title: Use of Intravenous Fat Emulsion in the Emergency Department for the Critically Ill Poisoned Patient.
abstract: BACKGROUND
  Multiple case reports of using intravenous fat emulsion (IFE) as an antidote for human poisoning from various xenobiotics have been published over the last decade. Given the rapidly evolving field, emergency physicians may be uncertain about the indications, timing, and dose for IFE treatment.
  
  
  METHODS
  A PubMed literature search was conducted from January 1996 to November 2015 and limited to human studies written in English and articles with relevant keywords. Guideline statements and nonsystematic reviews were excluded. Studies identified then underwent a structured review of their results.
  
  
  RESULTS
  There were 986 papers fulfilling the search criteria screened, and 85 appropriate articles were rigorously reviewed in detail. Recommendations were given on indications, timing, and dose of IFE. Most of these were based on case reports and anecdotal experience.
  
  
  CONCLUSIONS
  In critically ill patients with refractory shock or cardiac arrest after a suspected overdose of local anesthetics or selected xenobiotics, IFE may be considered as a potentially beneficial adjunctive treatment. Despite an abundance of reports on the use of IFE on xenobiotics poisoning, the quality of evidence is suboptimal and fraught with reporting bias.
  
  
  CONCLUSIONS
  IFE may be an effective antidote in poisonings from various xenobiotics. However, further research is needed to determine its optimal circumstances, timing, and dose of use.
authors.affiliation: Department of Emergency Medicine, University of California at San Diego Medical Center, San Diego, California.
authors.forename: Samuel H F
authors.initials: SH
authors.lastname: Lam
authors.affiliation: Department of Emergency Medicine, Staten Island University Hospital, New York, New York.
authors.forename: Nima
authors.initials: N
authors.lastname: Majlesi
authors.affiliation: Department of Emergency Medicine, University of California at San Diego Medical Center, San Diego, California.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
mesh_terms: D000931:Antidotes / Q000627:therapeutic use*; D016638:Critical Illness; D004636:Emergency Service, Hospital; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D006801:Humans; D011041:Poisoning / Q000628:therapy*
chemical_list: D000931:Antidotes; D005217:Fat Emulsions, Intravenous
keywords: intravenous fat emulsion; poisoned patient; review