Emulsión de lípidos intravenosos: un nuevo antídoto para uso en resucitación
Intravenous lipid emulsion:a new antidote for use in resuscitation
SANTIAGO NOGUÉ, NURIA COROMINAS, DOLORS SOY, JUAN CINO.
Sección de Toxicología Clínica. Área de Urgencias. Servicio de Farmacia. Servicio de Cardiología. Hospital
Clínic. Barcelona, Spain. 4Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS. Barcelona,
Spain.
Emergencias 2011;23:378-385
This review examines the pharmacologic and pharmacokinetic aspects of the intravenous infusion of lipid emulsion and surveys the literature on the indications for using this treatment in cases of intoxication. Although the level of evidence is low, intravenous lipid emulsion seems now to occupy an undisputed position as an antidote, not only in cardiotoxicity induced by local anesthetics but also in resuscitation after other toxic
insults affecting the cardiovascular system.
Key words: Intravenous lipid emulsion. Cardiovascular toxicity. Local anesthetics.
http://www.semes.org/revista/vol23_5/8_ing.pdf
Rescate con lípidos para sobredosis masiva de verapamil: informe de caso
Lipid rescue of massive verapamil overdose: a case report.
Liang CW, Diamond SJ, Hagg DS.
Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97201 USA.haggda@ohsu.edu.
J Med Case Rep. 2011 Aug 20;5:399. doi: 10.1186/1752-1947-5-399.
Abstract
INTRODUCTION:
Massive intentional verapamil overdose is a toxic ingestion which can cause multiorgan system failure and has no currently known antidote.CASE PRESENTATION: The patient is a 41-year-old Caucasian woman who ingested 19.2 g of sustained release verapamil in a suicide attempt. Our patient became hypotensive requiring three high-dose vasopressors to maintain arterial pressure. She also developed acute respiratory failure, bradycardic ventricular rhythm necessitating continuous transvenous pacing, and anuric renal failure. Our patient was treated with intravenous calcium, bicarbonate, hyperinsulinemic euglycemic therapy and continuous venovenous hemodialysis without success. On the fourth day after hospital admission continuous intravenous lipid therapy was initiated. Within three hours of beginning lipid therapy, our patient's vasopressor requirement decreased by half. Within 24 hours, she was on minimal vasopressor support and regained an underlying junctional rhythm. After three days of lipid infusion, she no longer required inotropic agents to maintain blood pressure or pacing to maintain stable hemodynamics. CONCLUSIONS: Intravenous fat emulsion therapy may be an effective antidote for massive verapamil toxicity.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169500/pdf/1752-1947-5-399.pdf
Insulina vs emulsión lipídico en un modelo de conejos para la toxicidad severa de propranolol. Estudio piloto
Insulin versus Lipid Emulsion in a Rabbit Model of Severe Propranolol Toxicity: A Pilot Study.
Harvey M, Cave G, Lahner D, Desmet J, Prince G, Hopgood G.
Department of Emergency Medicine, Waikato Hospital, Pembroke Street, Hamilton 3204, New Zealand.
Crit Care Res Pract. 2011;2011:361737. doi: 10.1155/2011/361737. Epub 2011 Mar 31.
Abstract
Background and objective. Beta-blocker overdose may result in intractable cardiovascular collapse despite conventional antidotal treatments. High dose insulin/glucose (ING), and more recently intravenous lipid emulsion (ILE), have been proposed as potentially beneficial therapies in beta blocker intoxication. We compare efficacy of the novel antidotes ING, with ILE, in a rabbit model of combined enteric/intravenous propranolol toxicity....... Conclusions. High dose insulin resulted in greater rate pressure product compared with lipid emulsion in this rabbit model of severe enteric/intravenous propranolol toxicity.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085310/pdf/CCRP2011-361737.pdf
Atentamente
Dr. Juan C. Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Intravenous lipid emulsion:a new antidote for use in resuscitation
SANTIAGO NOGUÉ, NURIA COROMINAS, DOLORS SOY, JUAN CINO.
Sección de Toxicología Clínica. Área de Urgencias. Servicio de Farmacia. Servicio de Cardiología. Hospital
Clínic. Barcelona, Spain. 4Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS. Barcelona,
Spain.
Emergencias 2011;23:378-385
This review examines the pharmacologic and pharmacokinetic aspects of the intravenous infusion of lipid emulsion and surveys the literature on the indications for using this treatment in cases of intoxication. Although the level of evidence is low, intravenous lipid emulsion seems now to occupy an undisputed position as an antidote, not only in cardiotoxicity induced by local anesthetics but also in resuscitation after other toxic
insults affecting the cardiovascular system.
Key words: Intravenous lipid emulsion. Cardiovascular toxicity. Local anesthetics.
http://www.semes.org/revista/vol23_5/8_ing.pdf
Rescate con lípidos para sobredosis masiva de verapamil: informe de caso
Lipid rescue of massive verapamil overdose: a case report.
Liang CW, Diamond SJ, Hagg DS.
Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97201 USA.haggda@ohsu.edu.
J Med Case Rep. 2011 Aug 20;5:399. doi: 10.1186/1752-1947-5-399.
Abstract
INTRODUCTION:
Massive intentional verapamil overdose is a toxic ingestion which can cause multiorgan system failure and has no currently known antidote.CASE PRESENTATION: The patient is a 41-year-old Caucasian woman who ingested 19.2 g of sustained release verapamil in a suicide attempt. Our patient became hypotensive requiring three high-dose vasopressors to maintain arterial pressure. She also developed acute respiratory failure, bradycardic ventricular rhythm necessitating continuous transvenous pacing, and anuric renal failure. Our patient was treated with intravenous calcium, bicarbonate, hyperinsulinemic euglycemic therapy and continuous venovenous hemodialysis without success. On the fourth day after hospital admission continuous intravenous lipid therapy was initiated. Within three hours of beginning lipid therapy, our patient's vasopressor requirement decreased by half. Within 24 hours, she was on minimal vasopressor support and regained an underlying junctional rhythm. After three days of lipid infusion, she no longer required inotropic agents to maintain blood pressure or pacing to maintain stable hemodynamics. CONCLUSIONS: Intravenous fat emulsion therapy may be an effective antidote for massive verapamil toxicity.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169500/pdf/1752-1947-5-399.pdf
Insulina vs emulsión lipídico en un modelo de conejos para la toxicidad severa de propranolol. Estudio piloto
Insulin versus Lipid Emulsion in a Rabbit Model of Severe Propranolol Toxicity: A Pilot Study.
Harvey M, Cave G, Lahner D, Desmet J, Prince G, Hopgood G.
Department of Emergency Medicine, Waikato Hospital, Pembroke Street, Hamilton 3204, New Zealand.
Crit Care Res Pract. 2011;2011:361737. doi: 10.1155/2011/361737. Epub 2011 Mar 31.
Abstract
Background and objective. Beta-blocker overdose may result in intractable cardiovascular collapse despite conventional antidotal treatments. High dose insulin/glucose (ING), and more recently intravenous lipid emulsion (ILE), have been proposed as potentially beneficial therapies in beta blocker intoxication. We compare efficacy of the novel antidotes ING, with ILE, in a rabbit model of combined enteric/intravenous propranolol toxicity....... Conclusions. High dose insulin resulted in greater rate pressure product compared with lipid emulsion in this rabbit model of severe enteric/intravenous propranolol toxicity.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085310/pdf/CCRP2011-361737.pdf
Atentamente
Dr. Juan C. Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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