Treatment methods following suicidal self-administration of IV organophosphate: What can additional lipid administration change?

Türkdoğan, Kenan Ahmet; Duman, Ali; Avcil, Mücahit; Aköz, Ayhan; Çanakçı, Selçuk Eren; Kantekin, Burçak

doi:10.1016/j.ajem.2017.06.058

Cited by 3 publications

(1 citation statement)

References 5 publications

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“…Three of the patients died during the treatment, and of those, the mortality occurred due to insecticide intake in two patients and quetiapine intake in one patient. It has been reported in the literature that low-dose lipid therapy could be useful in case of quetiapine and insecticide intoxications (19,20). In our study, the reasons for the response failure of ILE therapy could be the low GCS scores at admission (3,4,3) and late presentation to emergency service.…”

Section: Discussionmentioning

confidence: 55%

Lipid Emulsion Therapy in Lipophilic or Hydrophilic Drug Intoxication: The Last Weapon in Our Arsenal

Türkdoğan¹,

Aköz²,

Avcil³

et al. 2019

Eurasian J Emerg Med

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Aim: Previous case reports have described the administration of lipid emulsion therapy in lipophilic drug intoxication cases. In this study, we wanted to contribute to the literature that lipid emulsion therapy could also be given lipid as the last weapon in not only lipophilic drug intoxication but also all intoxication cases with worsening general condition. Materials and Methods: A total of 65 patients, who presented to the emergency room and received lipid therapy between January 1, 2014 and January 1, 2017, were included in this study. Each patient was given a 20% ClinOleic (Baxter) infusion of 1.5 mL/kg for 1-3 minutes and then 100 mL/h (0.025 mL/kg/min). Toxic drugs were divided into low or high permeability groups according to their lipid/water partition coefficients (LogP). Results: Of the 65 patients, 55.4% (n=36) were female and 44.6% (n=29) were male. These patients were grouped according to a lipid/water cutoff value of 1.72. The lipid therapy was administered in addition to antidotal therapy in two patients in the hydrophilic group and in five patients in the lipophilic group. The only variable that was significantly restored 12 hours after the lipid therapy was the respiratory rate, which was 16.0 (range, 15.5-17.3)/min in the hydrophilic group and 20.0 (range, 18.0-22.0)/min in the lipophilic group (p=0.003). Conclusion: We believe that lipid therapy can be used as a last resort in intoxication cases, especially in patients with low Glasgow coma scale scores and worsened vital signs despite antidotal and extracorporeal therapies, regardless of whether the causative agent is hydrophilic or lipophilic.

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Section: Discussionmentioning

confidence: 55%

Lipid Emulsion Therapy in Lipophilic or Hydrophilic Drug Intoxication: The Last Weapon in Our Arsenal

Türkdoğan¹,

Aköz²,

Avcil³

et al. 2019

Eurasian J Emerg Med

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Literature review of the evidence regarding intravenous lipid administration in drug-induced cardiotoxicity

Paneta

Waring

2019

Expert Review of Clinical Pharmacology

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Lipid Emulsion Treatment for Drug Toxicity Caused by Nonlocal Anesthetic Drugs in Pediatric Patients

2022

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Objective: Lipid emulsion (LE) has been used to treat children with cardiovascular collapse induced by toxic doses of nonlocal anesthetics with high lipid solubility. We aimed to analyze case reports on LE administration for resuscitation of toxicity induced by these drugs in pediatric patients.Methods: Case reports involving pediatric patients undergoing LE treatment for toxicity caused by nonlocal anesthetic drugs until December 31, 2021, were searched through PubMed and Scopus using the following terms: "toxicity, or intoxication, or poisoning, or overdose" and "LE or intralipid."Results: Twenty-eight cases on LE treatment for toxicity induced by nonlocal anesthetic drugs in pediatric patients (younger than 19 years) were retrieved. The total number of patients was 31. Lipid emulsion treatment was carried out during toxicity caused by amitriptyline, flecainide, bupropion, propranolol, and lamotrigine, which was unresponsive to supportive treatment. These drugs are highly lipid-soluble and inhibit cardiac sodium channels, which is similar to pharmacological properties of the local anesthetic bupivacaine. The most frequent method of delivery involved bolus administration followed by continuous infusion; 1.5 mL/kg LE administration followed by 0.25 mL/kg/min LE was most frequently used. Lipid emulsion improved various symptoms of drug toxicity in 29 patients (29/31, 93.54%), and symptoms were improved in 14 patients (14/31, 45.16%) within an h after LE administration. The trend in frequency of improved symptoms after LE treatment was as follows: the cardiovascular symptom alone > symptoms of the central nervous system alone > symptoms of the cardiovascular and central nervous systems. The adverse effects of LE treatment in the reported cases were hypertriglyceridemia, mild pancreatitis, and elevated levels of aspartate and alanine aminotransaminases.Conclusions: Lipid emulsion treatment may be effective in ameliorating intractable cardiovascular depression when systemic toxicity caused by drugs, including cardiac sodium channel blockers, is unresponsive to supportive treatments.

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Treatment methods following suicidal self-administration of IV organophosphate: What can additional lipid administration change?

Cited by 3 publications

References 5 publications

Lipid Emulsion Therapy in Lipophilic or Hydrophilic Drug Intoxication: The Last Weapon in Our Arsenal

Lipid Emulsion Therapy in Lipophilic or Hydrophilic Drug Intoxication: The Last Weapon in Our Arsenal

Literature review of the evidence regarding intravenous lipid administration in drug-induced cardiotoxicity

Lipid Emulsion Treatment for Drug Toxicity Caused by Nonlocal Anesthetic Drugs in Pediatric Patients

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