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

Abstract

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.

A cohort study of unstable overdose patients treated with intravenous lipid emulsion therapy

“…Unlike previously published human case reports, we enrolled consecutive patients that received ILE therapy and our results included patients that survived or died after the administration of ILE. The majority of published case reports on the utility of ILE in this setting have positive outcomes, [22][23][24][25][26][27][28][29][30][31][32] although negative case reports on the effect of ILE in overdose patients have also been published. 54,55 Limitations Our study has several limitations.…”

“…[15][16][17][18][19][20][21] To date, the human data on the effectiveness of ILE for cardiovascular toxins has been limited to small case series and reports, and review articles. [22][23][24][25][26][27][28][29][30][31][32] A recently published systematic review on the use of ILE in nonlocal anesthetic overdoses found current evidence to be heterogeneous and low quality. 33 Moreover, several publications have demonstrated adverse effects with its use, including interference with laboratory investigations such as the complete blood count (CBC) and electrolytes.…”

Treatment of Pieris Ingestion in Goats with Intravenous Lipid Emulsion

“…Thus far, there are relatively few reports of adverse effects due to ILE. Adverse effects reported in human patients treated using ILE include bronchospasm, elevated serum amylase in the absence of clinical pancreatitis, and transient erythema secondary to extravascular administration [5,16]. However, <1 % of human patients given lipid emulsions as a part of parenteral nutrition develop fat overload syndrome, which can induce lipemia, fat emboli, hepatomegaly, icterus, hemolysis, increased coagulation times, splenomegaly, thrombocytopenia, leukopenia, and pancreatitis [4,12].…”

“…Lipid emulsion should not be reused after opening to avoid microbial contamination [9,12,18]. Additionally, lipemia secondary to ILE can interfere with laboratory analyses, including glucose analyzers [4,16]. It is possible that ILE can interfere with lipophilic drugs used therapeutically [5,9].…”

Lipid Emulsion Infusion in Resuscitation for Local Anesthetic and Other Drug Overdose

“…The LIPAEMIC investigators reported 48 cases of use of ILE where details of intoxicant, treatment and outcome were entered into an online registry [19]. Complete capture of all cases treated in contributing centers was unlikely based on declining reporting rates over the time of data collection, meaning that inherent positive publication bias in case reports and series may still have been acting on this dataset.…”