| Emulsión de lípidos en toxicología clínica |
Intravenous lipid emulsion in clinical toxicology.
Rothschild L, Bern S, Oswald S, Weinberg G.
Department of Anesthesiology, University of Illinois at Chicago, UIC Medical Center, Chicago, Illinois, USA. leelach@uic.edu
Scand J Trauma Resusc Emerg Med. 2010 Oct 5;18:51.
Abstract
Intravenous lipid emulsion is an established, effective treatment for local anesthetic-induced cardiovascular collapse. The predominant theory for its mechanism of action is that by creating an expanded, intravascular lipid phase, equilibria are established that drive the offending drug from target tissues into the newly formed 'lipid sink'. Based on this hypothesis, lipid emulsion has been considered a candidate for generic reversal of toxicity caused by overdose of any lipophilic drug. Recent case reports of successful resuscitation suggest the efficacy of lipid emulsion infusion for treating non-local anesthetic overdoses across a wide spectrum of drugs: beta blockers, calcium channel blockers, parasiticides, herbicides and several varieties of psychotropic agents. Lipid emulsion therapy is gaining acceptance in emergency rooms and other critical care settings as a possible treatment for lipophilic drug toxicity. While protocols exist for administration of lipid emulsion in the setting of local anesthetic toxicity, no optimal regimen has been established for treatment of acute non-local anesthetic poisonings. Future studies will shape the evolving recommendations for lipid emulsion in the setting of non-local anesthetic drug overdose
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958894/pdf/1757-7241-18-51.pdf |
| Emulsión de lípidos como antídoto: Sumario de publicaciones de la experiencia humana |
Intravenous lipid emulsion as antidote: A summary of published human experience
Grant Cave, Martyn Harvey and Andis Graudins
Emergency Medicine Australasia (2011) 23, 123-14
Abstract Intravenous lipid emulsion (ILE) has been demonstrated to be effective in amelioration of cardiovascular and central nervous system sequelae of local-anaesthetic and non-localanaesthetic drug toxicity in animal models. Sequestration of lipophilic toxins to an expanded plasma lipid phase is credited as the predominant beneficial mechanism of action of ILE. Systematic review of published human experience is however lacking. We determined to report a comprehensive literature search of all human reports of ILE application in drug poisoning. Forty-two cases of ILE use (19 local-anaesthetic, 23 non-localanaesthetic) were identified, with anecdotal reports of successful resuscitation from cardiovascular collapse and central nervous system depression associated with ILE administration in lipophilic toxin overdose. Although significant heterogeneity was observed in both agents of intoxication, and reported outcomes; case report data suggest a possible benefit of ILE in potentially life-threatening cardio-toxicity from bupivacaine, mepivacaine, ropivacaine, haloperidol, tricyclic antidepressants, lipophilic beta blockers and calcium channel blockers. Further controlled study and systematic evaluation of human cases is required to define the clinical role of ILE in acute poisonings. Key words: antidote, emulsion, intravenous, lipid, overdose, poisoning http://onlinelibrary.wiley.com/doi/10.1111/j.1742-6723.2011.01398.x/pdf
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