title: Review of the effect of intravenous lipid emulsion on laboratory analyses.
abstract: BACKGROUND
  Although the clinical use of intravenous lipid emulsion therapy for the treatment of lipophilic drug toxicity is increasing, the focus of most publications is on outcome in laboratory animals or in patients. An unintended consequence of intravenous lipid emulsion is the creation of extremely lipemic blood, which may interfere with the laboratory analysis or interpretation of common analytes.
  
  
  OBJECTIVE
  The American Academy of Clinical Toxicology has established a lipid emulsion workgroup to review the evidence and produce recommendations on the use of this novel therapy for drug toxicity. The aim of this subgroup is to review the available evidence regarding the effect of intravenous lipid emulsion on common laboratory testing, which often forms the basis of the appraisal of the balance between benefits and potential adverse events.
  
  
  METHODS
  We performed a comprehensive review of the literature. Relevant articles were determined based upon a predefined methodology. Package inserts of manufacturers' assays were collected. Article inclusion required that the article met predefined inclusion criteria with the agreement of at least two members of the subgroup.
  
  
  RESULTS
  We included thirty-six articles in the final analysis. Evaluation of the reviewed analytes revealed heterogeneity with regards to the assessment of the effect of intravenous lipid emulsion in terms of consistency and magnitude of effect across the different analytic platforms.
  
  
  CONCLUSIONS
  The measurements of a number of common analytes can be markedly affected by the lipemia produced by lipid emulsions such that they cannot always be interpreted in the way that most physicians use this information in typical clinical situations. In fact, a lack of appreciation of this effect may lead to unintentional treatment errors. Because the effect of the lipemia produced is dependent on the reagents and laboratory platform used, it would be useful for all future reports to clearly document sample handling, reagents and laboratory platform used, as well as any procedures employed to reduce the lipid content.
authors.affiliation: a Division of Medical Biochemistry, Department of Medicine , McGill University Health Centre , Montreal , Québec , Canada ;
authors.forename: Ami M
authors.initials: AM
authors.lastname: Grunbaum
authors.affiliation: a Division of Medical Biochemistry, Department of Medicine , McGill University Health Centre , Montreal , Québec , Canada ;
authors.forename: Brian M
authors.initials: BM
authors.lastname: Gilfix
authors.affiliation: b Division of Medical Toxicology , Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine , New York , USA ;
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
authors.affiliation: c Department of Medical Biology , Sacré-Coeur Hospital, University of Montréal , Montréal , Québec , Canada ;
authors.forename: Valéry
authors.initials: V
authors.lastname: Lavergne
authors.affiliation: d Schulich Library of Science and Engineering , McGill University , Montréal , Québec , Canada ;
authors.forename: Martin
authors.initials: M
authors.lastname: Morris
authors.affiliation: d Schulich Library of Science and Engineering , McGill University , Montréal , Québec , Canada ;
authors.forename: Andrea
authors.initials: A
authors.lastname: Miller-Nesbitt
authors.affiliation: e Department of Emergency Medicine, McGill University Health Centre & Department of Medicine , McGill University , Montreal , Québec , Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Gosselin
mesh_terms: D000818:Animals; D016208:Databases, Factual; D004195:Disease Models, Animal; D004353:Drug Evaluation, Preclinical; D064420:Drug-Related Side Effects and Adverse Reactions / Q000188:drug therapy*; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D006801:Humans
chemical_list: D005217:Fat Emulsions, Intravenous
keywords: Analytical interference; Laboratory measurements; Lipemia; Lipid emulsion