Lipid Emulsion / IntraLipid

Liverpool Hospital Emergency Department


  • 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 


  • 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