Intravenous lipid emulsion in oral overdoses: what is the optimal dosing?

This article is an attempt to arrive at a rational dosing schedule for LE in oral overdoses. The authors consider a number of factors: Very high doses of lipid emulsion have been associated with adverse effects, including acute respiratory distress syndrome The FDA recommends a maximum dose of 12.5 mL/kg/day when LE is used for nutritional support The antidotal action of LE may depend on both the “lipid sink” effect and direct cardiac inotropy Both of the above effects require creation of a moderately lipemic plasma Combining these considerations with pharmacologic calculations, the authors make the following dosing recommendations for use of  20% LE in oral overdoses: give an initial bolus of 1.5 mL/kg,then an additional 0.25 mL/kg/min for 3 minutes following by infusion of 0.025 mL/kg/min, which can continued for up to 6.5 hours monitor serum triglyceride levels, aiming for 1000 mg/dL Is this regimen optimal? It’s impossible to know at this point. But it’s a reasonable starting point while we await more evidence. Related posts: Excellent review of lipid rescue therapy TPR Podcast #7: Interview with Guy Weinberg about lipid rescue therapy Acute respiratory distress syndrome following intralipid emulsion therapy  Complications associated with lipid emulsion therapy Lipid rescue therapy can interfere with critical lab values Case report: cocaine cardiotoxicity treated with intravenous lipid infusion Lipid emulsion therapy for poisonings: a revie...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical dosing intralipid lipid emulsion lipid rescue therapy Source Type: news