title: Intravenous lipid emulsion in the emergency department: a systematic review of recent literature.
abstract: BACKGROUND
  Intravenous lipid emulsion (ILE) has been broadly attempted in the resuscitation of neurologic and cardiac toxic drug overdoses, however, the role of ILE in the emergency department is poorly defined.
  
  
  OBJECTIVE
  This review aims to identify recent literature on the use of ILE in humans as an antidote and to familiarize emergency providers with the indications, availability, dosing recommendations, and adverse reactions associated with ILE use.
  
  
  METHODS
  A systemic literature search of MEDLINE, EMBASE, and major toxicology conference abstracts was performed for human cases using ILE as an antidote with documented clinical outcomes through January 2014.
  
  
  RESULTS
  Ninety-four published articles and 40 conference abstracts were identified, 85% of which had positive outcomes. The most common indication for ILE was for local anesthetic systemic toxicity (LAST). The most common nonlocal anesthetic xenobiotics were tricyclic-antidepressants and verapamil.
  
  
  CONCLUSIONS
  No standard of care is defined for the use of ILE, although the American Heart Association recommends use in LAST, and the American College of Medical Toxicology recommends consideration for circumstances of hemodynamic instability resultant from lipid-soluble xenobiotics. ILE should be administered per American Society of Regional Anesthesia and Pain Medicine dosing recommendations. Laboratory interference, pancreatitis, respiratory distress syndrome, and interference with vasopressors should be considered as risks but are uncommon.
  
  
  CONCLUSIONS
  In the setting of severe hemodynamic compromise by lipid-soluble xenobiotics, ILE may be considered for resuscitation by emergency physicians. As such, ILE may be stocked in emergency departments in close proximity to resuscitation rooms and areas where local nerve blocks are performed.
authors.affiliation: Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Dazhe
authors.initials: D
authors.lastname: Cao
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Kennon
authors.initials: K
authors.lastname: Heard
authors.affiliation: Department of Emergency Medicine, New York University School of Medicine, Bellevue Hospital Center, New York, New York.
authors.forename: Mark
authors.initials: M
authors.lastname: Foran
authors.affiliation: Department of Emergency Medicine, University of Texas at Southwestern Medical Center and Parkland Memorial Hospital, Dallas, Texas.
authors.forename: Alex
authors.initials: A
authors.lastname: Koyfman
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000506:poisoning; D000889:Anti-Arrhythmia Agents / Q000506:poisoning; D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning; D000931:Antidotes / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D011041:Poisoning / Q000628:therapy; D017410:Practice Guidelines as Topic; D014700:Verapamil / Q000506:poisoning
chemical_list: D000779:Anesthetics, Local; D000889:Anti-Arrhythmia Agents; D000929:Antidepressive Agents, Tricyclic; D000931:Antidotes; D005217:Fat Emulsions, Intravenous; D014700:Verapamil
keywords: Lipid emulsion; lipid solubility; overdose; resuscitation