Intravenous lipid emulsion

Intravenous lipid emulsion (IVLE) is a sterile emulsion of soyabean oil in water, used in parenteral nutrition. It is a novel antidote which requires further study but may have a role to play in the resuscitation of patients with refractory cardiac arrest induced by local anaesthetics that are resistant to standard protocols. It may also have a role when standard therapy has failed in the arrest of a propranolol, tricyclic antidepressant and verapamil overdose (limited evidence).


Administration:

  • Continue standard resuscitation
  • Give 1-1.5 ml/kg IVLE 20% as an IV bolus over 1 minute
  • Repeat bolus at 3-5 minute intervals if required (x2 max) then
  • Infuse IVLE 0.25 ml/kg/minute until haemodynamic stability is restored
  • Increase to 0.5 ml/kg/minute if hypotension persists, doses above 8ml/kg are unlikely to be beneficial
  • Therapeutic end points include return of spontaneous circulation and stabilisation of haemodynamics (infusions may need to be restarted if hypotension returns post cessation).

References

toxicology library antidote 700 1

Toxicology Library

Antidote

Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Burnaby Hospital in Vancouver Emergency. Loves the misery of alpine climbing and working in austere environments. Supporter of FOAMed, toxicology, tropical medicine, sim and ultrasound

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