Intralipid: Difference between revisions
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==Adult Dosing==
==Adult Dosing==
'Note that dosing for adults and children is not standardized but is based on case reports and recommendations<ref>http://www.lipidrescue.org/</ref>'
Note that dosing for adults and children is not standardized but is based on case reports and recommendations<ref>http://www.lipidrescue.org/</ref>


*1.5 mL/kg bolus over 1 minute<ref>Cave, G. Intravenous Lipid Emulsion as Antidote Beyond Local Anesthetic Toxicity: A Systematic Review. 2009. 16(9)815–824</ref><ref>https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/</ref>
*1.5 mL/kg bolus over 1 minute<ref>Cave, G. Intravenous Lipid Emulsion as Antidote Beyond Local Anesthetic Toxicity: A Systematic Review. 2009. 16(9)815–824</ref><ref>https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/</ref>
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==Pediatric Dosing==
==Pediatric Dosing==


As with adults, pediatric dosing is not standardized<ref>http://www.lipidrescue.org/</ref>
*Initial bolus of 0.8 - 3 mL/kg<ref>Lipid emulsion (conventional, soybean oil-based): Drug information. Uptodate. Accessed May 15 2019.</ref>
*No recommendations provided for rate of ongoing infusion


==Special Populations==
==Special Populations==
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**Pediatric
**Pediatric


==Emergency department indications==
==Emergency department indications<ref>http://www.lipidrescue.org/</ref><ref>https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/</ref>==
*[[Local anesthetic systemic toxicity]]
*Severe systemic drug toxicity plus:
*Refractory hemodynamic instability secondary to ingestion of cardiodepressive medications / toxins
**Persistent hemodynamic instability
**All conventional options have been exhausted
**Toxicity has poor prognosis
*Common toxicities
**[[Local anesthetic systemic toxicity]]
**[[Beta blocker]]
**[[Beta blocker]]
**[[Calcium Channel Blocker]]
**[[Calcium Channel Blocker]]
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*Fat embolism
*Fat embolism
*Hypersensitivity reactions
*Hypersensitivity reactions
*ARDS


===Common===
===Common===
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*Excretion:  
*Excretion:  
*Mechanism of Action:
*Mechanism of Action:
**Emulsion acts as a “lipid sink,” surrounding a lipophilic drug molecule and rendering it ineffective
**Unclear, but proposed mechanisms include<ref>https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/</ref>:
**Fatty acids from the ILE provide the myocardium with a ready energy source, improving cardiac function
***Lipid sink/partition
****Emulsion surrounds lipophilic drug molecule, partitioning it from target organs
***Cardiac metabolism
****Fatty acids provide the myocardium with a ready energy source, improving cardiac contractility


==Comments==
==Comments==
 
*Avoid co-administration of:<ref>http://www.lipidrescue.org/</ref>
**Vasopressin
**Calcium channel blockers
**Beta-blockers
**Local anesthetics
**High-dose epinephrine
**Propofol


==See Also==
==See Also==

Revision as of 19:13, 15 May 2019

General

  • Type: Lipid emulsion therapy
  • Dosage Forms: 10%, 20%, and 30% lipid emulsions
    • Note that 20% is used for lipid rescue therapy for systemic drug toxicity[1]
  • Routes of Administration: IV
  • Common Trade Names: Intralipid, Lipid Rescue [2]

Adult Dosing

Note that dosing for adults and children is not standardized but is based on case reports and recommendations[3]

  • 1.5 mL/kg bolus over 1 minute[4][5]
    • Note that dosing is based on lean or ideal body mass[6]
    • Followed by 0.25 mL/kg/min for 20 min or until hemodynamic stability is achieved.[7]

Persistent Cardiovascular Collapse

  • May repeat bolus once or twice for persistent cardiovascular collapse[8]
  • May double rate of infusion to 0.5 mL/kg/min for persistent hypotension[9]

After Cardiovascular Stability Achieved

  • Maintain infusion for at least 10 minutes[10]

Simplified Protocol[11]

  • Based on 'average' 70 kg patient
    • 100 mL IV bolus over 1 minute
    • Infusion at 18 mL/h IV

Pediatric Dosing

As with adults, pediatric dosing is not standardized[12]

  • Initial bolus of 0.8 - 3 mL/kg[13]
  • No recommendations provided for rate of ongoing infusion

Special Populations

Emergency department indications[14][15]

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

  • Asystole (case reported) [16]
  • Fat embolism
  • Hypersensitivity reactions
  • ARDS

Common

  • Pancreatitis[17]
  • Hypertriglyceridemia[17]
  • Interferes with some lab measurements
    • Glucose and magnesium concentrations become inaccurate
    • Creatinine and lipase become unmeasurable

Pharmacology

  • Half-life:
  • Metabolism:
  • Excretion:
  • Mechanism of Action:
    • Unclear, but proposed mechanisms include[18]:
      • Lipid sink/partition
        • Emulsion surrounds lipophilic drug molecule, partitioning it from target organs
      • Cardiac metabolism
        • Fatty acids provide the myocardium with a ready energy source, improving cardiac contractility

Comments

  • Avoid co-administration of:[19]
    • Vasopressin
    • Calcium channel blockers
    • Beta-blockers
    • Local anesthetics
    • High-dose epinephrine
    • Propofol

See Also

External Links

References

  1. ↑ http://www.lipidrescue.org/
  2. ↑ http://www.lipidrescue.org/
  3. ↑ http://www.lipidrescue.org/
  4. ↑ Cave, G. Intravenous Lipid Emulsion as Antidote Beyond Local Anesthetic Toxicity: A Systematic Review. 2009. 16(9)815–824
  5. ↑ https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/
  6. ↑ https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/
  7. ↑ Dillane D, Finucane BT. Local anesthetic systemic toxicity. Can J Anaesth. 2010 Apr;57(4):368-80.
  8. ↑ http://www.lipidrescue.org/
  9. ↑ http://www.lipidrescue.org/
  10. ↑ http://www.lipidrescue.org/
  11. ↑ https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/
  12. ↑ http://www.lipidrescue.org/
  13. ↑ Lipid emulsion (conventional, soybean oil-based): Drug information. Uptodate. Accessed May 15 2019.
  14. ↑ http://www.lipidrescue.org/
  15. ↑ https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/
  16. ↑ Cole JB et al. Asystole immediately following intravenous fat emulsion for overdose. J Med Toxicol. 2014;10(3)307-310
  17. ↑ 17.0 17.1 Kostic MA and Gorelick M. Review of the use of lipid emulsion in nonlocal anesthetic poisoning. Pediatric Emergency Care 2014;30:427-436
  18. ↑ https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/
  19. ↑ http://www.lipidrescue.org/
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