The Use of Intralipid in the Management of a Mixed Overdose

Orr, Karen; Bailie, R. W.

doi:10.1177/175114371001100413

Cited by 15 publications

(9 citation statements)

References 7 publications

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“…Due to the lipophilic nature of amlodipine, lipid emulsion rescue therapy was administered. Though benefits of ILE in critical patients ingested amlodipine has been presented in several reports [17][18][19][20] the only noticeable effect in our patient was transient, unsustainable increase of blood pressure.…”

Section: Discussionmentioning

confidence: 49%

Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers

et al. 2016

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Section: Discussionmentioning

confidence: 49%

Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers

et al. 2016

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“…The use of intralipid (20%) has been proposed to counteract the effects of lipid-soluble molecules on the brain 66. There have been several case reports where patients have been resuscitated from mixed overdoses (psychotropic medications, antihypertensives and a combination of both agents) following the administration of intralipid.…”

Section: Management For the Military Healthcare Professionalmentioning

confidence: 99%

“…There is no evidence as yet that intralipid is useful in the management of NPS toxicity; however, these cases indicate that intralipid might be of benefit where high doses of benzodiazepines have been ingested. One review suggests that intralipid may be of benefit where the patient has taken a lethal dose of cardiotoxic agents or sustained a cardiac arrest secondary to these drugs 66. However, administration of intralipid should be weighed against potential side effects (allergic reactions, blood dyscrasias, deranged liver function, clotting disorders, hyperlipidaemia and pancreatitis67).…”

Section: Management For the Military Healthcare Professionalmentioning

confidence: 99%

Phantom menace: novel psychoactive substances and the UK Armed Forces

Hunter

Ayres

Moreland³

et al. 2018

J R Army Med Corps

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Novel psychoactive substances (NPS) encompass a large group of synthesised compounds specifically designed to mimic traditional recreational drugs. Current UK Armed Forces compulsory drug testing does not screen for these substances, making them tempting to the small proportion of UK Armed Forces personnel who indulge in recreational drug use. The acute and chronic sequelae of NPS misuse are widely variable and associated with high morbidity. In this paper, we discuss NPS pharmacology and clinical presentation. We describe toxidromes and management of patients who have misused NPS.Finally, we reflect on the legal, ethical and military consequences of NPS misuse for both the service person misusing NPS and the Military Physician providing their care.

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“…The case of a 34-year-old male with a mixed overdose including an unknown amount of amlodipine described the use of 20% ILE at a total dose of 12 mL/kg. 25 After ILE administration, the patient's vasopressor requirements declined, acidosis improved, and hemodynamics stabilized. The authors concluded that ILE may have bound the lipid soluble medications of the mixed overdose and contributed to the survival of this patient.…”

Section: Intravenous Lipid Emulsion Therapymentioning

confidence: 99%

Intravenous Lipid Emulsion in the Management of Amlodipine Overdose

et al. 2013

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Objective: To report a case of amlodipine overdose successfully treated with intravenous lipid emulsion (ILE). Case Summary: A 47-year-old, 110 kg female ingested at least 350 mg of amlodipine with an unknown amount of ethanol. Initial blood pressure was 103/57 mm Hg, mean arterial pressure (MAP) 72 mm Hg, and heart rate 113 beats per minute. In the early clinical course, activated charcoal, intravenous fluid, and calcium boluses were administered. Worsening hypotension prompted a 100 mL bolus of 20% ILE. Stable hemodynamics were maintained for 2 hours. Subsequently, profound hypotension and shock developed (MAP 38 mm Hg), which failed to fully respond to 3 vasopressor agents, calcium, and glucagon. With continuing shock despite optimized vasopressors, an infusion of 2,300 mL 20% ILE was administered over 4.5 hours (20.9 mL/kg infusion total). By completion of the infusion, 2 vasopressors were tapered off and MAP remained above 70 mm Hg; within 12 hours, no further interventions were required. Possible adverse events of ILE, lipemia and hypoxia, were experienced but quickly resolved. The patient survived to hospital discharge within 8 days. Discussion: Toxicity of amlodipine presents similar to distributive shock as both are due to marked peripheral vasodilation. There are numerous interventions in the management of amlodipine overdose, despite which many patients continue to suffer life-threatening shock as observed with this patient. ILE has been used with promising preliminary results as salvage therapy in case reports of other lipophilic molecules. This is the first report of lone amlodipine overdose treated with ILE. Conclusion: ILE is a novel antidote for overdoses of lipophilic substances and demonstrated efficacy in this case of amlodipine overdose without the use of hyperinsulinemic euglycemia.

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The Use of Intralipid in the Management of a Mixed Overdose

Abstract: A 34-year-old man took a mixed overdose of multiple lipid-soluble drugs. He did not respond to maximal medical therapy but improved after the introduction of Intralipid. The possible mechanisms of action and potential adverse consequences of using Intralipid in this context are reviewed.

Cited by 15 publications

References 7 publications

Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers

Failure of intravenous lipid emulsion in treatment of cardiotoxicity caused by mixed overdose including dihydropyridine calcium channel blockers

Phantom menace: novel psychoactive substances and the UK Armed Forces

Intravenous Lipid Emulsion in the Management of Amlodipine Overdose

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