Intralipid: Difference between revisions
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==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]
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
- Pregnancy Rating: C
- Lactation risk:
- Renal Dosing
- Adult
- Pediatric
- Hepatic Dosing
- Adult
- Pediatric
Emergency department indications[14][15]
- Severe systemic drug toxicity plus:
- Persistent hemodynamic instability
- All conventional options have been exhausted
- Toxicity has poor prognosis
- Common toxicities
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
- Lipid sink/partition
- Unclear, but proposed mechanisms include[18]:
Comments
- Avoid co-administration of:[19]
- Vasopressin
- Calcium channel blockers
- Beta-blockers
- Local anesthetics
- High-dose epinephrine
- Propofol
See Also
- Beta-blocker toxicity
- Calcium channel blocker toxicity
- Local Anesthetic Systemic Toxicity (LAST)
- Tricyclic antidepressant toxicity
External Links
References
- ↑ http://www.lipidrescue.org/
- ↑ http://www.lipidrescue.org/
- ↑ http://www.lipidrescue.org/
- ↑ Cave, G. Intravenous Lipid Emulsion as Antidote Beyond Local Anesthetic Toxicity: A Systematic Review. 2009. 16(9)815–824
- ↑ https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/
- ↑ https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/
- ↑ Dillane D, Finucane BT. Local anesthetic systemic toxicity. Can J Anaesth. 2010 Apr;57(4):368-80.
- ↑ http://www.lipidrescue.org/
- ↑ http://www.lipidrescue.org/
- ↑ http://www.lipidrescue.org/
- ↑ https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/
- ↑ http://www.lipidrescue.org/
- ↑ Lipid emulsion (conventional, soybean oil-based): Drug information. Uptodate. Accessed May 15 2019.
- ↑ http://www.lipidrescue.org/
- ↑ https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/
- ↑ Cole JB et al. Asystole immediately following intravenous fat emulsion for overdose. J Med Toxicol. 2014;10(3)307-310
- ↑ 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
- ↑ https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/
- ↑ http://www.lipidrescue.org/