, 12 clomipramine, 15,19 metoprolol, 20 organophosphate pesticide, 21 propranolol 22,23 and verapamil 16,24 with variable outcome. A number of recent reviews summarizing the animal work in this area [25][26][27] have found repeatable large effects, dose responsiveness and mechanistic evidence of the biologic plausibility for ILE as an antidote for lipophilic toxins.…”

The use of high‐dose insulin therapy and intravenous lipid emulsion to treat severe, refractory diltiazem toxicosis in a dog

“…9 Although no prospective clinical trials are available to critically assess efficacy, there are multiple animal experimental models and human case reports that support these treatment interven-tions over previous traditional therapies (eg, glucagon, vasopressors). 7,9,11,12,16,18 The use of ILE, also known as intravenous fat emulsion and "lipid therapy," has been shown to be a potentially effective therapy for fat-soluble toxins. 8,10 Research in animal models along with human and veterinary case reports have described variable success in clinical improvement from fat-soluble toxicoses.…”

“…8,10 Research in animal models along with human and veterinary case reports have described variable success in clinical improvement from fat-soluble toxicoses. 8,11,12,[26][27][28] Current considerations in both human and veterinary medicine for the use of ILE include overdoses of local anesthetics (eg, lidocaine, bupivacaine, etc. ), antidepressants (eg, lamotrigine), beta blockers, CCBs, macrocytic lactones (eg, ivermectin, milbemycin, moxidectin), and muscle relaxants (eg, baclofen).…”

“…2,[5][6][7] Recently, the use of intravenous lipid emulsion (ILE) as an antidote for fat-soluble toxicants has gained much attention given its success in treating lifethreatening clinical signs otherwise refractory to traditional therapy. 2,[7][8][9][10] The use of ILE has been reported in several experimental animal models for bupivacaine, 8 propranolol, 8,11 verapamil, 8,11,12 clomipramine, 8,11 and chlorpromazine toxicosis. 11 In human case reports, ILE has been successfully used involving overdoses of bupivacaine, 8,11 mepivacaine, 11 bupropion, 8,11 lamotrigine, 8,11 diltiazem, 9 and verapamil.…”

Management of calcium channel blocker overdoses

“…41,42 Intravenous Lipid Emulsion Therapy CCBs are naturally lipophilic, and intravenous lipid emulsion (ILE) therapy has been attempted with success in cases of severe CCB overdose. 43,44 A systematic review by Jamaty et al 45 showed that, although the overall quality of the evidence for this modality was poor, ILE could be beneficial in the management of severe cases of CCB poisoning. ILE therapy was first described by Weinberg et al for bupivacaine toxicity in the year 2003.…”