Usefulness of Intravenous Lipid Emulsion for Cardiac Toxicity from Cocaine Overdose

Cardiovascular consequences of cocaine use

“…A recently published study by Lakkireddy et al [94] demonstrated considerable safety and success for radiofrequency ablation for the treatment of drug-refractory ventricular arrhythmia related to cocaine use in a small group of patients, similar to treatment for drug-refractory incessant ventricular tachycardia in the general population. Based on reported successes with intravenous lipid emulsion treatment for other lipidsoluble drugs, case reports have recently demonstrated success with intravenous infusion of a 20% lipid emulsion in patients with treatment-refractory cardiac instability related to cocaine use [95][96][97].…”

“…However, several potential diagnostic tools and therapies for cocaine-induced cardiovascular disease have been described, such as SPECT MPI as a diagnostic tool to prevent unnecessary admission [75], intravenous sodium bicarbonate or lipid emulsion infusions or radiofrequency ablation therapy for cocaine-induced cardiac arrhythmia [94][95][96], and drugs targeting mitochondrial oxidation [19] or platelet-von Willebrand factor interaction [26], but these require additional research before they can be recommended for routine use or contribute to development of standard diagnostic and therapeutic practices.…”

Experimental Treatments for Cocaine Toxicity: A Difficult Transition to the Bedside

“…Use of an intravenous 20% lipid emulsion was initially described as a rescue therapy for toxicity to local anesthetics (Weinberg et al, 1998;Rosenblatt et al, 2006), although it has now shown benefit in refractory cases of various overdoses (Jamaty et al, 2010). Case reports describe the effective use of intravenous lipid emulsion bolus followed by infusion in patients with hemodynamic compromise secondary to cocaine toxicity (Jakkala-Saibaba et al, 2011;Arora et al, 2013). The precise mechanism of lipid emulsion in overdose is not fully elucidated.…”

Out-of-hospital cardiac arrest after acute cocaine intoxication associated with Brugada ECG patterns: Insights into physiopathologic mechanisms and implications for therapy

“…In addition, the sodium loading in sodium bicarbonate therapy may help in counteracting the sodium channel blocking effect of cocaine [7]. Finally, a 20% lipid emulsion (Intralipid) may be effective in the treatment of cocaine toxicity because of its drug binding property [13]. Patients surviving cardiac arrest due to VF that exhibit a persistent or ajmaline-induced coved-type ST-segment elevation (Brugada syndrome), like our patient #2, should receive an ICD for secondary SCD prevention.…”