Intravenous lipid emulsion to reverse acute drug toxicity in pediatric patients

Joseph D Presley, Peter A Chyka
Annals of Pharmacotherapy 2013, 47 (5): 735-43

OBJECTIVE: To identify and summarize published cases in which intravenous lipid emulsion was used to treat pediatric patients with acute drug toxicities.

DATA SOURCES: PubMed, SCOPUS, and EMBASE were searched up to December 2012 for relevant publications using the terms fat emulsion, lipid emulsion, Intralipid, Liposyn, Medialipide, Medialipid, lipid rescue, ILE, IVLE, IFE, IVFE, or lipid and intoxication, overdose, poisoning, toxicity, resuscitation, antidote, and rescue that were limited to reports in humans aged 18 years or younger.

STUDY SELECTION AND DATA EXTRACTION: A publication was included if an intravenous lipid emulsion was used to treat acute-onset drug toxicity as reported in prospective or retrospective observational studies, case reports, and abstracts for patients aged 18 years or younger.

DATA SYNTHESIS: Fourteen case reports were identified in which intravenous lipid emulsion was used to treat toxicities due to local anesthetics and other medications (amitriptyline, diltiazem, bupropion, dosulepin, lamotrigine, quetiapine, and verapamil). Thirteen cases demonstrated a beneficial response in reversing systemic toxicity; 1 of these patients developed hypertriglyceridemia and pancreatitis. The dosage regimens used in this series were dissimilar.

CONCLUSIONS: There is an increasing interest in use of intravenous lipid emulsions to treat life-threatening toxicity from several lipophilic drugs in adults and children. Although most of the literature describes adult cases, intravenous lipid emulsion has been used in neonates and adolescents, with generally positive outcomes. Given the life-threatening, sometimes near-death situations in which an intravenous lipid emulsion is typically used after conventional resuscitation is unsuccessful and the dramatic positive response to this therapy in most published cases, its use likely will continue. Continued reporting of pediatric cases will guide the optimal use and safety profile of intravenous lipid emulsion for the emergent reversal of drug toxicity.

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