Lipid Emulsion Therapy in Lipophilic or Hydrophilic Drug Intoxication: The Last Weapon in Our Arsenal

Abstract

Aim: Previous case reports have described the administration of lipid emulsion therapy in lipophilic drug intoxication cases. In this study, we wanted to contribute to the literature that lipid emulsion therapy could also be given lipid as the last weapon in not only lipophilic drug intoxication but also all intoxication cases with worsening general condition. Materials and Methods: A total of 65 patients, who presented to the emergency room and received lipid therapy between January 1, 2014 and January 1, 2017, were included in this study. Each patient was given a 20% ClinOleic (Baxter) infusion of 1.5 mL/kg for 1-3 minutes and then 100 mL/h (0.025 mL/kg/min). Toxic drugs were divided into low or high permeability groups according to their lipid/water partition coefficients (LogP). Results: Of the 65 patients, 55.4% (n=36) were female and 44.6% (n=29) were male. These patients were grouped according to a lipid/water cutoff value of 1.72. The lipid therapy was administered in addition to antidotal therapy in two patients in the hydrophilic group and in five patients in the lipophilic group. The only variable that was significantly restored 12 hours after the lipid therapy was the respiratory rate, which was 16.0 (range, 15.5-17.3)/min in the hydrophilic group and 20.0 (range, 18.0-22.0)/min in the lipophilic group (p=0.003). Conclusion: We believe that lipid therapy can be used as a last resort in intoxication cases, especially in patients with low Glasgow coma scale scores and worsened vital signs despite antidotal and extracorporeal therapies, regardless of whether the causative agent is hydrophilic or lipophilic.

Intravenous lipid emulsion for a life-threatening prothipendyl intoxication

“…The logP of prothipendyl is 3.4, while it is 2.5 and 2.4 for zolpidem and lorazepam, respectively. Such logPs indicate that these drugs are lipophilic 10…”