2 further bolus doses and doubling of the infusion rate recommended at 5 minute intervals until cardiovascular stability is restored
Maximum cumulative dose 12mg/kg
PRACTICALITIES
Administration
Can be administered via a peripheral vein
If not administered immediately, use within 24 hours due to propensity to foster bacterial growth
Incompatibilities
In general other drugs should not be co-administered with Intralipid due to incompatibility by its emulsive properties
Practice tips
Administration may interfere with pulse oximetry function and some laboratory measurements (Hb, amylase, lipase, Cr, ALT, bili, Mg)
Monitoring of serum amylase/lipase should occur for 2 days after Intralipid therapy to detect pancreatitis
Clinical use should be reported to www.lipidrescue.org to allow ongoing monitoring of drug efficacy and safety
PHARMACOKINETICS
Onset, duration
Pharmacokinetic studies lacking
Metabolism, elimination
Uncertain, may follow normal physiological pathways of lipid handling
MECHANISM
Mechanism is not fully understood, theories include;
Lipid ‘sink’; concentrating local anaesthetic molecules and establishing a concentration gradient with the effect of drawing molecules from cardiac binding sites
Lipid supply; supplying cardiac muscle with its preferred energy substrate in the presence of local anaesthetic inhibition of fatty acid oxidation
Competitive inhibition of local anaesthetics; at cardiac sodium channel binding sites
Cytoprotection
Promoting intracellular calcium release in the cardiac myocyte
‘Shunting’ of local anaesthetic molecules to sequestering organs
DESIRED CLINICAL EFFECTS
Cardiovascular
Termination of cardiac arrhythmias and collapse secondary to LAST
Neurological
Termination of seizures secondary to LAST
OTHER CLINICAL EFFECTS, ADVERSE EFFECTS & TOXICITIES
Gastrointestinal
Hyperlipidaemia and fat overload syndrome; fever, fat infiltration, organ dysfunction, coma
Pancreatitis
Hepatic dysfunction
Refeeding syndrome
Other
Sepsis
CONSIDERATIONS
Precautions
Premature and low-birth weight infants (poor lipid clearance resulting in pulmonary accumulation and death)
Severe hepatic dysfunction; poor lipid clearance
Severely malnourished patients at risk of re-feeding syndrome
Obstetric ADEC category C
Drug interactions
Warfarin; Intralipid contains vitamin K1, counteracting the effect of vitamin K epoxide reductase inhibition by warfarin and reducing its efficacy
REFERENCES
Drug information has been compiled from multiple sources including
Drugs in Anaesthesia and Intensive Care (Scarth & Smith)
Micromedex (IBM)
BJA Education (Oxford Academic)
Pharmacology for Anaesthesia and Intensive Care (Cambridge)