Logging the potential for intravenous lipid emulsion in propranolol and other lipophilic drug overdoses

Samuels, T. L.; Uncles, D. R.; Willers, Johann; Monteiro, Rosângela; Halloran, Chris

doi:10.1111/j.1365-2044.2011.06635.x

Cited by 9 publications

(7 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…drugs or substances with low or negative log P values) [13,30]. Animal studies have provided some inferential support in this respect by demonstrating the relative ineffectiveness of lipid emulsion in the presence of the partially lipid soluble drug metoprolol [31].…”

Section: Discussionmentioning

confidence: 99%

In vitro suppression of drug‐induced methaemoglobin formation by Intralipid^® in whole human blood: observations relevant to the ‘lipid sink theory’*

Samuels¹,

Willers

Uncles

et al. 2011

Anaesthesia

Self Cite

View full text Add to dashboard Cite

SummaryTo provide further evidence for the lipid sink theory, we have developed an in vitro model to assess the effect of Intralipid Ò 20%on methaemoglobin formation by drugs of varying lipid solubility. Progressively increasing Intralipid concentrations from 4 to 24 mg.ml )1 suppressed methaemoglobin formation by the lipid soluble drug glyceryl trinitrate in a dose-dependent manner (p < 0.001). Both dose and timing of administration of Intralipid to blood previously incubated with glyceryl trinitrate for 10 and 40 min resulted in significant suppression of methaemoglobin formation (p < 0.0001 and p < 0.05, respectively). Mathematical modelling demonstrated that the entire process of methaemoglobin formation by glyceryl trinitrate was slowed down in the presence of Intralipid. Intralipid did not significantly suppress methaemoglobin formation induced by 2-amino-5-hydroxytoluene (partially lipid soluble) or sodium nitrite (lipid insoluble; both p > 0.5). This work may assist determination of the suitability of drugs taken in overdose for which Intralipid might be deployed.

show abstract

Section: Discussionmentioning

confidence: 99%

In vitro suppression of drug‐induced methaemoglobin formation by Intralipid^® in whole human blood: observations relevant to the ‘lipid sink theory’*

Samuels¹,

Willers

Uncles

et al. 2011

Anaesthesia

Self Cite

View full text Add to dashboard Cite

show abstract

“…Gastrik lavaj yapılarak ilaç alımından 75 dk sonra 1 g/kg aktif kömür (AQUA-carbo 50 g/240 mL) verildi. Kan glukoz düzeyi 122 mg/dL iken hastaya beta bloker zehirlenmesine yönelik 5…”

Section: Olgu Sunumuunclassified

“…Kalsiyumde plazma proteinlerine yüksek oranda bağlanır ve en lipofilik beta bloker grubunda yer alır(5). Yarılanma ömrü 2-6 saattir.…”

unclassified

Intravenous Lipid Emulsion Treatment for Propranolol in the Management of Multiple Drug Intoxication

Karabiyik¹,

Kalın²,

Aydın³

et al. 2019

tybd

View full text Add to dashboard Cite

GirişBeta bloker intoksikasyonları, tüm intoksikasyon olgularının içerisinde düşük bir yüzde (%0,9) oluşturmakla birlikte mortalite oranı yüksek seyretmektedir (1,2). Lipid çözünürlüğünün yüksek olması ve santral sinir sistemine kolay geçişine bağlı olarak intoksikasyon durumunda; nöbet, solunum depresyonu ve koma gibi ciddi bulgular görülebilir. Kardiyovasküler sistemde; dirençli bradikardi, hipotansiyon ve şok gözlenebilir. Beta bloker intoksikasyonu tedavisinde; insülin + dekstroz, glukagon, sodyum bikarbonat, noradrenalin, adrenalin, dopamin, mekanik destek (pacemaker, ekstra korporeal membran oksijenasyonu, intraaortik balon pompası) ve intravenöz (i.v.) lipid emülsiyon (İLE) tedavisi uygulanmaktadır. Lipid emülsiyonların, lipofilik ajanların yol açtığı kardiyak yan etkileri farklı mekanizmalar ile geriye çevirdiği çeşitli hayvan deneyleri ve olgu sunumları ile gösterilmiştir (3-7). Biz de çeşitli ilaç alımı eşliğinde yüksek doz propranolol alımı sonrasında İLE tedavisi sonucunda başarılı olduğumuz, tedaviye dirençli olguyu sunmayı amaçladık.ABSTRACT Diagnosis and treatment management is difficult in cases of intoxication with multiple drugs. A 29-year-old female patient was admitted to the emergency department with multiple doses of propranolol, biperidene, risperidone and valproic acid for suicidal purposes. She had cardiovascular collapse despite fluid therapy and multiple high-dose vasopressor infusions. Intravenous lipid emulsion (ILE) treatment was administered to the patient who had hypotension that was resistant to hyperinsulinemic euglycemia and glucagon therapy. Hemodynamic stability was achieved after three hours. Intoxication with beta-blockers may be life threatening. Propranolol is a beta-blocker drug that binds highly to plasma proteins and has high lipophilic properties. The classical therapies recommended for severe beta-blocker intoxications may be insufficient, and successful results can be obtained with ILE application. In this case report, we wanted to emphasize that management of multiple drug intoxication is difficult and ILE treatment may be successful in treatment-resistant beta-blocker intoxications.ÖZ Çok sayıda ilaç alınarak meydana gelen intoksikasyonlarda tanı ve tedavi yönetimi zordur. Yirmi dokuz yaşında kadın hasta özkıyım amaçlı aşırı doz propranolol, biperiden, risperidon ve valproik asit alarak çoklu ilaç zehirlenmesi tablosunda acil servise getirildi. Sıvı tedavisi ve çoklu yüksek doz vazopresör infüzyonuna karşın kardiyovasküler kollaps tablosu düzelmedi. Hiperinsülinemik öglisemi ve glukagon tedavisine dirençli hipotansiyonu devam eden olguya intravenöz lipid emülsiyon (İLE) tedavisi uygulandı. Üç saat sonra hemodinamik stabilite sağlandı. Beta blokerler ile olan zehirlenmeler hayatı tehdit edebilen ciddi zehirlenmelerdir. Propranolol, plazma proteinlerine yüksek oranda bağlanan yüksek lipofilik özellik gösteren beta bloker ilaçtır. Ciddi beta bloker zehirlenmelerinde önerilen klasik tedaviler yetersiz kalabilmekte ve İLE uygulaması ile başarılı sonuçlar alınabilmektedi...

show abstract

“…IVLE treatment is included in the treatment algorithms of beta blocker poisoning [5] . Previous studies have shown the beneficial effects of IVLE administration on propranolol, atenolol and nebivolol toxicities [19][20][21][22][23][24][25][26][27][28][29] . The common point of these events and experimental studies is the reversal of cardiovascular changes resulting from intoxication with highly lipid soluble drugs thanks to intravenous lipid administration.…”

Section: The Efficacy Of Intravenous Lipid Emulsion Therapy (Ivle)mentioning

confidence: 99%

Intravenous lipid emulsion therapy in a case of multiple drug intoxication (case report)

Hancı¹

2018

Haydarpasa Numune Med J

View full text Add to dashboard Cite

I n the United States every day approximately 2000 cases of intoxication apply to emergency services. Drug intoxication is the most important cause of mortality in adults aged 35-54 years [1]. Cardiovascular drugs are frequently used to commit suicide, and they are at the top of the list of deaths due to poisoning [2]. Standard resuscitation algorithms are often inadequate in intoxications and it is important to consider adjuvant treatments with appropriate antidotes for intoxicated patients. Current treatment algorithms often priorly suggest supportive and symptomatic treatments in the absence of specific therapeutic interventions. Specific antidotes are not available in the majority of intoxications [3]. Metoprolol is a selective β1 adrenergic antagonist. It is the only β1 adrenergic antagonist with official approval by the FDA (Food and Drug Administration) for the treatment of angina pectoris and complications after acute myocardial infarction. It may be used to control ventricular rate, to prevent tachycardia and hypertension in supraventricular tachycardias, atrial fibrillation or flutter occurring in response to perioperative stimuli. When used through IV route, its effect starts within 5-10 minutes and lasts for 2-4 hours [4]. Intake of cardiovascular drugs is frequently observed among the patients brought to emergency departments with an intoxication clinic. In those patients who are treated for intoxication, actual therapy is mainly supportive in most of the cases if there isn't any special antidote for the agent. This case report is about a patient who intended to commit suicide with oral intake of metoprolol, perindopril, atorvastati and isosorbide monohydrate. Upon worsening of her general condition in spite of supportive therapy, she was given intravenous lipid therapy. In this manuscript, application of intravenous lipid therapy is presented in a patient who intended to commit suicide, She was unresponsive to supportive therapy after ingestion of multiple cardiovascular drugs including metoprolol, perindopril, isosorbide monohydrate and atorvastatin.

show abstract

Logging the potential for intravenous lipid emulsion in propranolol and other lipophilic drug overdoses

Cited by 9 publications

References 6 publications

In vitro suppression of drug‐induced methaemoglobin formation by Intralipid^® in whole human blood: observations relevant to the ‘lipid sink theory’*

In vitro suppression of drug‐induced methaemoglobin formation by Intralipid^® in whole human blood: observations relevant to the ‘lipid sink theory’*

Intravenous Lipid Emulsion Treatment for Propranolol in the Management of Multiple Drug Intoxication

Intravenous lipid emulsion therapy in a case of multiple drug intoxication (case report)

Contact Info

Product

Resources

About

Logging the potential for intravenous lipid emulsion in propranolol and other lipophilic drug overdoses

Cited by 9 publications

References 6 publications

In vitro suppression of drug‐induced methaemoglobin formation by Intralipid® in whole human blood: observations relevant to the ‘lipid sink theory’*

In vitro suppression of drug‐induced methaemoglobin formation by Intralipid® in whole human blood: observations relevant to the ‘lipid sink theory’*

Intravenous Lipid Emulsion Treatment for Propranolol in the Management of Multiple Drug Intoxication

Intravenous lipid emulsion therapy in a case of multiple drug intoxication (case report)

Contact Info

Product

Resources

About

In vitro suppression of drug‐induced methaemoglobin formation by Intralipid^® in whole human blood: observations relevant to the ‘lipid sink theory’*

In vitro suppression of drug‐induced methaemoglobin formation by Intralipid^® in whole human blood: observations relevant to the ‘lipid sink theory’*