Lipid rescue therapy can interfere with critical lab values

3 out of 5 stars Caution with interpreting laboratory results after lipid rescue therapy. Punja M et al. Am J Emerg Med 2013 Oct;1536.e1-1536.e1 Reference (No abstract available) This case report describes a 54-year-old man who presented to the emergency department after ingesting a suicidal ingestion of diphenhydramine, amitriptyline, and acetaminophen (APAP). On arrival the patient had evidence of cardiotoxicity with unstable vital signs and a prolonged QRS interval (136 msec). His initial aspartate aminotransferase (AST) level was elevated (138 U/L). After treatment with sodium bicarbonate, N-acetylcysteine (NAC), and 20% intravenous lipid rescue therapy (apparently < 2 ml/kg) an AST level was repeated and was undetectable. Based partially on this result, treatment with NAC was stopped. Eight hours later a repeat serum AST was 488 U/L, increasing over the next 48 hours to peak at 1600 U/L. The authors make the point that significant serum lipidemia can interfere with laboratory tests. Although they don’t go into details, they mention that “[t]echniques such as dilution and centrifugation can be used with varying success in removing the lipemic interference.” In one previous report, ultracentrifuging the blood sample from a patient who received a lipid emulsion overdose allowed for measuring basic blood tests. In another recent case report, Bucklin et al describe a 14-yer-old girl who developed asymptomatic elevation of serum amylase and lipase after...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical amylase antidote aspartate intralipid laboratory error lipase lipid emulsion lipid rescue therapy pancreatitis transaminase Source Type: news