Use of Lipid Emulsion in the Resuscitation of a Patient With Prolonged Cardiovascular Collapse After Overdose of Bupropion and Lamotrigine

Sirianni, Archie; Osterhoudt, Kevin C.; Calello, Diane P.; Muller, Allison A.; Waterhouse, Marie R.; Goodkin, Michael B.; Weinberg, Guy; Henretig, Fred M.

doi:10.1016/j.annemergmed.2007.06.004

Cited by 263 publications

(210 citation statements)

References 11 publications

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“…Our serum TG measurements after infusion of 1 L ILE in a clinical case suggest that ILE serum concentration of 1 vol% is readily achievable in patients. Published reports of poisoning with verapamil as well as other drugs, such as bupropion and lamotrigine, demonstrate increased total serum drug concentrations following ILE administration [25]. This finding is also consistent with ILE acting as lipid sink that works by lowering free rather than total verapamil concentration in the blood.…”

Section: Discussionsupporting

confidence: 78%

“…On the other hand, a recent study in a rat model of bupivacaine toxicity suggests ILE causes a cardiotonic response that complements sequestration [21]. The authors postulate that these results (i.e., existence of several complementing mechanisms) explain how ILE provides beneficial effect in the treatment of less-lipophilic drugs that also provoke cardiovascular toxicity [8,25]. While we did not observe any inotropic effect (Fig.…”

Section: Discussionsupporting

confidence: 40%

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In Vitro Studies Indicate Intravenous Lipid Emulsion Acts as Lipid Sink in Verapamil Poisoning

et al. 2015

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Intravenous lipid emulsion (ILE), a component of parenteral nutrition, consists of a fat emulsion of soy bean oil, egg phospholipids, and glycerin. Case reports suggest that ILE may reverse hypotension caused by acute poisoning with lipophilic drugs such as verapamil, but the mechanism remains unclear. The methods used are the following: (1) measurement of ILE concentration in serum samples from a patient with verapamil poisoning treated with ILE, (2) measurement of free verapamil concentrations in human serum mixed in vitro with increasing concentrations of ILE, and (3) measurement of murine ventricular cardiomyocyte L-type Ca 2+ currents, intracellular Ca 2+ , and contractility in response to verapamil and/or ILE. Maximum patient serum ILE concentration after infusion of 1 L ILE over 1 h was approximately 1.6 vol%. In vitro GC/ MS verapamil assays showed that addition of ILE (0.03-5.0 vol%) dose-dependently decreased the free verapamil concentration in human serum. In voltage-clamped myocytes, adding ILE to Tyrode's solution containing 5 μM verapamil recovered L-type Ca 2+ currents (I Ca ). Recovery was concentration dependent, with significant I Ca recovery at ILE concentrations as low as 0.03 vol%. ILE had no effect on I Ca in the absence of verapamil. In field-stimulated intact ventricular myocytes exposed to verapamil, adding ILE (0.5 %) resulted in a rapid and nearly complete recovery of myocyte contractility and intracellular Ca 2+ . Our in vitro studies indicate that ILE acts as a lipid sink that rapidly reverses impaired cardiomyocyte contractility in the continued presence of verapamil.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 40%

In Vitro Studies Indicate Intravenous Lipid Emulsion Acts as Lipid Sink in Verapamil Poisoning

et al. 2015

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“…Since then, use in local anesthetic systemic toxicity, and more recently use in toxidromes from drugs other than local anesthetics, has been increasingly reported [18][19][20][21][22][23]. Systematic reporting of outcomes following ILE infusion for such indications has been lacking with only single case reports, and short case series [27] appearing in literature to date.…”

Section: Discussionmentioning

confidence: 99%

“…Lipid emulsion was administered for cardiovascular collapse and/or overt cardiac arrest in toxicity of drugs other than local anesthetics in eight patients reported to the registry. The present evidence base for use of ILE in cardiovascular toxicity is established biologic effect in animal models coupled with case reports demonstrating strong temporal association and survival from an otherwise irretrievable position [2,18]. On this basis, it is reasonable that lipid be used as a rescue therapy when circulatory compromise poses an immediate threat to life and all other available treatments have failed.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical use of ILE in non-local anesthetic poisoning has similarly been associated with successful resuscitation outcome in numerous case reports of overdose with pharmacologically disparate agents [18][19][20][21][22][23]. However, given the variability of drugs taken in overdose and the range of both generic and specific antidotes utilized to treat cardiovascular toxicity in concert with administered ILE therapy in these cases, the magnitude of any benefit attributable to ILE administration remains unclear [24].…”

Section: Introductionmentioning

confidence: 99%

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LIPAEMIC Report: Results of Clinical Use of Intravenous Lipid Emulsion in Drug Toxicity Reported to an Online Lipid Registry

et al. 2014

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The use of intravenous lipid emulsion (ILE) as an antidote has prompted significant academic and clinical interest. Between August 2009 and August 2012, data from cases of ILE use in intoxicated patients in different hospitals on different continents were voluntarily entered into a registry based on the world wide web (www.lipidregistry.org). Here, we report data from this project. Participating centers were given access to the registry following institutional subscription. Specifically sought were details of the individual patients' presenting condition, indications for ILE use, ILE administration regimen, potential complications, and of clinical outcome. Forty-eight uses of ILE were reported from 61 participating centers. Ten cases of local anesthetic systemic toxicity were reported; all (10/10) survived. Thirtyeight cases of intoxication by other agents were reported [30 decreased conscious state, 8 cardiovascular collapse (3 deaths)]. There was an elevation in GCS (p<0.0001) and increased systolic blood pressure (p=0.012) from immediately prior to ILE administration to 30 min after use. One serious and two minor adverse effects of ILE use were recorded in 48 reported cases (one case of bronchospastic reaction, one case of hyperamylasemia and one case of interference with laboratory testing). In this series of cases reported to the registry, improvements were seen for GCS in patients with central nervous system toxicity and in systolic blood pressure in shocked patients over a short time frame after the injection of ILE. Few adverse effects were recorded. Clinical trials and the reporting of drug concentrations after ILE use are necessary to further elucidate the role of ILE in clinical toxicology.

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Lipid “Rescue” Therapy

Benavides¹,

Babyak

2018

Textbook of Small Animal Emergency Medicine

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Use of Lipid Emulsion in the Resuscitation of a Patient With Prolonged Cardiovascular Collapse After Overdose of Bupropion and Lamotrigine

Cited by 263 publications

References 11 publications

In Vitro Studies Indicate Intravenous Lipid Emulsion Acts as Lipid Sink in Verapamil Poisoning

In Vitro Studies Indicate Intravenous Lipid Emulsion Acts as Lipid Sink in Verapamil Poisoning

LIPAEMIC Report: Results of Clinical Use of Intravenous Lipid Emulsion in Drug Toxicity Reported to an Online Lipid Registry

Lipid “Rescue” Therapy

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