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

Abstract

<jats:p> 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. </jats:p>

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

“…It is unclear if this difference in route of administration affects the reported efficacy of ILE 15. Despite recent literature underlining the weak evidence supporting the use of ILE during oral poisonings,16 many human and veterinary reports show promising beneficial properties of lipid emulsion therapy 4 17. However, further research is warranted to confirm the potential benefits and validate ILE use in the standard management of lipophilic intoxication.…”

Lipid Emulsion to Treat Acute Poisonings: Mechanisms of Action, Indications, and Controversies

“…Numerous meta-analyses, narrative reviews, and national guidelines exist, with slightly different and sometimes contradictory conclusions compared to those of the Lipid Emulsion Workgroup experts [ 101 , 102 , 103 , 104 , 105 ]. Interestingly, a quantitative meta-analysis of the same data set came to a different conclusion regarding evidence in support of ILE efficacy for LAST [ 80 ].…”

Intravenous Lipid Emulsion does NOT have a role in severe poisoning: CON

“…The authors assessed that 86% of oral overdose cases did not meet their definition of an ILE causal connection with regard to positive response to treatment. Almost all cases received multiple other treatments 28 . Smolinske et al aimed to reduce the influence of reporting bias by reviewing the utilization of ILE in fatal overdose cases in the USA 29 .…”

“…Almost all cases received multiple other treatments. 28 Smolinske et al aimed to reduce the influence of reporting bias by reviewing the utilization of ILE in fatal overdose cases in the USA. 29 Of the 459 cases, 45% had no response, 38% unknown response, 7% transient return of circulation, 7% minimal response and, notably, 3% immediate deterioration after ILE administration.…”