Intravenous Lipid Emulsion Overdose in Infancy: A Case Report and Overview of Opportunities, Challenges and Prevention

Khasawneh, Wasim; Hani, Salar Bani

doi:10.1007/s40800-018-0079-y

Cited by 10 publications

(5 citation statements)

References 20 publications

(21 reference statements)

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“…It should be noted, however, that the difference in bicarbonate is not significant. A deterioration of the state of consciousness, on the other hand, is mainly observed within one to three hours after the start of ILE administration and the latter was also observed in two case reports in human medicine and attributed to a fat overload syndrome [ 21 , 40 ]. Theoretically, it is conceivable that the rapid administration of a large amount of ILE within a short time and the accompanying increase in triglycerides in the blood lead to increased viscosity.…”

Section: Discussionmentioning

confidence: 93%

Clinical effects and adverse effects of intravenous lipid emulsion treatment in dogs and cats with suspected poisoning

Kiwitz,

Markert,

Dörfelt

2024

PLoS ONE

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This retrospective study aimed to evaluate the effects on the clinical signs of poisoning and adverse effects of intravenous lipid emulsion treatment in 82 animals (dogs and cats) with suspected poisonings over 18 months. Physical examination parameters and state of consciousness were documented every hour after the intravenous administration of a bolus of 2 ml/kg and 0.25 ml/kg/min over 60 minutes of a 20% intravenous lipid emulsion. The modified Glasgow coma scale and laboratory findings (blood gas analysis, triglyceride, lactate) were evaluated initially and three hours after discontinuing intravenous lipid emulsion administration. A statistical evaluation of the occurrence of adverse effects and the development of laboratory values was performed. A decrease in respiratory rate in the second control (8–12 hours) after ILE was observed. Three hours after completing of the intravenous lipid emulsion, triglyceride concentration increased about 10 times (p <0.001). Venous carbon dioxide partial pressure, bicarbonate, base excess, as well as the electrolytes sodium, potassium and ionized calcium decreased significantly (p <0.001). Patients who experienced a worsening of the modified Glasgow coma scale had a higher increase in triglyceride concentrations (p = 0.041) and plasma lactate (p = 0.034) and a larger decrease in bicarbonate concentrations (p = 0.053) compared to others. About 54% (n = 44) of the patients showed adverse effects which could be attributed to the administration of intravenous lipid emulsion and may be associated with a higher triglyceride increase. All of them were completely reversible within 33 hours. Adverse effects associated with intravenous lipid emulsion therapy were observed in half of the patients and were associated with a higher increase in triglycerides.

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Section: Discussionmentioning

confidence: 93%

Clinical effects and adverse effects of intravenous lipid emulsion treatment in dogs and cats with suspected poisoning

Kiwitz,

Markert,

Dörfelt

2024

PLoS ONE

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“…TPE has been used for ILE overdose in adult humans and neonates, although its benefit in lipid removal is controversial. 13,27,28 In this dog, manual TPE was performed achieving an estimated 1.2 plasma volume exchanges. The technique of manual TPE has been reported for neonatal humans and dogs previously and has the advantage of not needing a specialized apheresis machine.…”

Section: Discussionmentioning

confidence: 99%

Manual plasma exchange to treat an accidental overdose of intravenous lipid emulsion in a dog with baclofen toxicosis

Epstein

Hopper

Farrell

2022

javma

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CASE DESCRIPTION An approximately 2-year-old sexually intact male German Shorthair Pointer was presented for treatment of baclofen toxicosis. CLINICAL FINDINGS The dog had signs of severe baclofen toxicosis (no gag reflex, intermittent vocalization, and stupor) and received intravenous lipid emulsion (142 mL/kg) as a constant rate infusion over 11 hours. Severe hypertriglyceridemia (29,221 mg/dL; reference interval, 19 to 133 mg/dL) developed, followed by cardiovascular depression (poor peripheral perfusion, hyperlactatemia, and hypertension), severe hypoglycemia (26 mg/dL), acute kidney injury (serum creatinine, 3.6 mg/dL), intravascular hemolysis, and coagulopathy (hypocoagulable thromboelastogram and marked bilateral epistaxis). TREATMENT AND OUTCOME Therapeutic plasma exchange was performed in 4 stages to treat the hypertriglyceridemia. For each stage, an approximately 500-mL aliquot of blood (22 mL/kg) was removed and centrifuged, and the patient’s RBCs and allogenic fresh-frozen plasma were returned to the dog. Approximately 1.2 times the dog’s plasma volume was exchanged, reducing the serum triglyceride concentration to 1,349 mg/dL and improving the dog’s cardiovascular function and coagulation. Hours after the procedure was completed, the dog regurgitated and developed acute respiratory distress as a result of presumptive aspiration pneumonia, and the owner elected to have the dog euthanized. CLINICAL RELEVANCE Veterinarians should be aware of possible complications associated with administration of intravenous lipid emulsion, and veterinary-specific guidelines for the maximum dose of intravenous lipid emulsion should be developed to help prevent adverse effects. TPE appears to be an effective method for treating iatrogenic hypertriglyceridemia in dogs.

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“…In both cases, an ET with two blood volumes was performed, but the authors did not specify the delay between lipid overdose and ET completion. In addition, full recovery after single-volume blood exchange transfusion was reported in a case of accidental ILE overdose (serum triglyceride level 48 g/L), in a 3-month-old male infant [ 59 ]. The evolution of our case suggests that the clinical efficacy of this technique would have required more rapid implementation − perhaps at the observation of high blood lactate levels a few hours after the overdose − in order to avoid evolution towards multiple organ failure.…”

Section: Discussionmentioning

confidence: 99%

Fatal accidental lipid overdose with intravenous composite lipid emulsion in a premature newborn: a case report

et al. 2021

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Background Tenfold or more overdose of a drug or preparation is a dreadful adverse event in neonatology, often due to an error in programming the infusion pump flow rate. Lipid overdose is exceptional in this context and has never been reported during the administration of a composite intravenous lipid emulsion (ILE). Case presentation Twenty-four hours after birth, a 30 weeks’ gestation infant with a birthweight of 930 g inadvertently received 28 ml of a composite ILE over 4 h. The ILE contained 50% medium-chain triglycerides and 50% soybean oil, corresponding to 6 g/kg of lipids (25 mg/kg/min). The patient developed acute respiratory distress with echocardiographic markers of pulmonary hypertension and was treated with inhaled nitric oxide and high-frequency oscillatory ventilation. Serum triglyceride level peaked at 51.4 g/L, 17 h after the lipid overload. Triple-volume exchange transfusion was performed twice, decreasing the triglyceride concentration to < 10 g/L. The infant’s condition remained critical, with persistent bleeding and shock despite supportive treatment and peritoneal dialysis. Death occurred 69 h after the overdose in a context of refractory lactic acidosis. Conclusions Massive ILE overdose is life-threatening in the early neonatal period, particularly in premature and hypotrophic infants. This case highlights the vigilance required when ILEs are administered separately from other parenteral intakes. Exchange transfusion should be considered at the first signs of clinical or biological worsening to avoid progression to multiple organ failure.

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Intravenous Lipid Emulsion Overdose in Infancy: A Case Report and Overview of Opportunities, Challenges and Prevention

Cited by 10 publications

References 20 publications

Clinical effects and adverse effects of intravenous lipid emulsion treatment in dogs and cats with suspected poisoning

Clinical effects and adverse effects of intravenous lipid emulsion treatment in dogs and cats with suspected poisoning

Manual plasma exchange to treat an accidental overdose of intravenous lipid emulsion in a dog with baclofen toxicosis

Fatal accidental lipid overdose with intravenous composite lipid emulsion in a premature newborn: a case report

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