Intravenous Lipid Emulsion does NOT have a role in severe poisoning: CON

Abstract

Intravenous lipid emulsion (ILE) has been suggested as a potential universal antidote for cardiovascular and central nervous system toxicity resulting from a multitude of pharmaceutical and nonpharmaceutical poisonings. While there is some evidence to suggest that ILE may have a positive effect in cardiovascular system toxicity after accidental intravenous lipophilic local anaesthetic overdose, this cannot be extrapolated to cases of severe poisoning resulting from oral drug overdose. Treatment recommendations are based upon variable outcome animal studies and low-level clinical evidence with a significant degree of positive reporting bias. Currently, there is a paucity of controlled clinical data to support ILE use to treat severe drug poisoning after oral overdose. ILE use should be limited to well-designed, ethically approved, controlled clinical trials aimed at determining the true effectiveness of this therapy. This should replace the current scattergun clinical use in a multiplicity of poisoning scenarios and subsequent anecdotal reporting approach.

Administration of Intravenous Lipid Emulsion for Dextromethorphan Poisoning with Serotonin Syndrome: A Case Report

“…To exercise caution when administering ILE, if the drug remains in the intestinal tract in case of an oral overdose, drug absorption may be accelerated using ILE, as demonstrated in rodent models, suggesting that ILE injection can enhance the absorption of lipid-soluble drugs from the gastrointestinal lumen. Early administration of ILE after 30 min of oral amitriptyline and verapamil ingestion was associated with increased mortality [ 23 ]. In addition, early death after ILE administration owing to rectal thiopentone overdose has been reported in rat models [ 24 ].…”