Intravenous Lipid Emulsion

Aka: Intravenous Lipid Emulsion, Intralipid

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II. Indications

  1. Total Parenteral Nutrition
  2. Anesthesia drug delivery on agents poorly soluble in water
  3. Lipophilic drug toxicity
    1. Calcium Channel Blocker Overdose
      1. Amlodipine
      2. Verapamil
    2. Beta Blocker Overdose
      1. Betaxolol
      2. Carvedilol
      3. Metoprolol
      4. Propranolol
      5. Timolol
    3. AntidepressantOverdoses
      1. Bupropion
      2. Cyclic Antidepressants
    4. Local Anesthetics that have been intravenously injected (esp. regional blocks)
      1. See Local Anesthetic Systemic Toxicity (LAST Reaction)
      2. Bupivacaine (Sensorcaine, Marcaine)
      3. Clark (2008) J Perianesthesth Nurs 23(2): 111-6 [PubMed]
    5. Other lipophilic agents
      1. Bromadiolone
      2. Diphenhydramine
      3. Flecainide
      4. Organophosphates
      5. Quetiapine

III. Mechanism: Lipophilic Drug Overdose

  1. Sequesters lipophilic drugs (forms micelle)
    1. Draws out lipophilic agents from aqueous and intracellular spaces
  2. Increases Cardiac Function (possible)
    1. Increases intracellular Fatty Acids triggering increased ATP in cardiac tissue
    2. Increases intracellular Calcium

IV. Dosing: Lipophilic Drug Overdose

  1. Intralipid 20% emulsion
    1. Bolus: 1.5 ml/kg (Lean Body Mass) IV over 2-3 minutes (may be repeated once)
    2. Maintenance (start immediately): 0.25 ml/kg/min IV
      1. Typically 15 ml/kg (Lean Body Mass) IV over 60 minutes

V. Adverse Effects

  1. Allergic Reaction
  2. Fat overload syndrome (severely lipemic)
    1. Hepatomegaly
    2. Splenomegaly
    3. Pancreatitis
    4. Seizures
    5. Fat embolism
  3. Drug Interactions
    1. Interfere with other Drug Activity
  4. Lab alterations
    1. White Blood Cell Count
    2. Hemoglobin
    3. Platelet Count
    4. Serum Electrolytes
    5. Serum Triglycerides

VI. Resources

  1. Maryland Poison Center
    1. http://www.mdpoison.com/media/SOP/mdpoisoncom/healthcareprofessionals/antidote-facts/Intralipid%20Antidote%20Facts.pdf
  2. Lipid Rescue Resuscitation
    1. http://lipidrescue.org/

VII. References

  1. Yen (2015) Crit Dec Emerg Med 29(10):18-23

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