CLASS

Lipid emulsion

PRESENTATION

White, opaque fluid

Formulations

250ml bottle; 50g, 20% (200mg/ml)

INDICATIONS & DOSING

Local Anaesthetic Systemic Toxicity (LAST)

Adult; 100ml IV bolus
Paediatric; 1.5ml/kg IV bolus
Infusion; 15mg/kg/hr IV
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)
Australian Prescriber (NPS MedicineWise)

DRUGS

INTRALIPID