Role of intravenous lipid emulsion (ILE) in drug toxicity

Intravenous lipid emulsion (ILE) has been proposed in lipophilic drugs like beta-blockers, calcium channel blockers or tricyclic antidepressants. Help from hospital pharmacy should be obtained. Evidence for its use is weak and should be kept for unstable patients and should be used after due consideration of risks and benefits. Proposed mechanism is sinking of lipophilic drug by surrounding it.

Dosing: IV bolus of 1 to 1.5 mL/kg given over 1-3 minutes of a 20 percent lipid emulsion solution. Boluses can be repeated every 5 minutes upto maximum of 3 times - and if found effective, infusion can be continued at 0.25 to 0.5 mL/kg per minute untill patient becomes hemodynamically stable.



References:

1.  Jamaty C, Bailey B, Larocque A, et al. Lipid emulsions in the treatment of acute poisoning: a systematic review of human and animal studies. Clin Toxicol (Phila) 2010; 48:1. 

2. Young AC, Velez LI, Kleinschmidt KC. Intravenous fat emulsion therapy for intentional sustained-release verapamil overdose. Resuscitation 2009; 80:591. 

3. Sirianni AJ, Osterhoudt KC, Calello DP, et al. Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine. Ann Emerg Med 2008; 51:412. 

4. Doepker B, Healy W, Cortez E, Adkins EJ. High-dose insulin and intravenous lipid emulsion therapy for cardiogenic shock induced by intentional calcium-channel blocker and Beta-blocker overdose: a case series. J Emerg Med 2014; 46:486. 

5. Bologa C, Lionte C, Coman A, Sorodoc L. Lipid emulsion therapy in cardiodepressive syndrome after diltiazem overdose--case report. Am J Emerg Med 2013; 31:1154.e3.