This blog consists of my study notes. This post contains a link to an excellent resource on on when to use lipid emulsion therapy.
Here is the link to Episode 90 – Low and Slow Poisoning from Emergency Medicine Cases. The episode featured a detailed discussion of the lipid emulsion therapy. The discussion starts at 50:30 and ends at 1:19:20.
The topic is well covered in the excellent show notes and the key is to go to the show notes and review all the notes on lipid emulsion therapy. Although the notes are incredibly complete [note to myself], before or after rereviewing the show notes be sure and re-listen to this portion of the podcast.
So what follows are the show notes from the podcast relevant to the use of lipid emulsion therapy:
On this EM Cases podcast the Medical Director of The Ontario Poison Control Centre and Emergency Physician at St. Michael’s Hospital, Dr. Margaret Thompson, along with Dr. Emily Austin, Emergency Physician and Toxicologist at St. Michael’s Hospital, help us to recognize these overdoses early and manage them appropriately.
Lipid Emulsion Therapy
Lipid emulsion therapy (intralipid) is a management option for patients who have overdosed on a lipid soluble drug (e.g., lidocaine/bupivacaine, calcium channel blockers, amitriptyline, seroquel, buproprion) who are in refractory shock or peri-arrest.
There are downsides to lipid therapy including complications such as pancreatitis and pulmonary fat emboli. Electrolytes, blood gases etc. cannot be measured in lipemic serum.
Intralipid treatment should be reserved for lipophilic drug poisoning with:
- Hypotension or
- Dysrhythmias causing hemodynamic instability (not responsive to sodium bicarbonate or lidocaine) or
- Seizures unresponsive to usual treatments
There is no role for lipid emulsion therapy
- as prophylaxis
- in isolated altered mental status or coma
- as 1st line therapy
How do you give lipid emulsion therapy?
Draw up 100mL from a 500mL bag of lipid emulsion and give as an IV bolus, then run the remaining 400mL over 30mins.
And the following is from Dr. Weingart’s excellent Podcast 98 – Cyclic (Tricyclic) Antidepressant Overdose; May 14, 2013 by Dr. Scott Weingart.
[When should you use Intralipids?]
Certainly for cardiac arrest and probably for hypotension/increasing pressor necessity
For this or any other Lipid Question, you need to go immediately to the Lipid Rescue Site
You can find the Lipid Administration Instruction Sheet there, which should be hanging somewhere on the wall of your ED.