Lipid Rescue – Efficacy and Safety Still Unproven

Höjer, Jonas; Jacobsen, Dag; Neuvonen, Pertti J.; Rosenberg, P. H.

doi:10.1111/bcpt.12607

Cited by 6 publications

(4 citation statements)

References 48 publications

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“…Considering the findings of the present study, the weak and contradictory scientific evidence for lipid rescue being an effective antidote and its increasingly reported adverse effects, it is reasonable to strictly limit its use in clinical practice. 6,7,20,22 We would not recommend its use at all in cases of oral poisoning.…”

Section: Discussionmentioning

confidence: 99%

No support for lipid rescue in oral poisoning: A systematic review and analysis of 160 published cases

Forsberg

Edman

et al. 2016

Hum Exp Toxicol

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Lipid rescue is used as treatment of various poisonings despite weak scientific evidence. Some experimental studies have indicated a positive effect, but others have not. Clinical studies are lacking, wherefore a systematic review of virtually all published human case reports is presented. The case reports were searched for in PubMed and Web of Science and examined by two experts according to an assessment form grading the probability for a causal connection between lipid rescue and improved symptoms. A total of 160 cases were finally included, of which 30 had no positive effect of lipid rescue. Among the 130 included cases with alleged positive effect, 94 were oral poisonings and 36 were cases with local anesthetic systemic toxicity (LAST). The experts’ assessment resulted in a “certain” causal connection in three cases with LAST but not in oral poisoning. Moreover, the mean assessment score among the oral poisonings was significantly worse than the corresponding score in the cases with LAST. The average log p-value of the main toxins among the oral poisonings was significantly lower than the corresponding p-value in the cases with LAST. Among the oral poisonings, 91% had received some other resuscitative treatment more or less simultaneously with lipid rescue. Considering the findings of this study and the increasingly reported adverse effects of lipid rescue, it’s reasonable to strictly limit its use in clinical practice. We would not recommend it in oral poisonings.

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Section: Discussionmentioning

confidence: 99%

No support for lipid rescue in oral poisoning: A systematic review and analysis of 160 published cases

Forsberg

Edman

et al. 2016

Hum Exp Toxicol

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“…Hepatic function impairment is the primary concern of lipid emulsions, 26 and Intralipid is thus contraindicated in severe disorders of fat metabolism such as in severe liver damage and acute shock. The rare adverse effects reported with Intralipid in conventional use are pancreatitis, hepatic failure, dyspnea, and anaphylaxis, which are usually due to overdose or too rapid infusion rate, explaining our progressive infusion protocol 27 . Although caution should be given with Intralipid in conditions of impaired lipid metabolism such as renal insufficiency, uncompensated diabetes mellitus, pancreatitis, certain forms of liver insufficiency, hypothyroidism (if hypertriglyceridemic), metabolic disorders, and sepsis, 11 the added value for cardiac suppression of Intralipid certainly appears to outweigh the low associated risk of hepatic function impairment in most patients.…”

Section: Discussionmentioning

confidence: 99%

An Intravenous 100-mL Lipid Emulsion Infusion Dramatically Improves Myocardial Glucose Metabolism Extinction in Cardiac FDG PET Clinical Practice

et al. 2021

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Purpose Physiological myocardial accumulation of FDG impairs the diagnosis of inflammatory/infectious or tumoral myocardial detection by FDG PET/CT. We prospectively evaluated the addition, 3 hours before imaging, of an intravenous 100-mL lipid emulsion infusion (Intralipid) to a high-fat, low-carbohydrate diet (HFLCD) for at least 2 meals followed by a fast of at least 6 to 12 hours in patients referred for the diagnosis of myocardial inflammation, endocarditis, cardiac or paracardiac masses, intracardiac device, or prosthetic valve infections. Methods Data of 58 patients consecutively included (28 Intralipid patients, 30 controls with HFLCD alone) were compared. FDG uptake in normal myocardium was scored from 0 (complete myocardial suppression) to 3 (high diffuse uptake). Myocardial maximal, peak, and mean SUV and the rate of interpretable images according to the clinical indication were measured. Results Compared with controls, Intralipid infusion significantly improved the rate of score 0 (89% vs 63%, P = 0.021), of interpretable images according to the clinical indication (100% vs 72%, P = 0.0047) and decreased all myocardial SUV values (eg, SUVmax median, 1.9 [interquartile range, 1.7–2.5] vs 3.1 [interquartile range, 2.3–4.1]; P < 0.001). Conclusions A lipid emulsion infusion in addition to HFLCD better suppresses cardiac glucose metabolism than HFLCD alone.

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“…32 While the precise mechanism of action and optimum dose remains unclear, there is increasing experience of its beneficial effects reversing the toxicity from a widening range of drug classes. However, there is increasing concern that the threshold for the use of LE is too low 33 : while undoubtedly of benefit in some cases, there is reported concern over publication bias, and the lack of a clear mechanism of action or optimal dose. LE is often given simultaneously with other treatments, making its efficacy difficult to determine.…”

Section: Cardioprotection From Cell Damagementioning

confidence: 99%

Review of management in cardiotoxic overdose and efficacy of delayed intralipid use

Walter

McKinlay

Corbett

et al. 2017

Journal of the Intensive Care Society

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We present the case of a 51-year-old woman admitted to our intensive care unit following an intentional overdose of a calcium channel antagonist and a beta blocker. The resultant hypotension was reversed with glucagon, noradrenaline, calcium and high-dose insulin. Despite these interventions, she remained vasoplegic and received a delayed, standard dose of intralipid. Subsequently, the vasoplegia resolved rapidly, and the vasopressor was stopped. Here, we review the management of overdose of calcium channel and beta-adrenergic receptor blockers, concentrating on the pharmacology of lipid emulsion therapy. There remain some unanswered questions about lipid emulsion therapy: treatment with lipid therapy is usually advocated as soon as possible; this case report suggests that it remains efficacious even if its administration were delayed.

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Lipid Rescue – Efficacy and Safety Still Unproven

Cited by 6 publications

References 48 publications

No support for lipid rescue in oral poisoning: A systematic review and analysis of 160 published cases

No support for lipid rescue in oral poisoning: A systematic review and analysis of 160 published cases

An Intravenous 100-mL Lipid Emulsion Infusion Dramatically Improves Myocardial Glucose Metabolism Extinction in Cardiac FDG PET Clinical Practice

Review of management in cardiotoxic overdose and efficacy of delayed intralipid use

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