title: LIPAEMIC report: results of clinical use of intravenous lipid emulsion in drug toxicity reported to an online lipid registry.
abstract: The use of intravenous lipid emulsion (ILE) as an antidote has prompted significant academic and clinical interest. Between August 2009 and August 2012, data from cases of ILE use in intoxicated patients in different hospitals on different continents were voluntarily entered into a registry based on the world wide web (www.lipidregistry.org). Here, we report data from this project. Participating centers were given access to the registry following institutional subscription. Specifically sought were details of the individual patients' presenting condition, indications for ILE use, ILE administration regimen, potential complications, and of clinical outcome. Forty-eight uses of ILE were reported from 61 participating centers. Ten cases of local anesthetic systemic toxicity were reported; all (10/10) survived. Thirty-eight cases of intoxication by other agents were reported [30 decreased conscious state, 8 cardiovascular collapse (3 deaths)]. There was an elevation in GCS (p < 0.0001) and increased systolic blood pressure (p = 0.012) from immediately prior to ILE administration to 30 min after use. One serious and two minor adverse effects of ILE use were recorded in 48 reported cases (one case of bronchospastic reaction, one case of hyperamylasemia and one case of interference with laboratory testing). In this series of cases reported to the registry, improvements were seen for GCS in patients with central nervous system toxicity and in systolic blood pressure in shocked patients over a short time frame after the injection of ILE. Few adverse effects were recorded. Clinical trials and the reporting of drug concentrations after ILE use are necessary to further elucidate the role of ILE in clinical toxicology.
authors.affiliation: Department of Critical Care, Tamworth Rural Referral Hospital, Tamworth, NSW, Australia.
authors.forename: Grant
authors.initials: G
authors.lastname: Cave
authors.forename: Martyn
authors.initials: M
authors.lastname: Harvey
authors.forename: Johann
authors.initials: J
authors.lastname: Willers
authors.forename: David
authors.initials: D
authors.lastname: Uncles
authors.forename: Tim
authors.initials: T
authors.lastname: Meek
authors.forename: John
authors.initials: J
authors.lastname: Picard
authors.forename: Guy
authors.initials: G
authors.lastname: Weinberg
mesh_terms: D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000779:Anesthetics, Local / Q000009:adverse effects / Q000737:chemistry; D000931:Antidotes / Q000009:adverse effects* / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000009:adverse effects; D003244:Consciousness Disorders / Q000209:etiology / Q000517:prevention & control*; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000503:physiopathology / Q000628:therapy*; D012042:Registries; D012769:Shock / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000931:Antidotes; D005217:Fat Emulsions, Intravenous