title: Systematic review of clinical adverse events reported after acute intravenous lipid emulsion administration.
abstract: BACKGROUND
  Intravenous lipid emulsions (ILEs) were initially developed to provide parenteral nutrition. In recent years, ILE has emerged as a treatment for poisoning by local anesthetics and various other drugs. The dosing regimen for the clinical toxicology indications differs significantly from those used for parenteral nutrition. The evidence on the efficacy of ILE to reverse acute toxicity of diverse substances consists mainly of case reports and animal experiments. Adverse events to ILE are important to consider when clinicians need to make a risk/benefit analysis for this therapy.
  
  
  METHODS
  Multiple publication databases were searched to identify reports of adverse effects associated with acute ILE administration for either treatment of acute poisoning or parenteral nutrition. Articles were selected based on pre-defined criteria to reflect acute use of ILE. Experimental studies and reports of adverse effects as a complication of long-term therapy exceeding 14 days were excluded.
  
  
  RESULTS
  The search identified 789 full-text articles, of which 114 met the study criteria. 27 were animal studies, and 87 were human studies. The adverse effects associated with acute ILE administration included acute kidney injury, cardiac arrest, ventilation perfusion mismatch, acute lung injury, venous thromboembolism, hypersensitivity, fat embolism, fat overload syndrome, pancreatitis, extracorporeal circulation machine circuit obstruction, allergic reaction, and increased susceptibility to infection.
  
  
  CONCLUSIONS
  The emerging use of ILE administration in clinical toxicology warrants careful attention to its potential adverse effects. The dosing regimen and context of administration leading to the adverse events documented in this review are not generalizable to all clinical toxicology scenarios. Adverse effects seem to be proportional to the rate of infusion as well as total dose received. Further safety studies in humans and reporting of adverse events associated with ILE administration at the doses advocated in current clinical toxicology literature are needed.
authors.affiliation: a Department of Pharmacy , University of Maryland Medical Center and Department of Emergency Medicine, University of Maryland School of Medicine , Baltimore , MD , USA ;
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Hayes
authors.affiliation: b Department of Medicine, McGill Faculty of Medicine, Emergency Medicine , McGill University Health Centre , Montréal , Canada ;|c Province of Alberta Drug Information Services , Alberta , Canada ;|d Centre antipoison du Québec , Québec , Canada ;
authors.forename: Sophie
authors.initials: S
authors.lastname: Gosselin
authors.affiliation: e Medical Toxicology, Department of Emergency Medicine , Morristown Medical Center, Emergency Medical Associates , Morristown , NJ , USA ;
authors.forename: Diane P
authors.initials: DP
authors.lastname: Calello
authors.affiliation: f Department of Surgery, Division of Emergency Medicine , University of Vermont , Burlington , VT , USA ;
authors.forename: Nicholas
authors.initials: N
authors.lastname: Nacca
authors.affiliation: g Banner-University Medical Center Tucson, University of Arizona College of Pharmacy , Tucson , AZ , USA ;
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Rollins
authors.affiliation: h Department of Medicine, Division of Emergency Medicine , University of Toronto , Toronto , Canada ;
authors.forename: Daniel
authors.initials: D
authors.lastname: Abourbih
authors.affiliation: i Life Sciences Library , McGill University , Montréal , Canada ;
authors.forename: Martin
authors.initials: M
authors.lastname: Morris
authors.affiliation: i Life Sciences Library , McGill University , Montréal , Canada ;
authors.forename: Andrea
authors.initials: A
authors.lastname: Nesbitt-Miller
authors.affiliation: j Division of Geriatric Medicine , McGill University , Montréal , Québec , Canada ;
authors.forename: José A
authors.initials: JA
authors.lastname: Morais
authors.affiliation: k Department of Medical Biology , Sacré-Coeur Hospital, University of Montréal , Montréal , Canada.
authors.forename: Valéry
authors.initials: V
authors.lastname: Lavergne
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D055371:Acute Lung Injury / Q000139:chemically induced; D061605:Administration, Intravenous; D000779:Anesthetics, Local / Q000506:poisoning*; D000818:Animals; D016208:Databases, Factual; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004620:Embolism, Fat / Q000139:chemically induced; D005217:Fat Emulsions, Intravenous / Q000009:adverse effects*; D006323:Heart Arrest / Q000139:chemically induced; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology; D010195:Pancreatitis / Q000139:chemically induced; D011041:Poisoning / Q000209:etiology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D054556:Venous Thromboembolism / Q000139:chemically induced
chemical_list: D000779:Anesthetics, Local; D005217:Fat Emulsions, Intravenous
keywords: Gut and hepatotoxicity; liver; metabolic