Lipid Emulsion / IntraLipid
Liverpool Hospital Emergency Department
Indications:
- Refractory life-threatening cardiotoxicity secondary to bupivacaine.
- There is minimal to no evidence to support its use as a first line agent in toxicity related to other agents including other local anaesthetic agents or other compounds.
- Its use can be considered as a rescue therapy in life-threatening, treatment refractory cardiotoxicity due to lipophilic agents
- It is NOT indicated in seizures or stable dysrhythmias
- Consider the role of other agents such as NaHCO3 in local anaesthetic toxicity or TCA overdose
Formulation:
- 20% Intralipid Emulsion in 100ml or 500ml bottle / bag
Dosage and Administration:
- 1.5ml/kg bolus dosage over 1 minute
- Infusion of 15ml/kg/ hr (0.25ml/kg/min)
If no improvement in haemodynamic stability (persistent shock and dysrhythmias or arrest) over 5 minutes consider repeat bolus and double infusion rate to 30ml/kg/hr (0.5ml/kg/min)
- Maximum dose should not exceed 12ml/kg
- End point: Stability or maximum dose reached
Side Effects:
- Contraindication: anaphylaxis to soy beans or egg
- Pancreatitis
- ECMO filter dysfunction
- Lipaemic blood samples resulting in lab errors
- Acute lung injury (fat embolus)
Pit Falls:
- Failure to use standard resuscitative measures in cardiotoxic overdose including the use of vasoactive agents and NaHCO3