Effect of intravenous lipid emulsion and octreotide on enteric thiopentone absorption; a pilot study

Harvey, Martyn; Cave, Grant; Shaw, Tom

doi:10.3109/15563650.2013.766748

Cited by 20 publications

(13 citation statements)

References 10 publications

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“…A number of animal models have demonstrated that lipid could be less effective in treating oral overdose 131 . Harvey et al 179 raised the possibility that early treatment with lipid in oral overdoses could accelerate toxicity. As the mechanism of lipid is partially driven by redistribution, this effect could theoretically increase the rate of absorption of a lipophilic drug from the GI tract and movement to sites of toxicity before movement to sites for storage and detoxification.…”

Section: Part Iv: Next‐generation Lipid Therapymentioning

confidence: 99%

Past, Present, and Future of Lipid Resuscitation Therapy

Fettiplace

Weinberg

2015

J Parenter Enteral Nutr

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Lipid resuscitation therapy was identified in 1998 as an effective treatment for local anesthetic systemic toxicity in an animal model. Since the original observation, the field has progressed tremendously with successful clinical translation and expansion of use to treatment of other types of drug overdose. Recent work has expanded our understanding of the mechanism of this novel treatment, one that includes both a dynamic scavenging component and direct cardiotonic effect. In this review, we discuss the past, present, and future of lipid resuscitation therapy with a focus on our understanding of the mechanism and directions that the field is moving, both from a clinical and basic research side.

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Section: Part Iv: Next‐generation Lipid Therapymentioning

confidence: 99%

Past, Present, and Future of Lipid Resuscitation Therapy

Fettiplace

Weinberg

2015

J Parenter Enteral Nutr

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“…While our study did not support a beneficial effect of ILE, there were no harmful effects that could be definitively attributed to its administration. However recent animal evidence raises the possibility of a worse outcome if ILE is administered with a rodent study showing a significantly shorter time to respiratory arrest and death following sodium thiopentone administration if ILE was used, compared with both saline and octreotide in two treatment arms . Another study looking at amitriptyline, administered orogastrically, in rodents showed a survival rate of 10% at 120 min post administration with ILE versus a 70% rate in the sodium bicarbonate and Hartmanns solution treatment arms .…”

Section: Discussionmentioning

confidence: 99%

“…However recent animal evidence raises the possibility of a worse outcome if ILE is administered with a rodent study showing a significantly shorter time to respiratory arrest and death following sodium thiopentone administration if ILE was used, compared with both saline and octreotide in two treatment arms. 14 Another study looking at amitriptyline, administered orogastrically, in rodents showed a survival rate of 10% at 120 min post administration with ILE versus a 70% rate in the sodium bicarbonate and Hartmanns solution treatment arms. 15 Hence caution must be exercised in the use of ILE as these studies suggest that ILE may lead to an increase in drug absorbed and thus potentially expose patients to increased quantities of toxin.…”

Section: Discussionmentioning

confidence: 99%

Intralipid therapy does not improve level of consciousness in overdoses with sedating drugs: A case series

Downes

Calver

2014

Emerg Medicine Australasia

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“…It has been suggested that early ILE use could paradoxically worsen intoxication from an orally ingested intoxicant, with increased blood carrying capacity serving to increase absorption of lipophilic toxin from the gastrointestinal tract [25,26]. In order to explore this hypothesis, change in GCS between the pre-lipid (pre-ILE) time point and 30 min post (30 min) lipid was plotted against interval between ingestion and commencement of ILE.…”

Section: Analysis: Ile In Decreased Level Of Consciousnessmentioning

confidence: 99%

“…Concern has recently been raised that increasing blood carriage capacity for toxin in the absorptive phase of intoxication with early administration of ILE might increase absorption from the GI tract, paradoxically increasing intoxication [25,26]. The improvements seen over time in level of consciousness and blood pressure suggest this was not a major effect in the cases reported to the registry.…”

Section: N=8mentioning

confidence: 99%

LIPAEMIC Report: Results of Clinical Use of Intravenous Lipid Emulsion in Drug Toxicity Reported to an Online Lipid Registry

et al. 2014

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The use of intravenous lipid emulsion (ILE) as an antidote has prompted significant academic and clinical interest. Between August 2009 and August 2012, data from cases of ILE use in intoxicated patients in different hospitals on different continents were voluntarily entered into a registry based on the world wide web (www.lipidregistry.org). Here, we report data from this project. Participating centers were given access to the registry following institutional subscription. Specifically sought were details of the individual patients' presenting condition, indications for ILE use, ILE administration regimen, potential complications, and of clinical outcome. Forty-eight uses of ILE were reported from 61 participating centers. Ten cases of local anesthetic systemic toxicity were reported; all (10/10) survived. Thirtyeight cases of intoxication by other agents were reported [30 decreased conscious state, 8 cardiovascular collapse (3 deaths)]. There was an elevation in GCS (p<0.0001) and increased systolic blood pressure (p=0.012) from immediately prior to ILE administration to 30 min after use. One serious and two minor adverse effects of ILE use were recorded in 48 reported cases (one case of bronchospastic reaction, one case of hyperamylasemia and one case of interference with laboratory testing). In this series of cases reported to the registry, improvements were seen for GCS in patients with central nervous system toxicity and in systolic blood pressure in shocked patients over a short time frame after the injection of ILE. Few adverse effects were recorded. Clinical trials and the reporting of drug concentrations after ILE use are necessary to further elucidate the role of ILE in clinical toxicology.

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Effect of intravenous lipid emulsion and octreotide on enteric thiopentone absorption; a pilot study

Cited by 20 publications

References 10 publications

Past, Present, and Future of Lipid Resuscitation Therapy

Past, Present, and Future of Lipid Resuscitation Therapy

Intralipid therapy does not improve level of consciousness in overdoses with sedating drugs: A case series

LIPAEMIC Report: Results of Clinical Use of Intravenous Lipid Emulsion in Drug Toxicity Reported to an Online Lipid Registry

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