Lipid emulsion for the treatment of acute organophosphate poisoning: an Open-Label randomized trial

Pannu, Ashok Kumar; Garg, Sahil; Bhalla, Ashish; Dhibar, Deba Prasad; Sharma, Navneet

doi:10.1080/15563650.2021.2013496

Cited by 10 publications

(12 citation statements)

References 40 publications

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“…Nevertheless, volunteer studies of subtoxic doses confirm the mechanistic benefit of ILE in bupivacaine, 32 ropivacaine, levobupivacaine 33 and lidocaine. 55 Further, RCTs have emerged in the setting of non-LAST, [56][57][58][59][60][61][62][63] specifically demonstrating a clinical benefit of ILE in poisoning from pesticides, [57][58][59][60] antipsychotics (primarily clozapine), 61,62 tramadol 63 and metoprolol. 64 There are several conclusions to be drawn from these clinical trials [56][57][58][59][60][61][62][63] and volunteer studies 32,33,55,64 (Table 1).…”

Section: Clinical Supportmentioning

confidence: 99%

“…55 Further, RCTs have emerged in the setting of non-LAST, [56][57][58][59][60][61][62][63] specifically demonstrating a clinical benefit of ILE in poisoning from pesticides, [57][58][59][60] antipsychotics (primarily clozapine), 61,62 tramadol 63 and metoprolol. 64 There are several conclusions to be drawn from these clinical trials [56][57][58][59][60][61][62][63] and volunteer studies 32,33,55,64 (Table 1). First, ILE causes minimal complications.…”

Section: Clinical Supportmentioning

confidence: 99%

“…As stated above, recent clinical trials [57][58][59][60][61][62][63][64] report infrequent and mild complications (e.g. irritation at injection site).…”

Section: Complicationsmentioning

confidence: 99%

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Lipid emulsion for xenobiotic overdose: PRO

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Weinberg

2023

Brit J Clinical Pharma

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Infusion of lipid emulsion for drug overdose arose as a treatment for local anaesthetic systemic toxicity (LAST) initially based on laboratory results in animal models with the subsequent support of favourable case reports. Following successful translation to the clinic, practitioners also incorporated lipid emulsion as a treatment for non‐local anaesthetic toxicities but without formal clinical trials. Recent clinical trials demonstrate a benefit of lipid emulsion in antipsychotic, pesticide, metoprolol and tramadol overdoses. Formal trials of lipid emulsion in LAST may never occur, but alternative analytic tools indicate strong support for its efficacy in this indication; for example, lipid emulsion has obviated the need for cardiopulmonary bypass in most cases of LAST. Herein, we describe the pre‐clinical support for lipid emulsion, evaluate the most recent clinical studies of lipid emulsion for toxicity, identify a possible dose‐based requirement for efficacy and discuss the limitations to uncontrolled studies in the field.

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Section: Clinical Supportmentioning

confidence: 99%

Section: Clinical Supportmentioning

confidence: 99%

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Lipid emulsion for xenobiotic overdose: PRO

Fettiplace

Weinberg

2023

Brit J Clinical Pharma

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“…Many novel treatments have been evaluated to improve outcomes; however, they remain controversial or necessitate further research to confirm their efficacy. [ 8 34 35 36 ]…”

Section: Discussionmentioning

confidence: 99%

Changing spectrum of acute poisoning in North India

Pannu

Bhalla

Vamshi

et al. 2022

Turkish Journal of Emergency Medicine

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OBJECTIVES: Evaluating local trends and continued monitoring of patterns of acute poisoning are essential for prompt recognition of the toxidromes, the establishment of immediate treatment facilities (e.g., antidote availability), and effective preventive strategies (e.g., governmental regulation on hazardous substances marketing). We aimed to describe the prevalence of the various types of poisoning and associated case fatality in our academic hospital in North India. METHODS: A prospective observational descriptive study was conducted, enrolling patients aged ≥13 years with acute poisoning for 17 months from December 2016 to December 2017 and from September 2019 to December 2019, for a total of 17 months. RESULTS: Four hundred and two patients were enrolled (median age 28 years; 63.2% males). Majority of the acute poisoning cases resulted from ingestion ( n = 391, 97.3%) and the primary intention was most commonly self-harm ( n = 314, 78.1%). The major types of poisoning were pesticide ( n = 264, 65.7%), drug overdose ( n = 77, 19.2%), and corrosive ingestion ( n = 31, 7.7%). Pesticides included insecticides ( n = 146, 36.3%; cholinesterase inhibitors, n = 91), fungicides ( n = 76, 18.9%; all aluminum phosphide), herbicides ( n = 22, 5.5%; paraquat, n = 19), and rodenticides ( n = 20, 5.0%; coumarin-derived substances, n = 12). Benzodiazepines ( n = 33) and opioids ( n = 25) were frequent causes of drug overdose. 95.3% ( n = 379) received preliminary treatment at the previous health-care center, including gastric lavage ( n = 239) and antidotes ( n = 73). In-hospital case fatality rate was 17.3% ( n = 58). CONCLUSION: Herbicide ingestion and opioid overdose are emerging threats with a gradual decline in organophosphate and aluminum phosphide poisoning. Despite improving management of acute poisoning, the overall case fatality rate remains substantial.

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“…LEs rapidly decrease the threshold for seizure activity, amoxapine toxicity [ 46 ], and improve cardiac activity during heart transplantation [ 47 ]. They are also administered in cases of acute poisoning with neurotoxic organophosphorus compounds [ 48 ]. In a recent case, active toxic molecules have been removed from biological tissues using a lipophilic amine nanocarrier that is able to react with the toxin (cargo-aldehyde) inside the LEs, forming a lipophilic imine conjugate in the oil core.…”

Section: Types Of Nanodevices For Detoxification In Medicinementioning

confidence: 99%

Biomedical Nanosystems for <i>in vivo</i> Detoxification: From Passive Delivery Systems to Functional Nanodevices and Nanorobots

et al. 2023

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The problem of low efficiency of nanotherapeutic drugs challenges the creation of new alternative biomedical nanosystems known as robotic nanodevices. In addition to encapsulating properties, nanodevices can perform different biomedical functions, such as precision surgery, in vivo detection and imaging, biosensing, targeted delivery, and, more recently, detoxification of endogenous and xenobiotic compounds. Nanodevices for detoxification are aimed at removing toxic molecules from biological tissues, using a chemical- and/or enzyme-containing nanocarrier for the toxicant to diffuse inside the nanobody. This strategy is opposite to drug delivery systems that focus on encapsulating drugs and releasing them under the influence of external factors. The review describes various kinds of nanodevices intended for detoxification that differ by the type of poisoning treatment they provide, as well as the type of materials and toxicants. The final part of the review is devoted to enzyme nanosystems, an emerging area of research that provides fast and effective neutralization of toxins in vivo.

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Lipid emulsion for the treatment of acute organophosphate poisoning: an Open-Label randomized trial

Cited by 10 publications

References 40 publications

Lipid emulsion for xenobiotic overdose: PRO

Lipid emulsion for xenobiotic overdose: PRO

Changing spectrum of acute poisoning in North India

Biomedical Nanosystems for <i>in vivo</i> Detoxification: From Passive Delivery Systems to Functional Nanodevices and Nanorobots

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