Use of Lipidic Emulsions in a Patient With Severe Poisoning by Digoxin

Lipid Emulsion Treatment and Long Chain Fatty Acid Supply

“…I read with great interest the article entitled “Use of Lipidic Emulsions in a Patient With Severe Poisoning by Digoxin” published online in the American Journal of Therapeutics in 2020. 1 Currently, lipid emulsion has been widely used to treat the toxicity induced by local anesthetics, such as bupivacaine, ropivacaine, and lidocaine. 2 In addition, lipid emulsion was effective to treat cardiovascular collapse induced by toxic dose of nonlocal anesthetic drugs with high-lipid solubility (log [octanol/water partition coefficient]: >2).…”

“…2,6 Both Angulo and Castaño, and other group describe that “local anesthetics inhibit mitochondria carnitine acyltransferase”, which should be corrected to “local anesthetics inhibit mitochondria carnitine acylcarnitine translocase” because carnitine palmitoyltransferase I and II are known as carnitine acyltransferase, which are located at the upstream and downstream pathway from carnitine acylcarnitine translocase. 1,6–8 However, the underlying mechanism associated with lipid emulsion–induced long-chain fatty acid supply into mitochondria remains to be determined. This case report would be a worthwhile case report regarding lipid emulsion treatment of cardiovascular collapse caused by toxic dose of digoxin (log [octanol/water partition coefficient]: 2.37), which is highly lipid soluble.…”

“…This case report would be a worthwhile case report regarding lipid emulsion treatment of cardiovascular collapse caused by toxic dose of digoxin (log [octanol/water partition coefficient]: 2.37), which is highly lipid soluble. 1,9…”