Should we consider the infusion of lipid emulsion in the resuscitation of poisoned patients?

Cave, Grant; Harvey, Martyn

doi:10.1186/s13054-014-0457-5

Cited by 44 publications

(43 citation statements)

References 71 publications

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“…Lipid intravascular compartment, that is created, pulls lipophilic substances from the tissue and site of action (myocytes, brain) due to high lipid solubility and the established concentration gradient. This shift results in decreasing the free fraction substance concentration and clinical improvement 6,8 . Increasing intracellular fatty acid and providing energy substrate for myocytes, cardioprotective effect, direct cardiotonic effect and activating calcium channels are some of the other mechanisms that contribute to efficacy of ILE 8 .…”

Section: Discussionmentioning

confidence: 99%

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Successful usage of intravenous lipid emulsion in treatment of acute verapamil poisoning: A case report

et al. 2017

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Introduction. During the last few years, intravenous lipid emulsions have been effectively used in treatment of acute poisonings with lipophilic substances, including verapamil. Case report. A 37-year-old women presented 1 hour after ingestion of 2.8 g verapamil with hypotension and complete heart block. Because of the applied standard therapy failure and further patients impairment, Intralipid ® 20% was used. Sinus rhythm was restored, arterial blood pressure increased and verapamile concentrations, both total and free decreased. Conclusion. Intravenous lipid emulsion can be important in treatment of severe acute intoxication and cardiotoxicity caused by verapamil.Uvod. Poslednjih godina intravenske emulzije masti uspešno se koriste u terapiji akutnih trovanja lipofilnim supstancama, uključujući i verapamil. Prikaz bolesnika. Prikazana je 37godišnja pacijentkinja primljena jedan sat nakon ingestije 2,8 g verapamila. Na prijemu je bila hipotenzivna, sa kompletnim srčanim blokom. Zbog izostanka efekta primenjene standardne terapije i daljeg pogoršanja stanja pacijentkinje primenjen je Intralipid ® 20%, nakon čega je uspostavljen sinusni ritam. Zabeležen je porast arterijskog pritiska, uz smanjenje koncentracije verapamila, kako ukupnog, tako i slobodne frakcije leka. Zaključak. Intravenske emulzije masti mogu zauzeti važno mesto u terapiji teške akutne intoksikacije i kardiotoksičnosti uzrokovane verapamilom.

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Section: Discussionmentioning

confidence: 99%

“…Efficiency of ILE is shown in acute poisoning with other Ca 2+ -channel blockers, including diltiazem, nifedipine and amlodipine 8 . Knowing the similar characteristics of those drugs (liposolubility -partition coefficient and volume of distribution), such results are expected 14 .…”

Section: Discussionmentioning

confidence: 99%

Successful usage of intravenous lipid emulsion in treatment of acute verapamil poisoning: A case report

et al. 2017

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“…Likewise, ILE as an adjunctive antidote used in selected critically ill poisoned patients is well known to ameliorate toxicity of lipid soluble drugs (Gosselin et al, 2015), giving the fact that verapamil is a lipid soluble drug, it is possible that the mechanism for the effect of ILE is sequestration of fat-soluble toxins within an intravascular lipid compartment (Cave and Harvey, 2014). The "lipid sink" theory explains that infusion of a large amount of lipids to the blood can move the lipophilic substances away from the affected tissues and dissolve them in the plasma (Mir and Rasool, 2014).This eventually reduces free drug availability and may also enhance clearance because intralipid chylomicrons deliver compounds to the liver within the lipid phase.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, ILE has a long history of use as a parenteral nutrition formulation in both adult and pediatric patients. Over the past decade, ILE also emerged as a novel antidotal treatment for iatrogenic and intentional drug poisonings (Cave and Harvey, 2014). In clinical and experimental settings, ILE has proven effective in ameliorating toxicity from several lipid soluble agents, such as clomipramine, propranolol, amiodarone, bupivacaine and haloperidol (Harvey and Cave, 2007;Harvey and Cave, 2008 ;Niiya et al, 2010 ;Shi et al, 2013;Moshiri et al, 2014) Aim of the work Assessment of the beneficial effects of using L-carnitine and ILE 20% separately and in combination in treating acute verapamil (one of the nondihydropyridines class of CCB)-induced cardiotoxicity in rats.…”

Section: Introductionmentioning

confidence: 99%

The Effect of L-Carnitine and Intralipid Emulsion in Acute Verapamil Cardiotoxicity in Albino Rats

Elawady

Saad

2015

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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Calcium channel blockers (CCB) drugs poisoning continues to be deadly in severe cases despite recent advances and aggressive therapies. Clinically, this toxicity can manifest into severe cardiogenic shock that is often unresponsive to conventional calcium and supportive treatment. This study aimed to investigate the effectiveness of L-carnitine, as an essential compound in cellular energy production, and intralipid emulsion 20% (ILE), as an adjunctive antidote used in selected critically ill poisoned patients, for the treatment of hypotension, Electrocardiogram (ECG) changes and arterial blood gases (ABG) deficits in verapamil poisoned rats, either separately or in combination. The study was conducted on 64 albino rats divided into 8 groups (each of 8 rats). The groups are: group 1 (negative control group), group 2 (Lcarnitine group), group 3 (ILE group), group4 (L-carnitine and ILE group), group 5 (verapamil group), group 6 (verapamil and L-carnitine group), group7 (verapamil and ILE group), group8 (verapamil, Lcarnitine and ILE group). All animals were subjected to measurement of blood pressure, ECG recording, as well as ABG. Results: verapamil toxicity in group 5 was manifested by significant hypotension (both systolic and diastolic), ECG derangements in the form of bradycardia, prolongation of PR and QT intervals and ABG changes in the form of significant low (pH, HCO3, PaO2 and PaCO2). L-carnitine and ILE separate administration with verapamil in group 6 and group 7 respectively improved the blood pressure, heart rate, ECG and ABG parameters but they still showed statistical significant difference with both the control group and group 8, regarding)blood pressure and ECG(in group 6 and)blood pressure, ECG and ABG(in group 7. Co-administration of L-carnitine and ILE together with verapamil in group 8 showed significant improvement of all toxic parameters with insignificant difference with the control group. In conclusion, this study proved that the combined use of L-carnitine and ILE was the most effective treatment of verapamil-induced acute cardiotoxicity. Further studies are recommended on larger scale and on clinical implication to establish more the advantageous and disadvantageous of this novel therapy. It is recommended to use this novel therapy as an additive to the usual regime and when the latter fails to correct potentially fatal cases of CCB poisonings.

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“…ILE also emerged as a new treatment for iatrogenic and intentional poisoning with medications [2]. ILE is a new method for treating systemic toxicity of local anesthetics (LAST), which is an effective antidote for poisoning by other lipophilic drugs.…”

Section: Introductionmentioning

confidence: 99%

Lipid Emulsion Infusion in Resuscitation for Local Anesthetic and Other Drug Overdose

Chaparoska¹,

Baneva²

2014

Macedonian Medical Review

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The use of intravenous lipid emulsions (ILEs) as antidote in local anesthetic systemic toxicity has gained widespread support following convincing data from animal models, and successful case reports in humans. Аn injection of a simple, intravenous nutritional solution could be acutely life-saving for a patient with severe drug overdose. But dozens of published case reports support this observation, the first ones made more than a decade ago in a rodent model of bupivacaine toxicity. It is even more surprising that such a simple formulation can rapidly reverse severe clinical toxicity from a variety of vastly disparate medications with distinct pharmacodynamics and mechanisms of action. This review will focus on the clinical application of lipid emulsion therapy in resuscitation from drug-related toxicity and will provide an introduction to the development of a method, guidelines for its use, and insights into potential controversies and future applications [1].

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Should we consider the infusion of lipid emulsion in the resuscitation of poisoned patients?

Cited by 44 publications

References 71 publications

Successful usage of intravenous lipid emulsion in treatment of acute verapamil poisoning: A case report

Successful usage of intravenous lipid emulsion in treatment of acute verapamil poisoning: A case report

The Effect of L-Carnitine and Intralipid Emulsion in Acute Verapamil Cardiotoxicity in Albino Rats

Lipid Emulsion Infusion in Resuscitation for Local Anesthetic and Other Drug Overdose

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