Being aware of possible complications of experimental antidote therapy, like ILE, can improve the treatment approach and outcomes for these patients.ĬRRT lipid emulsion renal insufficiency toxicology.Ĭopyright © 2014 Elsevier Inc. However, the first use of lipid emulsion therapy in treating non-local anesthetic drug toxicity was described by Sirianni et al 11 who reported on the remarkable rescue of an adolescent near-suicide who suffered a witnessed cardiac arrest hours after hospitalization for a massive overdose of bupropion and lamotrigine. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians treat patients with toxic ingestions on a regular basis. The patient's family decided to withdraw care and the patient expired. An attempt was made to remove the lipid by plasmapheresis to restart CVVHF, but the patient continued to deteriorate despite maximal vasopressor support. ![]() After 15 min, the transmembrane pressures of the filter began to rise in the absence of observed clotting of the blood and the filter then became completely obstructed. Lipemic blood was immediately observed in the CVVHF filter. Continuous venovenous hemofiltration (CVVHF) was attempted to remove volume and correct metabolic abnormalities. The patient deteriorated, with development of both acute respiratory and renal failure. A continuous intravenous infusion of ILE therapy was started. After failure of conventional therapy, an initial bolus of ILE (20%) was given with some improvement in his heart rate, and the dose was repeated. ![]() At presentation, he had hypotension and bradycardia that was unresponsive to treatment with intravenous saline, calcium, glucagon, and vasopressors. Isolated reports of pulmonary edema or severe lipemia exist as a complication of therapy.Ī 26-year-old hypertensive, male, kidney transplant recipient presented to an outside emergency department (ED) after an intentional overdose of his medications (ie, amlodipine, metoprolol, lisinopril). The current review includes the following: 1) an introduction, 2) a list of the proposed mechanisms, 3) a discussion of the best lipid emulsion treatment for reversal of local anesthetic toxicity, 4) a description of the effect of epinephrine on lipid emulsion-mediated resuscitation, 5) a description of the recommended lipid emulsion treatment, and 6) a conclusion.īupivacaine lipid emulsion lipid shuttle lipid sink local anesthetic systemic toxicity.Intralipid emulsion (ILE) is a nutritional fatty acid supplementation that is emerging as a potential therapy for local anesthetic systemic toxicity and is also being considered as a therapy for other lipophilic medication intoxications. Investigators have suggested mechanisms associated with the lipid emulsion-mediated recovery of cardiovascular collapse caused by local anesthetic systemic toxicity these mechanisms include lipid sink, a widely accepted theory in which highly soluble local anesthetics (particularly bupivacaine) are absorbed into the lipid phase of plasma from tissues (e.g., the heart) affected by local-anesthetic-induced toxicity enhanced redistribution (lipid shuttle) fatty acid supply reversal of mitochondrial dysfunction inotropic effects glycogen synthase kinase-3β phosphorylation associated with inhibition of the mitochondrial permeability transition pore opening inhibition of nitric oxide release and reversal of cardiac sodium channel blockade. A systemic review and meta-analysis confirm the efficacy of this treatment. Pete Stiles, BA, is a senior medical student at the University of Minnesota Medical School. Start an infusion at 0.25 mL/kg/min for 30-60 minutes increase infusion rate up to 0.50 mL/kg/min for refractory hypotension. ![]() ![]() Lipid emulsion has been shown to be an effective treatment for systemic toxicity induced by local anesthetics, which is reflected in case reports. 20 Intralipid: Administer 1.5 mL/kg as an initial bolus the bolus can be repeated 1- 2 times for persistent asystole.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |