Intralipid and lipid rescue therapy
CLASS
- lipid
FORMULATION
- 20% intralipid
USE
- as an antidote of last resort in cardiotoxic overdoses of lipophilic agents (best described for bupivacaine)
- source of lipid and calories in parenteral nutrition
DOSE
Cardiotoxic overdoses when standard resuscitation measures have failed:
- 1.5 mL/kg as an initial bolus
(e.g. about 100 mL in a 70kg adult)
followed by - 0.25 mL/kg/min for 30-60 minutes
(e.g. about 600 mL over 30 minutes in a 70kg adult) - Bolus could be repeated 1-2 times for persistent asystole
(e.g. at 5 minute intervals) - Infusion rate could be increased if blood pressure declines
(e.g. double the infusion rate)
COMPLICATIONS
- hyperlipidemia
- pancreatitis
- hyperviscosity
EVIDENCE
- support as an antidote comes from animal studies and case reports
- omega 6 fatty acids may be harmful when provided as a nutritional supplement due to pro-inflammatory effects
References and Links
FOAM and web resources
Journal articles
- Cave G, Harvey M. Intravenous lipid emulsion as antidote beyond local anesthetic toxicity: a systematic review. Acad Emerg Med. 2009 Sep;16(9):815-24. PMID:19845549.
- Leskiw U, Weinberg GL. Lipid resuscitation for local anesthetic toxicity: is it really lifesaving? Curr Opin Anaesthesiol. 2009 Oct;22(5):667-71. PMID: 19581805.
- 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 Apr;51(4):412-5, 415.e1. Epub 2007 Sep 4. PMID: 17766009.
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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