Scientific Online Resource System

Varna Medical Forum

Intravenous lipid emulsions - a new method for the treatment of acute intoxications with lipophilic drugs

Gabriela Kehayova, Snezha Zlateva, Petko Marinov

Abstract

Introduction: The use of intravenous lipid emulsions (LEs) is a new method of treating lipophilic drug intoxications. Useful mechanisms of action of LE include intravascular sequestration of the toxicant and subsequent enhanced redistribution to biologically inert tissues, increased use of fatty acids for ATP synthesis as well as direct positive cardiac inotropic effect. Although not a validated healing method, LE provides lifesaving therapy to hundreds of patients worldwide.

Aims: The aim of this article is to analyze the results of published studies on experimental animals and humans, to prove the cardioprotective effect of LE as a new method for the treatment of acute exogenous lipophilic drug intoxications in induced cardiac injury.

Material and Methods: A systematic review of studies, demonstrating successful resuscitation of humans and animals as a result of poisoning with cardiotoxic lipophilic drugs was conducted.

Results: Hundreds of reports announce successful resuscitation of humans and experimental animals poisoned with lipophilic drugs such as beta blockers, calcium blockers, neuroleptics, and antidepressants. Increased survival after LE infusion was reported in rats poisoned with verapamil. Less pronounced rhythm and conduction disturbances, hemodynamic stabilization and a shorter recovery period were observed in patients treated with LE.

Conclusion: Based on the hundreds of studies in humans and animals, it can be concluded that LE can be useful in treating any overdose with lipophilic drugs in addition to standard resuscitation protocols. Although it is not yet a first-line treatment method, the use of LE should be seriously considered, especially in cases of unsuccessful resuscitation.


Keywords

lipid emulsions; acute intoxications; parenteral nutrition; lipophilic drugs

Full Text


References

Златева Сн, Маринов П, Йовчева М, Аспарухова М. Отравяне с Verapamil– клинични симптоми и промени в клиничен опит. Български медицински журнал, 2, 2008, № 2: 70-75.

Huang JM, Xian H, Bacaner M. Long-chain fatty acids activate calcium channels in ventricular myocytes. Proc Natl Acad Sci USA. 1992;89:6452–6456. doi: 10.1073/pnas.89.14.6452.

Olson K.R. What is the best treatment for acute calcium channel blocker overdose?Ann Emerg Med. 2013; 62: 259–261.

Seyffart G. Poison Index: The Treatment of Acute Intoxication. PABST, 1997, 166.

Sirianni AJ, Osterhoudt KC, Calello DP, Muller AA, Waterhouse MR, Goodkin MB, Weinberg GL, Henretig FM. Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine. Ann Emerg Med. 2008;51:412–415. doi: 10.1016/j.annemergmed.2007.06.004.

Tebbutt S, Harvey M, Nicholson T, Cave G. Intralipid prolongs survival in a rat model of verapamil toxicity. Acad Emerg Med. 2006;13:134–139. doi: 10.1111/j.1553-2712.2006.tb01661.x.

Weinberg G, Ripper R, Feinstein DL, Hoffman W. Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity. Reg Anesth Pain Med. 2003;28:198–202.

Weinberg G. Lipid infusion resuscitation for local anesthetic toxicity: proof of clinical efficacy. Anesthesiology. 2006;105:7–8. doi: 10.1097/00000542-200607000-00005.

Weinberg 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. 1998;88:1071–1075. doi: 10.1097/00000542-199804000-00028.

Weinberg GL. Lipid infusion therapy: translation to clinical practice. Anesth Analg. 2008;106:1340–1342. doi: 10.1213/ane.0b013e31816a6c09.

Young AC, Velez LI, Kleinschmidt KC. Intravenous fat emulsion therapy for intentional sustained-release verapamil overdose. Resuscitation. 2009;80:591–593. doi: 10.1016/j.resuscitation.2009.01.023.

URL

Хубенова Aн. Отравяне с калциеви антагонисти. 27.02.2011. Available from: http://www.hapche.bg/sastoyaniya-i-zabolyavaniya/otravyane-s-kaltsievi-antagonisti

FDA Authorizes Qualified Health Claim for Soy Oil. 31.07. 2017. Available from: www.unitedsoybean.org;

Soybean oil: dietary source of long-chain triglycerides and other lipids. Available from:

https://www.sigmaaldrich.com/

Tacon on Lipid Rescue Therapy. Published on Jan 19, 2013. Available from: https://www.slideshare.net/oliflower/tacon-on-lipid-rescue-therapy

Stavro M. Qualified Health Claim Petition – Soybean Oil and Reduced Risk of Coronary Heart Disease. (Docket No. FDA-2016-Q-0995). July 21, 2017 Available from: https://www.fda.gov/downloads/Food/IngredientsPackagingLabeling/LabelingNutrition/UCM56 8508.pdf




DOI: http://dx.doi.org/10.14748/vmf.v7i1.5107

Refbacks

Font Size


|