The possible role of intravenous lipid emulsion in the treatment of chemical warfare agent poisoning

Eisenkraft, Arik; Falk, Avshalom

doi:10.1016/j.toxrep.2015.12.007

Cited by 24 publications

(21 citation statements)

References 142 publications

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“…The therapeutic effect of ILE in organophosphorus poisonings has been described for the first time for acute parathion intoxication (12). A number of authors recommend ILE as a new potential method for the treatment of severe organophosphorus intoxications (13,14,15). The main mechanism of action of ILE is the so-called "lipid sink" phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Intravenous lipid emulsion infusion in acute intoxication with fenitrothion

Marinov¹,

Ivanov²,

Zlateva³

et al. 2018

Scripta Scientifica Pharmaceutica

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Organophosphorus pesticides (OPs) are widely used in agriculture as insecticides, fungicides and rodenticides. They have a specific unpleasant odor. Due to their widespread use and high lethality, intoxications with them are a global problem (1,2). More than 200,000 people die each year after poisoning with OPs (3). Patients with acute organophosphorus intoxications require immediate treatment to prevent complications and lethal outcome. Despite the con-ABSTRACT Acute intoxications with organophosphorus pesticides (OPs) are a challenge for the clinical toxicology, because they are common, severe and with high lethality. Most OPs are lipophilic. In recent years, intravenous lipid emulsion (ILE) has been successfully used to treat acute poisoning with lipophilic xenobiotics. A clinical case of a 64-year-old male hospitalized after oral intake of 50 ml of fenitrothion is reported. He had been hospitalized with tachypnea and depressed consciousness-8 by Glasgow Coma Scale (GCS). Treatment standardized for this type of intoxication was initiated. On the 3rd hour treatment with Intralipid 20% was started, with a bolus dose of 1.5 ml/kg followed by infusion at a rate of 0.25 ml/kg/min to a total dose of 1000 ml. At the 16th hour consciousness was restored to GCS-15. In severe OPs intoxications ILE can be used as an additional method of controlling cardiotoxic and neurotoxic effects.

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Section: Discussionmentioning

confidence: 99%

Intravenous lipid emulsion infusion in acute intoxication with fenitrothion

Marinov¹,

Ivanov²,

Zlateva³

et al. 2018

Scripta Scientifica Pharmaceutica

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“…93,94 Therapeutic approaches under study include enzyme hydrolases such as human butyrylcholinesterase and paraoxenase; novel combinations of oximes, anticonvulsant agents, and anticholinergic agents; magnesium; beta-adrenergic agonists; neuromuscular blocking agents (e.g., rocuronium); and intravenous lipid emulsions. 89,95,96 Hospita l , Communit y, a nd Nationa l Pr epa r edness…”

Section: Cholinergic Agentsmentioning

confidence: 99%

Hazardous Chemical Emergencies and Poisonings

2019

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H azardous chemical emergencies and related poisonings result from various exposures, including inadvertent residential, industrial, occupational, or transportation mishaps; natural disasters; and hazardoussubstance releases that are intended to cause harm. 1-3 Up to 100,000 industrial chemicals are used each day in the United States, 4 and federal authorities estimate that more than 10,000 potentially consequential releases of hazardous substances occur annually. 4,5 In addition, numerous compounds have been developed primarily as military weapons, with exceedingly high toxicity. 6-8 Both toxic industrial chemicals and military chemical weapons are capable of causing mass casualties in a substantive release and may be deployed intentionally in the context of chemical terrorism, 8-10 targeted assassination attempts, 8,11,12 or wartime attacks on civilian populations, as tragically shown in the current Syrian war. 13,14 A toxidrome-based, emergency medical systems (EMS) approach to chemical weapons attacks was presented recently by Ciottone in the Journal. 8 (Toxidromes are constellations of clinical signs, particularly vital signs, mental status, and ocular, respiratory, neurologic, and skin findings, that are characteristic of general classes of poison.) A similar approach is useful for the myriad possible entities in nonintentional hazardous chemical incidents. We review the toxicology and hospital-based management of acute poisonings caused principally by dermal and inhalational exposure to several representative chemical-agent classes in incidents involving the release of hazardous substances or chemical attacks (Table 1). Cyanide and organophosphate poisonings are emphasized, since they can also affect individual patients in the more familiar contexts of occupational and residential exposures or ingestions with suicidal intent and since specific emergency antidotal therapy is crucial for good outcomes. Ov erv iew of Hospita l-Ba sed Emergenc y M a nagement Incidents involving the release of hazardous chemicals may result in widespread chaos and confusion, affecting the EMS response and emergency department (ED) care. 2,8 A rapid influx of multiple critically ill victims with unfamiliar illnesses, as well as numerous low-risk but understandably anxious patients, potentially far outnumbering the seriously ill, 1 poses significant challenges to hospital-based emergency care providers. Patients may bypass prehospital care and arrive at the hospital unaware of or misinformed regarding the cause of their symptoms, with the potential to chemically contaminate bystanders and staff. 2,15-17 Thus, prompt recognition of the chemical event is important so that ED staff and hospital emergency management personnel can secure hospital entrances and decontaminate contami

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“…Most of these pesticides are liposoluble. ILE infusions are a new potential method for the treatment of such intoxications (61,62,63). A patient who has swallowed parathion with a suicidal intention has a depressed consciousness -GCS 6 points, ventricular tachycardia followed by ventricular fibrillation and CPR undertaken was unsuccessful.…”

Section: Therapeutic Effects Of Ile Administrationmentioning

confidence: 99%

Intravenous lipid infusion in toxicological practice

Marinov

Ivanov

Zlateva

et al. 2018

Scripta Scientifica Pharmaceutica

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The use of intravenous lipid emulsions (ILEs) is a relatively new method of treatment in toxicology. Initially, it was applied to control the resistant to other therapeutic methods systemic toxicity of local anesthetics. In the last decade this therapeutic method has been approved and recommended. Thereafter, attempts have been made to clarify the effect of ILEs in cases of acute intoxications with lipophilic xenobiotics, other than the local anesthetics.

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The possible role of intravenous lipid emulsion in the treatment of chemical warfare agent poisoning

Cited by 24 publications

References 142 publications

Intravenous lipid emulsion infusion in acute intoxication with fenitrothion

Intravenous lipid emulsion infusion in acute intoxication with fenitrothion

Hazardous Chemical Emergencies and Poisonings

Intravenous lipid infusion in toxicological practice

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