title: Lipid rescue 911: Are poison centers recommending intravenous fat emulsion therapy for severe poisoning?
abstract: Intravenous fat emulsion (IFE) therapy is a novel treatment that has been used to reverse the acute toxicity of some xenobiotics with varied success. We sought to determine how US Poison Control Centers (PCCs) have incorporated IFE as a treatment strategy for poisoning. A closed-format multiple-choice survey instrument was developed, piloted, revised, and then sent electronically to every medical director of an accredited US PCC in March 2011. Addresses were obtained from the American Association of Poison Control Centers listserv, and participation was voluntary and remained anonymous. Data were analyzed using descriptive statistics. The majority of PCC medical directors completed the survey (45 out of 57; 79 %). Of the 45 respondents, all felt that IFE therapy played a role in the acute overdose setting. Most PCCs (30 out of 45; 67 %) have a protocol for IFE therapy. In a scenario with "cardiac arrest" due to a single xenobiotic, directors stated that their center would "always" or "often" recommend IFE after overdose of bupivacaine (43 out of 45; 96 %), verapamil (36 out of 45; 80 %), amitriptyline (31 out of 45; 69 %), or an unknown xenobiotic (12 out of 45; 27 %). In a scenario with "shock" due to a single xenobiotic, directors stated that their PCC would "always" or "often" recommend IFE after overdose of bupivacaine (40 out of 45; 89 %), verapamil (28 out of 45; 62 %), amitriptyline (25 out of 45; 56 %), or an unknown xenobiotic (8 out of 45; 18 %). IFE therapy is being recommended by US PCCs; protocols and dosing regimens are nearly uniform. Most directors feel that IFE is safe but are more likely to recommend IFE in patients with cardiac arrest than in patients with severe hemodynamic compromise.
authors: Division of Clinical Pharmacology and Medical Toxicology, Children's Mercy Hospital and Clinics, Kansas City, MO, USA, mumike78@hotmail.com.
authors: Michael R
authors: MR
authors: Christian
authors: Erin M
authors: EM
authors: Pallasch
authors: Michael
authors: M
authors: Wahl
authors: Mark B
authors: MB
authors: Mycyk
mesh_terms: D000208:Acute Disease; D000328:Adult; D000639:Amitriptyline / Q000506:poisoning; D002045:Bupivacaine / Q000506:poisoning; D062787:Drug Overdose / Q000503:physiopathology / Q000628:therapy*; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects / Q000627:therapeutic use*; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D008486:Physician Executives; D011039:Poison Control Centers; D011041:Poisoning / Q000503:physiopathology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D019114:Remote Consultation; D012720:Severity of Illness Index; D012769:Shock / Q000209:etiology / Q000517:prevention & control*; D012955:Societies, Medical; D014481:United States; D014700:Verapamil / Q000506:poisoning; D015262:Xenobiotics / Q000506:poisoning
chemical_list: D005217:Fat Emulsions, Intravenous; D015262:Xenobiotics; D000639:Amitriptyline; D014700:Verapamil; D002045:Bupivacaine
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