Lipid emulsion for xenobiotic overdose: PRO

Abstract

Infusion of lipid emulsion for drug overdose arose as a treatment for local anaesthetic systemic toxicity (LAST) initially based on laboratory results in animal models with the subsequent support of favourable case reports. Following successful translation to the clinic, practitioners also incorporated lipid emulsion as a treatment for non‐local anaesthetic toxicities but without formal clinical trials. Recent clinical trials demonstrate a benefit of lipid emulsion in antipsychotic, pesticide, metoprolol and tramadol overdoses. Formal trials of lipid emulsion in LAST may never occur, but alternative analytic tools indicate strong support for its efficacy in this indication; for example, lipid emulsion has obviated the need for cardiopulmonary bypass in most cases of LAST. Herein, we describe the pre‐clinical support for lipid emulsion, evaluate the most recent clinical studies of lipid emulsion for toxicity, identify a possible dose‐based requirement for efficacy and discuss the limitations to uncontrolled studies in the field.

Effect of lipid emulsion on neuropsychiatric drug-induced toxicity: A narrative review

“…[ 85 , 86 ] On the other hand, these side effects may be partially due to underlying conditions rather than lipid emulsion treatment itself (protopathic bias). [ 87 ] Consistent with previous reports, Intralipid was commonly used for the treatment of neuropsychiatric drug toxicity. [ 2 , 3 ] However, the availability of Intralipid is limited because linoleic acid, which is the main long-chain fatty acid in Intralipid, produces pro-inflammatory mediators and induces lipid perioxidation.…”