Intralipid: Difference between revisions

(Created page with "==General== *Type: *Dosage Forms: *Routes of Administration: *Common Trade Names: ==Adult Dosing== ==Pediatric Dosing== ==Special Populations== *Drug Ratings in Pregnan...")
 
 
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==General==
==General==
*Type:  
*Type: Lipid emulsion therapy
*Dosage Forms:
*Dosage Forms: 10%, 20%, and 30% lipid emulsions
*Routes of Administration:
**Note that 20% is used for lipid rescue therapy for systemic drug toxicity<ref>http://www.lipidrescue.org/</ref>
*Common Trade Names:  
*Routes of Administration: IV
*Common Trade Names: Intralipid, Lipid Rescue <ref>http://www.lipidrescue.org/</ref>


==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>
*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>
**Note that dosing is based on lean or ideal body mass<ref>https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/</ref>
**Followed by 0.25 mL/kg/min for 20 min or until hemodynamic stability is achieved.<ref>Dillane D, Finucane BT. Local anesthetic systemic toxicity. Can J Anaesth. 2010 Apr;57(4):368-80.</ref>
===Persistent Cardiovascular Collapse===
*May repeat bolus once or twice for persistent cardiovascular collapse<ref>http://www.lipidrescue.org/</ref>
*May double rate of infusion to 0.5 mL/kg/min for persistent hypotension<ref>http://www.lipidrescue.org/</ref>
*Max cumulative dose: 12 ml/kg
===After Cardiovascular Stability Achieved===
*Maintain infusion for at least 10 minutes<ref>http://www.lipidrescue.org/</ref>
===Simplified Protocol<ref>https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/</ref>===
*Based on 'average' 70 kg patient
**100 mL IV bolus over 1 minute
**Infusion at 18 mL/h IV


==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==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]:
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*[[Lactation risk categories|Lactation risk]]:
*[[Lactation risk categories|Lactation risk]]:
*Renal Dosing
*Renal Dosing
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**Adult
**Adult
**Pediatric
**Pediatric
==Emergency department indications<ref>http://www.lipidrescue.org/</ref><ref>https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/</ref>==
*Severe systemic drug toxicity plus:
**Persistent hemodynamic instability
**All conventional options have been exhausted
**Toxicity has poor prognosis
*Common toxicities
**[[Local anesthetic systemic toxicity]]
**[[Beta blocker]]
**[[Calcium Channel Blocker]]
**[[TCA]]
**[[Bupropion]]


==Contraindications==
==Contraindications==
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==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*Asystole (case reported) <ref>Cole JB et al. Asystole immediately following intravenous fat emulsion for overdose. J Med Toxicol. 2014;10(3)307-310</ref>
*Fat embolism
*Hypersensitivity reactions
*ARDS


===Common===
===Common===
*[[Pancreatitis]]<ref name = review> Kostic MA and Gorelick M. Review of the use of lipid emulsion in nonlocal anesthetic poisoning. Pediatric Emergency Care 2014;30:427-436</ref>
*Hypertriglyceridemia<ref name=review></ref>
*Interferes with some lab measurements
**Glucose and magnesium concentrations become inaccurate
**Creatinine and lipase become unmeasurable


==Pharmacology==
==Pharmacology==
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*Excretion:  
*Excretion:  
*Mechanism of Action:
*Mechanism of Action:
**Unclear, but proposed mechanisms include<ref>https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/</ref>:
***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==
*[[Beta-blocker toxicity]]
*[[Calcium channel blocker toxicity]]
*[[Local Anesthetic Systemic Toxicity (LAST)]]
*[[Tricyclic antidepressant toxicity]]
==External Links==
*[http://www.lipidrescue.org/ LipidRescue]


==References==
==References==
<references/>
<references/>


[[Category:Drugs]]
[[Category:Pharmacology]]
[[Category:Tox]]
[[Category:Toxicology]]

Latest revision as of 20:18, 17 April 2024

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]
  • Max cumulative dose: 12 ml/kg

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

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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