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Successful use of intravenous fat emulsion in severe poisoning following ingestion of lipid soluble drugs [Abstract]

Cooper, George A., Dyas, J., Krishna, Channarayapatna and Thompson, John Paul 2010. Successful use of intravenous fat emulsion in severe poisoning following ingestion of lipid soluble drugs [Abstract]. Clinical Toxicology 48 (3) , p. 298. 10.3109/15563651003740240

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Objective: Intravenous fat emulsion (IFE) has been successfully used as an antidote in cases of local anaesthetic toxicity and the possibility of its usefulness in overdose of other lipid-soluble drugs continues to provoke interest. We report a case of a mixed overdose where IFE was given successfully to treat a haemodynamically compromised patient.  Case report: A 52 year old female was admitted to A&E three hours after ingestion of amitriptyline (350 mg), diltiazem SR (1680 mg), dihydrocodeine (840 mg), temazepam (70 mg), diazepam (35 mg) and citalopram (70 mg). She presented with features of calcium channel blocker toxicity; pulse 38, blood pressure 80/50, RR 10, GCS 8/15, and ECG showing complete heart block. Despite receiving conventional treatment - saline, naloxone, atropine, calcium gluconate and sodium bicarbonate she showed no improvement and required admission to the intensive care unit for ventilatory and inotropic support. Awaiting transfer to ITU, 20% intralipid (500 mL) was administered over 30 minutes. Her post-lipid ECG showed sinus rhythm, pulse 79, PR 191, QRS 107 ms, QT/ QTc 407/467 ms. Her blood pressure on admission to ITU was 124/55 mmHg. She subsequently continued to improve requiring no inotropic support and was extubated the following day. A mild aspiration pneumonia was treated successfully with co-amoxiclav and she was discharged after psychiatric assessment without sequelae.  Conclusion: Animal studies have demonstrated a reduction in morbidity and mortality from lipid-soluble drug cardiotoxicity with IFE, and in humans it has been used to treat local anaesthetic toxicity, as well as bupropion/lamotrigine toxicity. Its exact mode of action is unclear but it may trap lipophilic drugs in an expanded plasma lipid compartment (lipid sink).1 This case demonstrates the successful use of IFE in an overdose involving amitriptyline and diltiazem. Administration of intralipid rapidly reversed ECG changes and improved haemodynamic status without the need for inotrope therapy or extended ITU support. Although data from human poisonings are still limited, we believe there is a role for IFE therapy in managing patients with overdose from lipid-soluble drugs.  References: 1. Sirianni AJ, Osterhoudt KC, Calello DP, et al. Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine. Ann Emerg Med 2008; 51:412–5.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Additional Information: 2010 International Congress of the European Association of Poisons Centres and Clinical Toxicologists, 11-14 May 2010, Bordeaux, France
Publisher: Informa Healthcare
ISSN: 0731-3810
Last Modified: 19 Oct 2021 01:16

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