![]() ![]() Additional data may be necessary to further define the role of intravenous fat emulsion in this setting.īased on the American College of Medical Toxicology (ACMT) Position Statement: Guidance for the Use of Intravenous Lipid Emulsion, the American Society of Regional Anesthesia and Pain Medicine (ASRA), and the American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, IV fat emulsion given for hemodynamic or other instability secondary to local anesthetics and other highly lipid soluble substances may be considered when the patient does not respond to standard resuscitation measures (eg, fluids, vasopressors, inotropes) ACMT 2016, AHA, ASRA in patients with any local anesthetic systemic toxicity event judged to be potentially serious, lipid emulsion should be administered soon after airway management ASRA. Serious hemodynamic or other instability secondary to highly lipid soluble substancescyesĭata from a limited number of patients studied and case reports suggest that IV fat emulsion may be beneficial for the treatment of serious hemodynamic or other instability not responsive to standard resuscitation measures (eg, fluids, vasopressors, inotropes) secondary to highly lipid soluble substances including, but not limited to: lipophilic local anesthetics, beta blockers, calcium channel blockers, tricyclic antidepressants, cocaine, benzonatate, bupropion, lamotrigine, quetiapine, and venlafaxine Arora 2013, Carr 2009, Carr 2009, Castanares-Zapatero 2012, Cohen 2009, Dagtekin 2011, Dix 2011, Finn 2009, Foxall 2007, Franxman 2011, French 2011a, Geib 2012, Hillyard 2010, Jakkala-Saibaba 2011, Jovic-Stosic 2011, Kundu 2013, Liang 2011, Litz 2006, Lu 2009, Montiel 2011, Oakes 2009, Rosenblatt 2006, Sirianni 2008, Weinberg 2009, Young 2009. Pharmacokinetics/Pharmacodynamics Metabolismįatty acids, phospholipids, and glycerol are metabolized by cells to adenosine triphosphate (ATP), carbon dioxide, and water Excretionīiliary (phospholipids) Half-Life EliminationĬaloric/fatty acid source: Source of calories and essential fatty acids for patients requiring parenteral nutrition for extended periods of time (usually for longer than 5 days) or when oral or enteral nutrition is not possible, insufficient, or contraindicated to prevent and treat essential fatty acid deficiency (except Clinolipid and Nutrilipid). Lipid administration may also affect the heart in a metabolically advantageous way by improving fatty acid transport (Weinberg 2006). High lipid partition constant and large volumes of distribution are good predictors of success when using lipid therapy (French 2011). ![]() ![]() In toxicity secondary to highly lipid soluble substances, exogenous lipids provide an alternative source of binding (Rowlingson 2008), commonly known as the "lipid sink" effect. Nutrilipid: 20% (250 mL, 500 mL, 1000 mL) Pharmacology Mechanism of Actionįat emulsion is metabolized and utilized as an energy source provides the essential fatty acids, linoleic acid, and alpha linolenic acid necessary for normal structure and function of cell membranes in local anesthetic toxicity, lipid emulsion probably extracts lipophilic local anesthesia from cardiac muscle Excipient information presented when available (limited, particularly for generics) consult specific product labeling.Ĭlinolipid: 20% (100 mL, 250 mL, 500 mL, 1000 mL)
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