title: Complications following antidotal use of intravenous lipid emulsion therapy.
abstract: The primary objective is to identify and describe the complications associated with the use of intravenous lipid emulsion (ILE) therapy as an antidote for lipophilic drug toxicity. This study is a retrospective chart review of patients treated with ILE at two academic medical centers between 2005 and 2012. Based on previously reported complications, we hypothesized that pancreatitis, ARDS, and lipemia-induced laboratory interference might occur. Clinical definitions of these complications were defined a priori. Subjects treated with ILE who did not develop at least one complication were excluded. A total of nine patients were treated with ILE during the study period, six of whom experienced potential complications as a result of the ILE. Two patients developed pancreatitis, and four patients had lipemia-induced interference of interpretation of laboratory studies, despite ultracentrifugation. Laboratory interference precluded one patient from being an organ donor. Three patients developed ARDS; although temporally associated, a causal relationship between ILE and the development of ARDS cannot be clearly established. As ILE is increasingly used for less severe cases of drug toxicity, clinicians should be aware of potential complications associated with its use. A risk-benefit assessment for the use of ILE should be implemented on a case-by-case basis.
authors: Department of Emergency Medicine, Section of Medical Toxicology, University of Southern California, 1200 North State Street, #1011, Los Angeles, CA, 90033, USA, Michael.Levine@bannerhealth.com.
authors: Michael
authors: M
authors: Levine
authors: Aaron B
authors: AB
authors: Skolnik
authors: Anne-Michelle
authors: AM
authors: Ruha
authors: Adam
authors: A
authors: Bosak
authors: Nathan
authors: N
authors: Menke
authors: Anthony F
authors: AF
authors: Pizon
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000931:Antidotes / Q000009:adverse effects* / Q000378:metabolism / Q000627:therapeutic use; D062787:Drug Overdose / Q000628:therapy; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects* / Q000378:metabolism / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000209:etiology*; D008297:Male; D008499:Medical Records; D010195:Pancreatitis / Q000097:blood / Q000209:etiology*; D012042:Registries; D015203:Reproducibility of Results; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000209:etiology*; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D000931:Antidotes; D005217:Fat Emulsions, Intravenous