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Lipid emulsion therapy - Intralipid
⚠️ Evidence base: There is a lack of controlled trials, and efficacy remains uncertain. Use is based on case reports and expert consensus.
ℹ️ About
Always check the BNF link here 📖 for the latest guidance.
⚙️ Mode of Action
- Intravenous fat emulsion (IFE, e.g. Intralipid 20%) acts as a "lipid sink," sequestering lipid-soluble drugs from target tissues (heart, brain) and improving mitochondrial metabolism.
- Used for life-threatening arrhythmias or cardiac arrest due to lipophilic drug toxicity, especially local anaesthetics.
💊 Indications & Dose
- Indication: Severe toxicity from local anaesthetics (e.g. bupivacaine) or other lipid-soluble cardiotoxic drugs.
- Initial bolus: 1.5 mL/kg IV over 1 min (≈100 mL for a 65 kg adult).
- Infusion: Follow with 0.25 mL/kg/min; continue CPR if pulseless for up to 1 hour.
- Repeat bolus if cardiovascular instability persists (see BNF/local protocol).
💊 Examples of Drug Toxicity Treated
- Local anaesthetics (bupivacaine, lidocaine).
- Tricyclic antidepressants (TCAs).
- Calcium channel blockers (e.g. verapamil, diltiazem).
- Lipid-soluble beta-blockers (e.g. propranolol).
⚠️ Interactions
- See BNF — limited data; theoretical interference with IV drug delivery.
🔎 Cautions
- See BNF — ensure resuscitation equipment and ALS protocols in place.
🚫 Contraindications
- See BNF — generally avoided outside life-threatening emergencies due to uncertain efficacy and risks.
❗ Side Effects
- Hypertriglyceridaemia 📈
- Acute pancreatitis 🩺
- Cholestasis and liver dysfunction (rare) 🧪
📚 References
- BNF — Severe local anaesthetic-induced cardiovascular toxicity
- Further information: Lipid Rescue Website 🌐
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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