title: A cohort study of unstable overdose patients treated with intravenous lipid emulsion therapy.
abstract: OBJECTIVE
  Intravenous lipid emulsion (ILE) has been used increasingly over the last decade for a range of drug overdoses. Although the use of ILE in local anesthetic toxicity (LAST) is well established, the hemodynamic effectiveness of ILE in non-LAST poisonings is still unclear. Thus, the primary objective of this study was to examine a cohort of poisoned patients in whom ILE was administered.
  
  
  METHODS
  Consecutive patients were identified by calls to a regional poison center from May 1, 2012 to May 30, 2014. Patients were enrolled if they ingested a drug, developed hemodynamic instability, failed conventional treatment, and received ILE therapy. Data were collected by medical record review. The primary outcome was the change in mean arterial pressure (MAP) in the first hour after ILE administration. Secondary outcomes included survival, length of stay, and the effect of drug class on patient outcome.
  
  
  RESULTS
  Thirty-six patients were enrolled. Agents ingested included calcium channel blockers and beta blockers (10/36, 27.8%), tricyclic antidepressants (5/36, 13.9%), bupropion (3/36, 8.3%), and antiepileptic agents (1/36, 2.8%). Seventeen patients (47.2%) ingested multiple agents. Twenty-five patients survived (69.0%). Overall, MAP increased by 13.79 mm Hg (95% CI 1.43-26.15); this did not meet our a priori definition of clinical significance.
  
  
  CONCLUSIONS
  Our study did not find a clinically important improvement in MAP after ILE administration. Until future research is done to more definitively study its efficacy, ILE should remain a potential treatment option for hemodynamically unstable overdose patients only after conventional therapy has failed.
authors.affiliation: *Department of Emergency Medicine,University of Alberta,Edmonton,AB.
authors.forename: Shazma
authors.initials: S
authors.lastname: Mithani
authors.affiliation: *Department of Emergency Medicine,University of Alberta,Edmonton,AB.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Dong
authors.affiliation: §Department of Emergency Medicine,University of Calgary,Calgary,AB.
authors.forename: Ashlea
authors.initials: A
authors.lastname: Wilmott
authors.affiliation: **Poison and Drug Information Service,Alberta Health Services,Calgary,AB.
authors.forename: Heather
authors.initials: H
authors.lastname: Podmoroff
authors.affiliation: ‡‡Department of Emergency Medicine,University of Saskatchewan,Saskatoon,SK.
authors.forename: Nadim
authors.initials: N
authors.lastname: Lalani
authors.affiliation: †Department of Pediatrics,University of Alberta,Edmonton,AB.
authors.forename: Rhonda J
authors.initials: RJ
authors.lastname: Rosychuk
authors.affiliation: §Department of Emergency Medicine,University of Calgary,Calgary,AB.
authors.forename: Ryan
authors.initials: R
authors.lastname: Chuang
authors.affiliation: *Department of Emergency Medicine,University of Alberta,Edmonton,AB.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Yarema
mesh_terms: D002170:Canada; D062787:Drug Overdose / Q000188:drug therapy* / Q000401:mortality; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D005217:Fat Emulsions, Intravenous
keywords: antidote; lipid emulsion; overdose; resuscitation