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Toxicology

Lipid infusion in the management of poisoning: an introduction

02 July 2016
Clinical
9 mins read
02 July 2016
Volume 7 · Issue 6
Figure 2. Lipid is given as an intravenous bolus, followed by an infusion.
Figure 2. Lipid is given as an intravenous bolus, followed by an infusion.

Abstract

Lipid infusion therapy is the intravenous infusion of a parental lipid formulation which can be used in the management of some toxic substances, particularly fat soluble (lipophilic) compounds, such as permethrin and ivermectin. Although the mechanism is not fully understood the lipid is thought to act as a ‘shuttle’ resulting in redistribution of the toxic compound. Adverse effects from the use of lipid infusion in the management of poisoning appear to be rare. Lipid is straightforward to administer and a relatively cheap treatment option and should be considered in an animal failing to respond to other therapies after exposure to a substance which fits the criteria for lipid infusion treatment which is high lipid solubility, high volume of distribution and short to moderate half-life.

Lipid infusion can be used in the management of poisoning with fat soluble (lipophilic) substances. It is also known as lipid rescue, intravenous fat emulsion and intravenous lipid emulsion (IVLE) and was first proposed by Weinberg in 2006 as a treatment for the management of severe local anaesthetic toxicity in humans (Weinberg, 2006).

Lipid infusion therapy is the intravenous infusion of a parenteral lipid formulation which is usually used as part of parenteral nutrition as a source of calories and essential fatty acids. The lipid used is commonly soy bean oil in water. The most commonly used product is Intralipid® 20% (Fresenius Kabi), but other products are available. Intralipid®, for example, contains soy bean oil, egg yolk phospholipids, glycerin and water for injection.

In simplest terms the lipid acts as a ‘shuttle’ where the toxic chemical is redistributed away from target sites. The lipophilic drug or chemical dissolves in the lipid emulsion with accelerated removal of the toxic molecules from target tissues (Fettiplace et al, 2015a). There is some support for the lipid ‘shuttle’ theory. In experimental studies a higher concentration of a toxic agent was found in the lipid phase of the blood in rats compared with the aqueous (water) phase for several drugs (Krieglstein et al, 1974; Straathof et al, 1984; Weinberg et al, 1998), suggesting that the drugs were sequestered in the lipid. In clinical cases involving ivermectin toxicity the blood concentration of ivermectin in a Shetland pony (Bruenisholz et al, 2012) and a Border collie (Clarke et al, 2011) increased substantially after administration of the lipid, suggesting that the drug moved into the blood from other compartments.

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poisoning
toxicology
lipid infusion