title: Lipid emulsion therapy given intraosseously in massive verapamil overdose.
abstract: Intravenous fat emulsion (IFE) therapy has been widely used in the emergency department (ED) for treating various medication overdoses. The standard recommended route to administer IFE therapy is intravenously through a peripheral or central vein. No reports of intraosseous (IO) administration in humans could be found in the literature after a brief search. We report of a patient emergently receiving IFE through the IO route. A 24-year-old woman presented to ED after a massive deliberate verapamil overdose. A decision was then made to start both vasopressors and 20% IFE therapy. Central access was established, and a norepinephrine drip was started. Intravenous fat emulsion was to be started, but peripheral access was lost at that time and not able to be reestablished. An IO line was then placed without difficulty in the left proximal tibia using an EZ-IO system. Approximately half way during the bolus administration, the intravenous pump began to alarm that the infusion was not flowing adequately. At this point, peripheral access was obtained, and IFE infusion was moved to that site. We believe that this is the first report of IFE administered via the IO route in a human. This case report illustrates a novel way of administering IFE therapy in an emergency situation where intravenous access may be difficult to obtain.
authors.affiliation: Department of Emergency Medicine, University of Missouri-Columbia, Columbia, MO. Electronic address: sampsoncs@health.missouri.edu.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Sampson
authors.affiliation: Department of Emergency Medicine, University of Missouri-Columbia, Columbia, MO.
authors.forename: Starr-Mar'ee
authors.initials: SM
authors.lastname: Bedy
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000506:poisoning*; D062787:Drug Overdose / Q000628:therapy*; D005217:Fat Emulsions, Intravenous; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D017148:Infusions, Intraosseous; D013406:Suicide, Attempted; D014700:Verapamil / Q000506:poisoning*; D055815:Young Adult
chemical_list: D000889:Anti-Arrhythmia Agents; D005217:Fat Emulsions, Intravenous; D014700:Verapamil