Evidence-based recommendations on the use of intravenous lipid emulsion therapy in poisoning*

Published on Sep 8, 2016in Clinical Toxicology4.467
· DOI :10.1080/15563650.2016.1214275
Sophie Gosselin24
Estimated H-index: 24
(MUHC: McGill University Health Centre),
Lotte C. G. Hoegberg15
Estimated H-index: 15
(Copenhagen University Hospital)
+ 16 AuthorsValery Lavergne27
Estimated H-index: 27
(UdeM: Université de Montréal)
Sources
Abstract
AbstractBackground: Although intravenous lipid emulsion (ILE) was first used to treat life-threatening local anesthetic (LA) toxicity, its use has expanded to include both non-local anesthetic (non-LA) poisoning and less severe manifestations of toxicity. A collaborative workgroup appraised the literature and provides evidence-based recommendations for the use of ILE in poisoning.Methods: Following a systematic review of the literature, data were summarized in four publications: LA and non-LA poisoning efficacy, adverse effects, and analytical interferences. Twenty-two toxins or toxin categories and three clinical situations were selected for voting. Voting statements were proposed using a predetermined format. A two-round modified Delphi method was used to reach consensus on the voting statements. Disagreement was quantified using RAND/UCLA Appropriateness Method.Results: For the management of cardiac arrest, we recommend using ILE with bupivacaine toxicity, while our recommendations are neutral regardin...
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#1Matthew Musielak (Jewish Hospital)H-Index: 5
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Pain control is a major concern for patients suffering burns. The addition of bupivacaine to the donor site infiltration solution containing epinephrine could offer a safe and effective means to treat postanesthesia pain. Despite the addition of epinephrine to localize the effects, systemic absorption occurs, and there exists the possibility of inadvertent intravascular injection, with potential CNS and cardiac toxicity. The patient is a 6-year-old boy who sustained flame burns to bilateral lowe...
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ABSTRACTContext: Poisoning is an important category of avoidable deaths in Norway and an important public health issue. Close monitoring of any development in this field is essential for effective preventive measures. Objective: To assess the pattern and trends of poisoning mortality in Norway from 2003 to 2012 based on official mortality data. Materials and methods: This is a population-based registry study. We analyzed the underlying external cause of death data, in order to assess poisoning d...
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AbstractBackground: Intravenous lipid emulsions (ILEs) were initially developed to provide parenteral nutrition. In recent years, ILE has emerged as a treatment for poisoning by local anesthetics and various other drugs. The dosing regimen for the clinical toxicology indications differs significantly from those used for parenteral nutrition. The evidence on the efficacy of ILE to reverse acute toxicity of diverse substances consists mainly of case reports and animal experiments. Adverse events t...
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#1Lotte C. G. Hoegberg (Copenhagen University Hospital)H-Index: 15
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AbstractContext Although the clinical use of intravenous lipid emulsion therapy for the treatment of lipophilic drug toxicity is increasing, the focus of most publications is on outcome in laboratory animals or in patients. An unintended consequence of intravenous lipid emulsion is the creation of extremely lipemic blood, which may interfere with the laboratory analysis or interpretation of common analytes. Objective The American Academy of Clinical Toxicology has established a lipid emulsion wo...
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: Flecainide is a Class Ic antiarrythmic agent associated with adverse events due to its pro-arrythmic effects. We report the case of a 33-year-old female presenting in cardiac arrest after a flecainide overdose treated with intravenous fat emulsion (IFE), sodium bicarbonate (NaHCO₃), and extracorporeal membrane oxygenation (ECMO). This case reviews the pathophysiology and management of flecainide toxicity including novel strategies of IFE and ECMO.
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Intravenous lipid emulsions (ILEs) have been used widely for the treatment of local anesthetic (LA) poisoning and have been proposed as a treatment for intoxication by other drugs. However, the degree of evidence for this kind of therapy is not strong, as it comes mostly from clinical cases. The aim of this narrative review is to describe the proposed mechanisms of action for ILEs in poisoning by LA and other drugs and to evaluate recent studies in animals that support the recommendations for th...
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