Intravenous Lipid Emulsion as an Adjuvant Therapy of Acute Antipsychotic Poisoning: A randomized Controlled Trial

Abstract

Background: Antipsychotics toxicity is one of the top five substances most frequently included in human poisoning. Various case reports documented successful use of intravenous lipid emulsion (ILE) in the management of acute antipsychotics poisoning. Aim: The aim of this study was to assess the efficacy and safety of ILE as adjuvant therapy for acute antipsychotic poisoning. Patients and methods: Forty patients presented with moderate to severe acute antipsychotic poisoning were randomly allocated into two equal groups. The control group was given the standard treatment only while the intervention group was given the standard treatment plus ILE infusion. For all patients, history, clinical examination, ECG, and laboratory investigations were done. The safety and efficacy outcomes were evaluated. Results: results revealed that the median Glasgow Coma Scale assessed at 6 and 12 hours after admission was significantly higher in the intervention group compared to the control group. Both corrected QT intervals measured 12 hours after admission and period of hospital stay were significantly shorter in the intervention group compared to the control group. During follow-up of the intervention group, there were no significant differences between serum triglycerides levels, liver enzymes and, platelet count measured at admission and 12 hours later. Conclusion: It was concluded that ILE was a safe and effective therapy for acute antipsychotic poisoning.

Lipid emulsion for xenobiotic overdose: PRO

“…15 The pre-clinical, scientific underpinnings of ILE as a treatment for LAST include a homogeneous survival benefit in different animal models from several laboratories, 48,49 a comprehensive and reproducible mechanism 30,31,100,101 and beneficial, mechanistic effects in subtoxic volunteer studies. 32,33 Beyond LAST, emerging RCTs [56][57][58][59][60][61][62][63] are providing high-level evidence for ILE in treatment of other, primarily oral, drug overdoses. It is possible that there is a threshold-based effect of ILE (at $4 mL/kg; see Figure 2), and the treatment benefit may extend beyond lipophilic substances as demonstrated in clinical trials of metoprolol 64 and aluminium phosphide.…”

“…This recommendation not only neglects a century of experience in the anaesthesia community that pressor‐based resuscitation is ineffective in LAST 14,15 but also ignores the recommendations from professional anaesthesia societies 20,21 and directly contradicts quantitative meta‐analysis of data presented in the LEW's own publications 48,49 . Beyond LAST, emerging human models suggest the utility of ILE in pesticide, 57–60 antipsychotics (primarily clozapine), 61,62 tramadol 63 and metoprolol 64 toxicities, outdating the LEW's strong recommendation of ‘not using ILE … as part of treatment modalities” 99 for beta‐blocker toxidromes and calling into question their recommendation of ‘not using ILE as first‐line therapy’ for many others.…”

“…Nevertheless, volunteer studies of subtoxic doses confirm the mechanistic benefit of ILE in bupivacaine, 32 ropivacaine, levobupivacaine 33 and lidocaine. 55 Further, RCTs have emerged in the setting of non-LAST, [56][57][58][59][60][61][62][63] specifically demonstrating a clinical benefit of ILE in poisoning from pesticides, [57][58][59][60] antipsychotics (primarily clozapine), 61,62 tramadol 63 and metoprolol. 64 There are several conclusions to be drawn from these clinical trials [56][57][58][59][60][61][62][63] and volunteer studies 32,33,55,64 (Table 1).…”

“…55 Further, RCTs have emerged in the setting of non-LAST, [56][57][58][59][60][61][62][63] specifically demonstrating a clinical benefit of ILE in poisoning from pesticides, [57][58][59][60] antipsychotics (primarily clozapine), 61,62 tramadol 63 and metoprolol. 64 There are several conclusions to be drawn from these clinical trials [56][57][58][59][60][61][62][63] and volunteer studies 32,33,55,64 (Table 1). First, ILE causes minimal complications.…”

“…As stated above, recent clinical trials [57][58][59][60][61][62][63][64] report infrequent and mild complications (e.g. irritation at injection site).…”