![]() ![]() 29 As the ILE circulates throughout the body, it is cleared by skeletal muscle, splanchnic viscera, myocardium, and subcutaneous tissues, which help dilute and clear the offending toxin from the body. This lipid phase sets up a gradient that pulls the offending lipid-soluble drug into the newly formed lipid partition in the blood, away from the heart and brain. The prevailing theory of ILE’s mechanism of action is a phenomenon termed “lipid sink.” 30 Administration of ILE results in the creation of an IV lipid phase within the plasma. That cat clinically recovered from the cardiovascular effects of lidocaine toxicity following the administration of a 1.5 mL/kg IV bolus of ILE over 30 min. 3 A recent case report in the veterinary literature documents the successful use of ILE therapy in a cat suffering from a local anesthetic toxicity. Eventually, the literary support for ILE’s potential effects against local anesthetic toxicities led to the first documented successful use of ILE in the clinical setting as a rescue treatment of bupivacaine-induced cardiovascular collapse in a human in 2006. (1998), laid the groundwork for continued research into the use of ILE as an antidote for local anesthetic toxicities. ![]() Guy Weinberg, a leading researcher in the field of ILE, was motivated by this discovery to perform a study in rats that documented a decrease in the cardiotoxic threshold of bupivacaine following ILE administration. 26 The potential benefit of ILE was first theorized in 1997 after the incidental discovery of carnitine’s relationship to local anesthetic cardiotoxicity. Although rarely encountered in human medicine, systemic absorption of local anesthetics has the potential for causing cardiovascular collapse that is considered to be resistant to current resuscitative protocols. The use of ILE as an antidote was first introduced into human medicine as a rescue treatment of local anesthetic toxicities. In turn, morbidity and mortality in poisoned small animals would decrease. If ILE can be shown to be effective for treating lipid-soluble toxicities with minimal adverse effects, it could potentially be used as an antidote by emergency veterinarians for lipid-soluble toxicities that presently do not have effective antidotes. A review of the experimental evidence in both the human and the veterinary literature, case reports of ILE use, theorized mechanisms of action, current dosing recommendations, and potential adverse effects of ILE are described. 25 Included in this review article is a comprehensive review of the use of ILE in the treatment of various lipophilic toxicities. ILE has proven to be an effective treatment of local anesthetic systemic toxicity in both humans and animals and shows promise as a novel antidote for a wide array of other lipophilic drug poisonings. 1 Over the last decade there has been emerging experimental and anecdotal evidence published in both the human and (to a much lesser extent) veterinary literature supporting the use of IV lipid emulsion (ILE) to reverse hemodynamically and neurologically significant poisonings resulting from ingestion of lipophilic medications. 1 For the ingestion of toxic substances where no proven antidote exists, general recommendations for medical management center on decontamination and supportive care. ![]() 1 Of the toxins ingested in that year, the most commonly reported toxins included painkillers, antipsychotics, and insecticides/herbicides. In 2009, the American Society for the Prevention of Cruelty to Animals Animal Poison Control Center handled >45,000 calls related to pets ingesting human medications and >29,000 calls related to insecticide poisonings. Every year, animal poison control helplines receive thousands of calls regarding the consumption of household substances that can result in fatal toxicities. ![]()
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