The novel use of intravenous lipids in clinical toxicology
The novel discovery of intravenous lipids in countering the toxicity
of local anaesthetics has been tremendous for a condition that was
previously associated with a high mortality rate. Due to the single
mindedness of a group of individuals (1), the simple calorific component
of parental nutrition has been transform to becoming the saviour of nerve
blocks and clinical toxicology.
More recently, intravenous lipids have been used in drug overdoses
involving lipid-soluble drugs like verapamil, propanolol, bupropion and
some pesticides with success even after prolonged cardio-pulmonary
resuscitation (2). These are anodotal evidence, but in each case report,
cardiovascular stability was achieved in a temporal relationship after
intravenous lipids were given.
I would like readers to consider the use of intravenous lipids for
drug overdoses in failed resuscitations as most of these outcomes are
extremely poor.
References
1. Weinburg et al. Pretreatment or resuscitation with a lipid
infusion shifts the dose-response to bupivacaine-induced asystole in rats.
Anesthesiology. 1998 Apr;88(4):1071-5.
2. Rosthchild et al. Intraveous lipids emulsion in clinical
toxicology. Scand J Trauma Resusc Emerg Med. 2010; 18: 51.
Rapid Response:
The novel use of intravenous lipids in clinical toxicology
The novel discovery of intravenous lipids in countering the toxicity
of local anaesthetics has been tremendous for a condition that was
previously associated with a high mortality rate. Due to the single
mindedness of a group of individuals (1), the simple calorific component
of parental nutrition has been transform to becoming the saviour of nerve
blocks and clinical toxicology.
More recently, intravenous lipids have been used in drug overdoses
involving lipid-soluble drugs like verapamil, propanolol, bupropion and
some pesticides with success even after prolonged cardio-pulmonary
resuscitation (2). These are anodotal evidence, but in each case report,
cardiovascular stability was achieved in a temporal relationship after
intravenous lipids were given.
I would like readers to consider the use of intravenous lipids for
drug overdoses in failed resuscitations as most of these outcomes are
extremely poor.
References
1. Weinburg et al. Pretreatment or resuscitation with a lipid
infusion shifts the dose-response to bupivacaine-induced asystole in rats.
Anesthesiology. 1998 Apr;88(4):1071-5.
2. Rosthchild et al. Intraveous lipids emulsion in clinical
toxicology. Scand J Trauma Resusc Emerg Med. 2010; 18: 51.
Competing interests: No competing interests