II. Indications

  1. Total Parenteral Nutrition
  2. Anesthesia drug delivery on agents poorly soluble in water
  3. Lipophilic drug toxicity
    1. Calcium Channel Blocker Overdose
      1. Amlodipine
      2. Verapamil
    2. Beta Blocker Overdose
      1. Betaxolol
      2. Carvedilol
      3. Metoprolol
      4. Propranolol
      5. Timolol
    3. AntidepressantOverdoses
      1. Bupropion
      2. Cyclic Antidepressants
    4. Local anesthetics that have been intravenously injected (esp. regional blocks)
      1. Bupivacaine
      2. Clark (2008) J Perianesthesth Nurs 23(2): 111-6 [PubMed]
    5. Other lipophilic agents
      1. Bromadiolone
      2. Diphenhydramine
      3. Flecainide
      4. Organophosphates
      5. Quetiapine

III. Mechanism: Lipophilic Drug Overdose

  1. Sequesters lipophilic drugs (forms micelle)
    1. Draws out lipophilic agents from aqueous and intracellular spaces
  2. Increases cardiac function (possible)
    1. Increases intracellular Fatty Acids triggering increased ATP in cardiac tissue
    2. Increases intracellular calcium

IV. Dosing: Lipophilic Drug Overdose

  1. Intralipid 20% emulsion
    1. Bolus: 1.5 ml/kg (Lean Body Mass) IV over 2-3 minutes (may be repeated once)
    2. Maintenance (start immediately): 0.25 ml/kg/min IV
      1. Typically 15 ml/kg (Lean Body Mass) IV over 60 minutes

V. Adverse Effects

  1. Allergic Reaction
  2. Fat overload syndrome (severely lipemic)
    1. Hepatomegaly
    2. Splenomegaly
    3. Pancreatitis
    4. Seizures
    5. Fat embolism
  3. Drug interactions
    1. Interfere with other drug activity
  4. Lab alterations
    1. White Blood Cell Count
    2. Hemoglobin
    3. Platelet Count
    4. Serum electrolytes
    5. Serum Triglycerides

VII. References

  1. Yen (2015) Crit Dec Emerg Med 29(10):18-23

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Ontology: Fat Emulsions, Intravenous (C0015667)

Definition (MSH) Emulsions of fats or lipids used primarily in parenteral feeding.
Concepts Pharmacologic Substance (T121) , Lipid (T119)
MSH D005217
SnomedCT 409429004
English Emulsions, Intravenous Fat, Emulsions, Intravenous Lipid, Fat Emulsions, Intravenous, Intravenous Fat Emulsions, Intravenous Lipid Emulsions, Lipid Emulsions, Intravenous, fat emulsion, intravenous, fat emulsions intravenous, intravenous fat emulsion, fat emulsion intravenous, Fat emulsions, Intravenous, FAT EMULSION, INTRAVENOUS, Fat emulsion for injection, Fat emulsion for intravenous administration, Intravenous fat emulsion (product), Intravenous fat emulsion, Intravenous Fat Emulsion
Swedish Fettemulsioner, intravenösa
Czech tukové emulze intravenózní
Finnish Suonensisäiset rasvaemulsiot
Russian ZHIROVYE EMUL'SII VNUTRIVENNYE, LIPIDNAIA EMUL'SIIA VNUTRIVENNAIA, ЖИРОВЫЕ ЭМУЛЬСИИ ВНУТРИВЕННЫЕ, ЛИПИДНАЯ ЭМУЛЬСИЯ ВНУТРИВЕННАЯ
Polish Emulsje tłuszczowe dożylne
Japanese 脂肪乳剤-静注用, 静注用脂肪乳剤
Norwegian Intravenøse fettemulsjoner, Lipidemulsjoner, intravenøse, Fettemulsjoner, intravenøse, Intravenøse lipidemulsjoner
Portuguese Emulsões Gordurosas Endovenosas, Emulsões Lipídicas Endovenosas, Emulsões Gordurosas Intravenosas, Emulsões Lipídicas Intravenosas
French Émulsion lipidique intraveineuse
German Fettemulsionen, intravenöse, Lipidemulsionen, intravenöse
Italian Emulsioni lipidiche per uso endovenoso
Spanish emulsión grasa para administración endovenosa (producto), emulsión grasa para administración endovenosa, Emulsiones Grasas Intravenosas, Emulsiones Lipídicas Intravenosas

Ontology: Intralipid (C0733854)

Concepts Pharmacologic Substance (T121) , Lipid (T119)
MSH C545823
English Intralipid, Clintec brand of soybean oil, phospholipid emulsion, intralipid