Use of intravenous lipids in clinical toxicologyBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1764 (Published 23 March 2011) Cite this as: BMJ 2011;342:d1764
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Reply to Dr Doug Murray, Doug.Murray@luht.scot.nhs.uk
We read with interest Dr Loh's letter "Old drug, new tricks: Use of
intravenous lipids in clinical toxicology." Whilst we echo his view that
the advent of lipid emulsion therapy for certain drug toxicity is a step
forward, (Jamaty et al) we do not feel it is appropriate to support its
use in all failed toxicological resuscitations.
Although the possible benefits of lipid emulsion therapy were first
described in 1998 (Weinburg et al), we still have a poor understanding of
its mechanism of action. Novel treatments, especially those used in
conditions associated with poor outcome, are prone to publication bias
which can exaggerate the efficacy of these treatments. The field of
clinical toxicology is particularly littered with case reports of
promising therapies that on subsequent close analysis prove incorrect. We
believe rigorous studies are needed to define both appropriate targets and
mechanism of action of lipid emulsion therapy before it is possible to be
as positive about its use as your correspondant.
We would particularly encourage readers to discuss all cases of
serious poisoning with their national poisons information service: NPIS in
the UK and NPIC in Ireland, in order that a body of evidence can be
collected that will drive appropriate clinical trials and properly
identify the place of this therapy.
1. Jamaty C, Bailey B, Larocque A, Notebaert E, Sanogo K, Chauny JM.
Lipid emulsions in the treatment of acute poisoning: a systematic review
of human and animal studies. Clinical Toxicology (Philadelphia, Pa.) 2010,
2. Weinburg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik
MJ. Pretreatment or resuscitation with a lipid infusion shifts the dose-
response to bupivacaine-induced asystole in rats. Anesthesiology
Competing interests: No competing interests