Prolonged lipemia and pancreatitis due to extended infusion of lipid emulsion in bupropion overdose

Bucklin, Mason H.; Gorodetsky, Rachel; Wiegand, Timothy J.

doi:10.3109/15563650.2013.831436

Cited by 37 publications

(18 citation statements)

References 11 publications

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“…The lipemic appearance of blood has been reported to occur for several days after infusion of ILE [11,12]. Previous reports of ILE administration have described no laboratory interference as well as interference lasting up to 25 h after infusion of ILE [4].…”

Section: Discussionmentioning

confidence: 98%

Prolonged Laboratory Interference After Administration of Intravenous Lipid Emulsion Therapy

2014

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Background Pancreatitis and laboratory interference are rarely reported complications of intravenous lipid emulsion (ILE) therapy. We report a case of significant laboratory interference after ILE administration. Case Report A 43-year-old female was admitted to the hospital after an unwitnessed ingestion of propranolol, tramadol, zolpidem, and alprazolam. She was intubated and treated with intravenous normal saline, insulin/glucose, and norepinephrine infusions due to hypotension. Two bolus doses and one maintenance dose of 20 % ILE were administered. Beginning approximately 2 h after ILE administration, laboratory assays were unable to be performed due to the presence of lipemia. The patient developed refractory hypotension and was transferred to a tertiary care center. Upon admission to the ICU, the patient received one additional bolus of 20 % ILE. Laboratory assays were again attempted but were unable to be adequately performed due to a pinkish-white discoloration of the patient's blood. Percutaneous femoral extracorporeal membrane oxygenation (ECMO) was initiated, but laboratory interference noted with the arterial blood gas analyzer prevented the analysis of oxygenation. The patient's hemodynamic condition did not improve; she expired 31 h after initial admission. Case Discussion In one previous report, centrifugation was effective in removing more than 90 % of glycerol-banked triglycerides, thus minimizing lipid interference with laboratory assays. We noted persistent laboratory interference for more than 20 h after ILE administration, despite ultracentrifugation of specimens. Conclusion Clinicians should be aware that ILE administration may cause significant and prolonged interference with laboratory assays, which may affect the monitoring of critically ill patients.

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Section: Discussionmentioning

confidence: 98%

Prolonged Laboratory Interference After Administration of Intravenous Lipid Emulsion Therapy

2014

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“…Lipit emülsiyonlarının yan etkileri arasında hipersensitivite, hipertrigliseridemi, kolestaz, artmış enfeksiyon riski ve pankreatit sayılabilir. Literatürde bupripion yüksek dozu için lipit tedavisi uygulanan bir hastada geçici hipertrigliseridemi ve pankreatit görülmüştür (8).…”

Section: Discussionunclassified

Cardiac Arrest After Status Epilepticus: Bupropion and Ecstasy Intoxication

Duran¹,

Karabacak²,

Gülsoy³

et al. 2018

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“…31 • Pancreatitis: Several possible cases of pancreatitis (temporally associated with the administration of intravenous lipids) have been reported. 28,32 The patients did not have adverse effects or require treatment. Pancreatitis associated with lipid infusion is most likely to occur if the patient has received multiple doses or a prolonged infusion of lipid.…”

Section: Adverse Effects Of Intravenous Lipid When Used As An Antidotementioning

confidence: 99%

“…Lipids can interfere with determination of complete blood cell counts and measurements of serum alanine aminotransferase, albumin, amylase, bilirubin, creatine kinase, creatinine, electrolytes, glucose, lipase, magnesium, phosphate, and total protein. [28][29][30] The interference with laboratory testing can persist up to 24 hours after administration of the lipid. 31 • Pancreatitis: Several possible cases of pancreatitis (temporally associated with the administration of intravenous lipids) have been reported.…”

Section: Adverse Effects Of Intravenous Lipid When Used As An Antidotementioning

confidence: 99%

Intravenous Lipids: Antidotal Therapy for Drug Overdose and Toxic Effects of Local Anesthetics

Bartlett

2014

Critical Care Nurse

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Intravenous lipid emulsion is an accepted therapy for the treatment of severe cardiac toxic effects caused by local anesthetics. Lipid emulsion therapy has also been used successfully to treat cardiac arrest and intractable arrhythmias caused by overdoses of antiepileptic drugs, cardiovascular drugs, and psychotropic medications, but experience with intravenous lipids as antidotal therapy in these clinical situations is limited. However, intravenous lipids are relatively safe, widely available, and easy to administer, and many published case reports document their dramatic effectiveness. Patients who have not responded to standard therapies have been quickly revived by administration of intravenous lipids. Use of lipids most likely will increase, and critical care nurses should be familiar with lipid therapy.

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Prolonged lipemia and pancreatitis due to extended infusion of lipid emulsion in bupropion overdose

Abstract: Large doses of lipid emulsion may result in lipemia, severe hypertriglyceridemia, interference in laboratory analyses, and pancreatitis. This is the third reported adverse event due to lipid emulsion therapy used for overdose.

Cited by 37 publications

References 11 publications

Prolonged Laboratory Interference After Administration of Intravenous Lipid Emulsion Therapy

Prolonged Laboratory Interference After Administration of Intravenous Lipid Emulsion Therapy

Cardiac Arrest After Status Epilepticus: Bupropion and Ecstasy Intoxication

Intravenous Lipids: Antidotal Therapy for Drug Overdose and Toxic Effects of Local Anesthetics

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