ILE

Q: What are the three mechanisms by which Intravenous Lipid Emulsion (ILE) Therapy works in toxicology?


Answer: The first question is to determine that if ingested drug/toxin molecule is lipophilic or not? If the answer is yes than ILE works via three mechanisms:

1. Lipid emulsion acts as a "lipid sink". It surrounds a lipophilic drug molecule making it ineffective.

2. The second and less well-known action is via the fatty acids present in ILE. It provides the myocardium with an extra energy source, enhancing its contractility leading to improved hemodynamics.

3. ILE works as a "lipid shuttle". It encapsulates the toxin and transports to the liver and kidney for metabolism.

#toxicology


References:

1. Gueret G, Pennec JP, Arvieux CC. Hemodynamic effects of intralipid after verapamil intoxication may be due to a direct effect of fatty acids on myocardial calcium channels. Acad Emerg Med 2007; 14:761.

2. Gosselin S, Hoegberg LC, Hoffman RS, et al. Evidence-based recommendations on the use of intravenous lipid emulsion therapy in poisoning(). Clin Toxicol (Phila) 2016; 54:899.

3. 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.