- 20% intralipid
- as an antidote of last resort in cardiotoxic overdoses of lipophilic agents (best described for bupivacaine)
- source of lipid and calories in parenteral nutrition
Cardiotoxic overdoses when standard resuscitation measures have failed:
- 1.5 mL/kg as an initial bolus
(e.g. about 100 mL in a 70kg adult)
- 0.25 mL/kg/min for 30-60 minutes
(e.g. about 600 mL over 30 minutes in a 70kg adult)
- Bolus could be repeated 1-2 times for persistent asystole
(e.g. at 5 minute intervals)
- Infusion rate could be increased if blood pressure declines
(e.g. double the infusion rate)
- support as an antidote comes from animal studies and case reports
- omega 6 fatty acids may be harmful when provided as a nutritional supplement due to pro-inflammatory effects
References and Links
FOAM and web resources
- Cave G, Harvey M. Intravenous lipid emulsion as antidote beyond local anesthetic toxicity: a systematic review. Acad Emerg Med. 2009 Sep;16(9):815-24. PMID:19845549.
- Leskiw U, Weinberg GL. Lipid resuscitation for local anesthetic toxicity: is it really lifesaving? Curr Opin Anaesthesiol. 2009 Oct;22(5):667-71. PMID: 19581805.
- Sirianni AJ, Osterhoudt KC, Calello DP, Muller AA, Waterhouse MR, Goodkin MB, Weinberg GL, Henretig FM. Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine. Ann Emerg Med. 2008 Apr;51(4):412-5, 415.e1. Epub 2007 Sep 4. PMID: 17766009.