Lipid rescue therapy for local anesthetic toxicity: is less more

DISCUSSION: Most of the “adverse events” associated with lipid rescue therapy have occurred after administration of relatively high doses. Although there have been no good studies demonstrating the maximum “safe” dose of intralipid for lipid rescue therapy, many authors recommended limiting the dose to that recommended by the FDA for nutritional support: 12.5 mL/kg (lean body mass) per day total. In specific cases it may be reasonable to consider extending the infusion beyond this, but such situations are likely rare. In this patient, who did not appear to have cardiovascular instability, it is not clear if the high dose administered was the result of careful consideration or lack of attention to total dose received as the patient was transferred and treated at a new hospital. By the way, if the reader goes by Figure 1 in the paper, the total dose received would have been not 66 mL/kg but approximately 110 mL/kg. the authors do not explain the discrepancy. To read my recent Emergency Medicine News column on lipid rescue therapy, click here. Related posts: Effect of lipid rescue therapy on laboratory tests Excellent review of lipid rescue therapy Lipid rescue therapy can interfere with critical lab values    
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical adverse event intralipid lipid rescue therapy local anesthetic toxicity mepivacaine Source Type: news