11/18/2023 0 Comments Iv lipid emulsion therapy indications![]() ![]() Without clarification of the ILE mechanism of action, caution should remain regarding its role and indications. Uncertainties are still present regarding the optimal composition, dosing, mechanisms of action, and efficiency of ILE. Several mechanisms of action have been hypothesized, including i: intravascular sequestration of the toxicant and its enhanced redistribution to biologically inert tissues ii: augmentation of fatty acid utilization for adenosine triphosphate (ATP) synthesis and iii: direct cardiotonic and ion channel effects. ![]() Įvidence for ILE use in poisoning is evolving. To date, ILE has been used in poisoned patients to reverse cardiac toxicity induced by a broad spectrum of drugs ( Table 1). Its easy administration in emergent conditions at the bedside and its original properties, supporting its ability to alter both the pharmacokinetics (PK) and the pharmacodynamics (PD) of lipophilic toxicants synergistically with supportive care, antidotes, and decontamination and elimination enhancement techniques, opened up new perspectives for emergency physicians and intensivists to improve the management of severe poisonings. ![]() ILE was suggested as a promising agent for poisonings involving lipophilic agents, especially if unresponsive to the recommended therapies. The use of intravenous lipid emulsion (ILE) as an antidote to reverse local anesthetic-related systemic toxicity (LAST) has gained widespread support following convincing data from successful case reports and animal studies. Two thirds of these calls are in relation to the ingestion of overdosed prescription drugs, with major fatality risk if cardiovascular medications are involved. Poisoning is responsible for more than 3 million calls to US poison control centers annually. Although emerging research shows great potential, several challenges need to be overcome before parenteral detoxifying agents could be considered as an established treatment for severe poisonings.īiodetoxification using drug scavenging agents is of growing interest, as drug overdoses represent a major health problem accounting for thousands of deaths annually worldwide, most often among the young. Based on their absorptive properties, the next generation of scavenging agents is additionally presented. Our review presents the internationally accepted recommendations according to the clinical poisoning scenario and provides the precautions of use to optimize the expected efficacy of ILE and limit the inconveniences of its futile administration. However, the level of evidence is low to very low, as for most other commonly used antidotes. ![]() Present evidence supports the use of ILE as first-line therapy to reverse local anesthetic-related systemic toxicity and as adjunct therapy in lipophilic non-local anesthetic drug overdoses refractory to well-established antidotes and supportive care. Many practical aspects are still controversial, including the optimal dose, the optimal administration timing, and the optimal duration of infusion for clinical efficacy, as well as the threshold dose for adverse effects. Here, we present a narrative review on lipid resuscitation, focusing on the recent literature with advances in understanding ILE-attributed mechanisms of action and evaluating the evidence supporting ILE administration that enabled the international recommendations. Additional mechanisms based on ILE-attributed vasoactive and cytoprotective properties are still under investigation. Both pharmacokinetic and pharmacodynamic mechanisms have been postulated to explain its possible benefits, mainly combining a scavenging effect called “lipid sink” and cardiotonic activity. As well as for local anesthetics, ILE is currently used to reverse toxicity caused by a broad-spectrum of lipophilic drugs. Biodetoxification using intravenous lipid emulsion (ILE) in acute poisoning is of growing interest. ![]()
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