Systematic review of clinical adverse events reported after acute intravenous lipid emulsion administration

Hayes, Bryan D.; Gosselin, Sophie; Calello, Diane P.; Nacca, Nicholas; Rollins, Carol J.; Abourbih, Daniel; Morris, Martin; Nesbitt-Miller, Andrea; Morais, José A.; Lavergne, Valéry; Workgroup, Lipid Emulsion

doi:10.3109/15563650.2016.1151528

Cited by 131 publications

(102 citation statements)

References 119 publications

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“…Fat overload syndrome is a well‐known complication of IVFE therapy. It is characterized by headaches, jaundice, hepatosplenomegaly, respiratory distress, and spontaneous hemorrhage 100 . It has been described in several case reports in the presence of rapid infusion and/or high doses of IVFE.…”

Section: Complications Associated With Ivfesmentioning

confidence: 99%

Intravenous Fat Emulsion Formulations for the Adult and Pediatric Patient

et al. 2016

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Intravenous lipid emulsions (IVLE) provide essential fatty acids (FA) and are a dense source of energy in parenteral nutrition (PN). Parenterally administered lipid was introduced in the 17th century but plagued with side effects. The formulation of lipid emulsions later on made it a relatively safe component for administration to patients. Many ingredients are common to all IVLE, yet the oil source(s) and its (their) percentage(s) makes them different from each other. The oil used dictates how IVLE are metabolized and cleared from the body. The FA present in each type of oil provide unique beneficial and detrimental properties. This review provides an overview of IVLE and discuss factors that would help clinicians choose the optimal product for their patients. Elucidating the characteristics of each oil source over time has resulted in an evolution of the different formulations currently available. Emulsions have gone from being solely made with soybean oil, to being combined with medium-chain triglycerides (i.e., coconut oil), olive oil, and more recently, fish oil. Unfortunately, the lipid, among other constituents in PN formulations, has been associated with the development of liver disease. Lipid-sparing or lipid-reduction strategies have therefore been proposed to avoid these complications. The ideal IVLE would reverse or prevent essential FA deficiency without leading to complications, while simultaneously providing energy to facilitate normal growth and development. Modifications in their ingredients, formulation, and dosing have made IVLE a relatively safe component alone or when added to PN formulations. The ideal emulsion, however, has yet to be developed.

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Section: Complications Associated With Ivfesmentioning

confidence: 99%

Intravenous Fat Emulsion Formulations for the Adult and Pediatric Patient

et al. 2016

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“…ARDS was reported in few cases as a complication of ILE [7,11,12]. Suggested mechanisms include hypoperfusion, hypoxic injury from pulmonary vasoconstriction, and effects from resultant localized alveolar edema [13].…”

Section: Discussionmentioning

confidence: 99%

Acute Respiratory Distress Syndrome Associated with Intravenous Lipid Emulsion Therapy for Verapamil Toxicity, Successfully Treated with Veno-Venous ECMO

Friedman¹,

Feld²,

Adler³

et al. 2017

J Dev Drugs

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Calcium channel blocker (CCB) overdose is a potentially fatal poisoning. The use of intravenous lipid emulsion (ILE) therapy for CCB poisoning has emerged in the past few years. In 2017, the American College of Medical Toxicology published interim guidance for the use of ILE resuscitation in these cases. We report an uncommon complication of ILE, acute respiratory distress syndrome, treated with veno-venous extracorporeal membrane oxygenation (ECMO).Case report: A 40-year-old hypertensive woman presented with shock (blood pressure 62/34 mmHg, pulse 86/ min) following ingestion of 4,800 mg verapamil slow release and 1,500 mcg clonidine during a suicide attempt. She was treated with calcium gluconate, sodium bicarbonate, IV high dose insulin, IV glucagon, cardiac amines and vasopressors without response (blood pressure 69/37 mmHg, pulse 78/min). ILE was initiated, and two hours later, she developed acute respiratory failure necessitating intubation and mechanical ventilation. Due to poor oxygenation (pO 2 44 mmHg; FiO 2 100%) emergent veno-venous ECMO was instituted. After one hour her blood pressure increased to 104/50 mmHg (pulse 80, pO 2 75 mmHg), and continued so until weaning from ECMO and ventilation. Conclusion:Acute respiratory distress syndrome can be a major life threating complication following ILE; venovenous ECMO is suggested for its treatment.

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“…showed that ACLS with lipid emulsion resulted in lower rates of spontaneous circulation compared with ACLS alone in a rabbit asphyxial model . Also, several adverse events have been reported after a rapid lipid emulsion infusion (Table ) …”

Section: Acute Toxicities Of Local Anestheticsmentioning

confidence: 99%

Local anesthetic toxicity: acute and chronic management

Sekimoto

Tobe

Saito

2017

Acute Medicine & Surgery

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Local anesthetics are commonly used medicines in clinical settings. They are used for pain management during minor interventional treatments, and for postoperative care after major surgeries. Cocaine is the well-known origin of local anesthetics, and the drug and related derivatives have long history of clinical usage for more than several centuries. Although illegal use of cocaine and its abuse are social problem in some countries, other local anesthetics are safely and effectively used in clinics and hospitals all over the world. However, still this drug category has several side-effects and possibilities of rare but serious complications. Acute neurotoxicity and cardiac toxicity are derived from unexpected high serum concentration. Allergic reactions are observed in some cases, especially following the use of ester structure drugs. Chronic toxicity is provoked when nerve fibers are exposed to local anesthetics at a high concentration for a long duration. Adequate treatments for acute toxic reactions can secure complete recovery of patients, and careful use of drugs prevents long-lasting neurological complications. In addition to respiratory and circulatory management, effectiveness of lipid rescue in the acute toxicity treatment has been certified in many clinical guidelines. Prevention of the use of high concentration of local anesthetics is also validated to be effective to decrease the possibility of nerve fiber damage.

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Systematic review of clinical adverse events reported after acute intravenous lipid emulsion administration

Cited by 131 publications

References 119 publications

Intravenous Fat Emulsion Formulations for the Adult and Pediatric Patient

Intravenous Fat Emulsion Formulations for the Adult and Pediatric Patient

Acute Respiratory Distress Syndrome Associated with Intravenous Lipid Emulsion Therapy for Verapamil Toxicity, Successfully Treated with Veno-Venous ECMO

Local anesthetic toxicity: acute and chronic management

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