Hemodynamic Effects of Intralipid after Verapamil Intoxication May Be Due to a Direct Effect of Fatty Acids on Myocardial Calcium Channels

Guéret, Gildas; Pennec, Jean Pierre; Arvieux, Charles C.

doi:10.1197/j.aem.2007.04.006

Cited by 23 publications

(9 citation statements)

References 6 publications

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“…Many ideas have been proposed, most of which lack convincing scientific evidence or have too many experimental confounders. The 2 most popular hypotheses are “the calcium hypothesis” and “fatty acid hypothesis.” Gueret et al 65 proposed the calcium hypothesis in an editorial, claiming that fatty acids increase Ca+ influx into cardiac myocytes to produce inotropy. They cited a single article from 1992 in support of the idea that used guinea pig ventricles 66 .…”

Section: Part Ii: Mechanism Of Lipid Emulsion 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 Ii: Mechanism Of Lipid Emulsion Therapymentioning

confidence: 99%

Past, Present, and Future of Lipid Resuscitation Therapy

Fettiplace

Weinberg

2015

J Parenter Enteral Nutr

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“…It has been stated that although the rescue effect of lipid emulsions in treatment of LAST due to bupivacaine has been proven and a practice guide has been established, there are authors that state a similar rescue protocol may not be valid for verapamil since while bupivacaine binds to cardiac sodium channels very strongly, verapamil binds to calcium channels, and it is too early to designate that lipid solutions are life saving antidotes for verapamil and similar drugs (18,19). However, in verapamil toxicity cases, clinical improvement was observed following the administration of lipid emulsion in the course of treatment after various treatment methods were tried (20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

Effect of intralipid administration on calcium therapy in verapamil toxicity

Özen¹,

Çelebi²,

Coşkun³

et al. 2019

BLL

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Aim: Lipid emulsions are promising with regard to the treatment of toxicity by agents of high lipophilic nature. Our objective is to investigate the effi cacy of intralipid 20% and calcium administration at different times when symptoms of cardiac toxicity occur during verapamil infusion. Method: 24 adult male Spraque-Dawley rats were randomly divided into 4 different groups, the control group, calcium group, calcium following 20% intralipid group and concomitant 20% intralipid and calcium group. Following monitoring under ketamine anesthesia, all groups were administered 37.5 mg kg-1 h-1 verapamil infusion until a 50% decrease occurred in MAP b. At the end of the infusion, verapamil infusion was decreased down to 15 mg kg-1 h-1 and the treatment agents predetermined for the groups were administered concomitantly. Results: There is no statistically signifi cant difference between the administration of 20% intralipid synchronized with calcium or as a pretreatment, but both groups provided a higher survival rate when compared to the other groups. Conclusions:The administration of calcium alone in verapamil toxicity is not suffi cient; when calcium and 20% intralipid are administered together, there is no difference between the administration of lipid and calcium concomitantly and the administration of lipid prior to calcium (Tab. 1, Fig. 2, Ref. 23). Text in PDF www.elis.sk.

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“…Furthermore, it has been suggested that ILE may have a direct influence on calcium channels, producing a dose-dependent increase in calcium current that reverses cardiac toxicity (Gueret et al, 2007;Cave and Harvey, 2014).…”

Section: Discussionmentioning

confidence: 99%

The Effect of L-Carnitine and Intralipid Emulsion in Acute Verapamil Cardiotoxicity in Albino Rats

Elawady

Saad

2015

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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Calcium channel blockers (CCB) drugs poisoning continues to be deadly in severe cases despite recent advances and aggressive therapies. Clinically, this toxicity can manifest into severe cardiogenic shock that is often unresponsive to conventional calcium and supportive treatment. This study aimed to investigate the effectiveness of L-carnitine, as an essential compound in cellular energy production, and intralipid emulsion 20% (ILE), as an adjunctive antidote used in selected critically ill poisoned patients, for the treatment of hypotension, Electrocardiogram (ECG) changes and arterial blood gases (ABG) deficits in verapamil poisoned rats, either separately or in combination. The study was conducted on 64 albino rats divided into 8 groups (each of 8 rats). The groups are: group 1 (negative control group), group 2 (Lcarnitine group), group 3 (ILE group), group4 (L-carnitine and ILE group), group 5 (verapamil group), group 6 (verapamil and L-carnitine group), group7 (verapamil and ILE group), group8 (verapamil, Lcarnitine and ILE group). All animals were subjected to measurement of blood pressure, ECG recording, as well as ABG. Results: verapamil toxicity in group 5 was manifested by significant hypotension (both systolic and diastolic), ECG derangements in the form of bradycardia, prolongation of PR and QT intervals and ABG changes in the form of significant low (pH, HCO3, PaO2 and PaCO2). L-carnitine and ILE separate administration with verapamil in group 6 and group 7 respectively improved the blood pressure, heart rate, ECG and ABG parameters but they still showed statistical significant difference with both the control group and group 8, regarding)blood pressure and ECG(in group 6 and)blood pressure, ECG and ABG(in group 7. Co-administration of L-carnitine and ILE together with verapamil in group 8 showed significant improvement of all toxic parameters with insignificant difference with the control group. In conclusion, this study proved that the combined use of L-carnitine and ILE was the most effective treatment of verapamil-induced acute cardiotoxicity. Further studies are recommended on larger scale and on clinical implication to establish more the advantageous and disadvantageous of this novel therapy. It is recommended to use this novel therapy as an additive to the usual regime and when the latter fails to correct potentially fatal cases of CCB poisonings.

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Hemodynamic Effects of Intralipid after Verapamil Intoxication May Be Due to a Direct Effect of Fatty Acids on Myocardial Calcium Channels

Cited by 23 publications

References 6 publications

Past, Present, and Future of Lipid Resuscitation Therapy

Past, Present, and Future of Lipid Resuscitation Therapy

Effect of intralipid administration on calcium therapy in verapamil toxicity

The Effect of L-Carnitine and Intralipid Emulsion in Acute Verapamil Cardiotoxicity in Albino Rats

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