Intravenous lipid emulsion in oral overdoses: what is the optimal dosing?
This article is an attempt to arrive at a rational dosing schedule for LE in oral overdoses. The authors consider a number of factors:
Very high doses of lipid emulsion have been associated with adverse effects, including acute respiratory distress syndrome
The FDA recommends a maximum dose of 12.5 mL/kg/day when LE is used for nutritional support
The antidotal action of LE may depend on both the “lipid sink” effect and direct cardiac inotropy
Both of the above effects require creation of a moderately lipemic plasma
Combining these considerations with pharmacologic calculations, the authors make the following dosing recommendations for use of 20% LE in oral overdoses:
give an initial bolus of 1.5 mL/kg,then an additional 0.25 mL/kg/min for 3 minutes
following by infusion of 0.025 mL/kg/min, which can continued for up to 6.5 hours
monitor serum triglyceride levels, aiming for 1000 mg/dL
Is this regimen optimal? It’s impossible to know at this point. But it’s a reasonable starting point while we await more evidence.
Related posts:
Excellent review of lipid rescue therapy
TPR Podcast #7: Interview with Guy Weinberg about lipid rescue therapy
Acute respiratory distress syndrome following intralipid emulsion therapy
Complications associated with lipid emulsion therapy
Lipid rescue therapy can interfere with critical lab values
Case report: cocaine cardiotoxicity treated with intravenous lipid infusion
Lipid emulsion therapy for poisonings: a revie...
Source: The Poison Review - Category: Toxicology Authors: Leon Tags: Medical dosing intralipid lipid emulsion lipid rescue therapy Source Type: news
More News: Anesthesia | Anesthesiology | Cardiology | Heart | Nutrition | Overdose | Podcasts | Poisoning | Respiratory Medicine | Toxicology