Lipid Therapy for Intoxications

Robben, Joris H.; Dijkman, Marieke A.

doi:10.1016/j.cvsm.2016.10.018

Cited by 23 publications

(43 citation statements)

References 57 publications

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“…ILE involves a sterile formulation of triglycerides that traditionally is used as parenteral nutrition supplementation for anorexic patients. 36 However, this formulation has been useful in the treatment of acute drug poisoning and overdoses, particularly toxicities associated with intravenous administration of local anesthetics. 31,36 The mechanism of action of ILE is hypothesized to be related to its attraction of lipophilic agents, transiently sequestering the drug in the circulation and speeding delivery to the metabolizing and excreting organs.…”

Section: Discussionmentioning

confidence: 99%

“…36 However, this formulation has been useful in the treatment of acute drug poisoning and overdoses, particularly toxicities associated with intravenous administration of local anesthetics. 31,36 The mechanism of action of ILE is hypothesized to be related to its attraction of lipophilic agents, transiently sequestering the drug in the circulation and speeding delivery to the metabolizing and excreting organs. The efficacy of ILE for toxicities due to agents other than local anesthetics is not established, but some reports suggest a rapid improvement of consciousness in severely obtunded human patients hospitalized due to overdose of various prescription or illicit drugs other than midazolam.…”

Section: Discussionmentioning

confidence: 99%

“…14,31 Current recommendations for drug intoxications indicate the use of ILE for overdose conditions that involve lipid-soluble drugs and that are refractory to standard supportive measures. 24,36 Therefore, in the present study, we selected ILE for treatment of the second cat in light of the persistent oversedation and the lack of response to flumazenil administration.…”

Section: Discussionmentioning

confidence: 99%

“…Intralipid 20% (Fresenius Kabi, Uppsala, Sweden) was administered at 1.5 mL/kg as a bolus, followed by infusion of 0.25 mL/kg/min for 60 min, according to published guidelines for the treatment of toxicity with local anesthetics. 24,36 At 1 h after ILE administration, the cat appeared more alert and active. Over the next 10 h, its condition varied between active and somnolent.…”

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confidence: 99%

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Prolonged Anesthetic Recovery after Continuous Infusion of Midazolam in 2 Domestic Cats (Felis catus)

Dholakia¹,

Seddighi²,

Odunayo³

et al. 2019

comp med

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Midazolam is a water-soluble benzodiazepine that is used for sedation and as an anesthetic coinduction agent in cats. 21,28,37 Similar to other benzodiazepines, midazolam is considered to cause minimal cardiovascular or respiratory depression and provides good muscle relaxation. 10,35 The rapid elimination halflife of midazolam in dogs (28 to 31 min) 35 and humans (1.5 to 3 h) 33 makes midazolam a more suitable agent for use in continuous infusion than diazepam. 10,33 In humans, midazolam is considered to have a wide margin of safety in comparison to other drugs in this class 33 and is often administered through continuous infusion for patients in the critical care setting. 16,29,34 Midazolam is a useful adjunctive agent during general anesthesia in dogs, 15,39 rabbits, 17 and goats, 12 primarily through the reduction of the minimum alveolar concentration (MAC) of inhalant anesthetics or as part of a total intravenous anesthetic technique. Continuous infusion of midazolam in cats has been reported in only one prior study; 6 however, plasma concentrations were not measured. At present, there is no published report on its effects on MAC in cats. Therefore, we designed a pharmacokinetic evaluation and a subsequent pharmacodynamic study to investigate the sparing effects of 3 midazolam infusion rates on the minimum alveolar concentration of sevoflurane that prevented movement in response to noxious stimulation (MAC NM) in cats. Adverse effects from midazolam administration in cats occur infrequently. In some experiments, a wide range of midazolam doses (from 0.05 to 20 mg/kg IV) have been administered to cats. 19,26 Paradoxical behavior such as increased aggression, restlessness, and increased appetite have been described to occur with administration of midazolam even at low doses. 5,19 Sedation, ataxia, and recumbency have also been observed, but treatment is usually neither indicated nor attempted .6,20,21 During the start of our pharmacodynamics study, the occurrence of prolonged and recurrent sedation in 2 of the 6 cats, despite administration of the specific reversal agent (flumazenil), ultimately prompted discontinuation of the study. The clinical signs and treatment outcomes for those 2 cats are described here.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Prolonged Anesthetic Recovery after Continuous Infusion of Midazolam in 2 Domestic Cats (Felis catus)

Dholakia¹,

Seddighi²,

Odunayo³

et al. 2019

comp med

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“…3 In veterinary patients, ILE therapy has been mainly reported as an adjunctive therapy during acute exogenous neurotoxicity, when the standard therapy seemed inadequate to control clinical signs. 4 However, high-dose ILE infusion is potentially associated with clinically relevant adverse effects, including pancreatitis, fat overload syndrome (FOS), acute respiratory distress syndrome (ARDS) and reduction in the effectiveness of other drugs. 5 Furthermore, there are no validated, evidencebased dosing regimens, and different treatment protocols on ILE have been reported in terms of time of initial dosing, bolus size, rate of continuous infusion, number of treatments and treatment intervals.…”

Section: Introductionmentioning

confidence: 99%

Low‐dose intravenous lipid emulsion as a safe treatment for lipophilic intoxications in five cats

Pelizzola

Mattavelli

Troìa

et al. 2018

Vet Record Case Reports

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The use of a low-dose infusion of intravenous lipid emulsion (ILE) in five young cats presented with acute neurotoxicity is reported. Suspected toxic compounds were permethrin (three, dermal), fipronil/eprinomectin/praziquantel (one, oral) and milbemycin (one, oral). Cats presented with acute onset of generalised tremors of variable severity. Initial treatment included toxin decontamination whenever possible, and control of neurological signs by administration of benzodiazepine and eventually a continuous rate infusion of propofol. Due to persisting clinical signs, a low-dose ILE therapy was additionally given. Discontinuation of treatment, once a resolution of neurological signs was achieved, ranged between two and nine hours from hospital admission. All the cats fully recovered and were discharged within 18–92 hours. No side effects were noticed and follow-up was normal. The authors report the use of a low-dose infusion of ILE as an adjunctive and safe treatment for the management of lipophilic intoxications in cats.

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The effect of intravenous lipid emulsion (ILE) on the pharmacokinetic/toxicokinetic dispositions of ivermectin and carprofen in rabbits

Akyol,

Gokbulut

2023

Naunyn-Schmiedeberg's Arch Pharmacol

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Lipid Therapy for Intoxications

Cited by 23 publications

References 57 publications

Prolonged Anesthetic Recovery after Continuous Infusion of Midazolam in 2 Domestic Cats (Felis catus)

Prolonged Anesthetic Recovery after Continuous Infusion of Midazolam in 2 Domestic Cats (Felis catus)

Low‐dose intravenous lipid emulsion as a safe treatment for lipophilic intoxications in five cats

The effect of intravenous lipid emulsion (ILE) on the pharmacokinetic/toxicokinetic dispositions of ivermectin and carprofen in rabbits

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