Intralipid uses and doses

RE: Intralipid uses and doses

mariette asselbergs — Tue, 17 Oct 2017 18:38:20 GMT

VPIS now recommends it for any unknown intoxication with neurological symptoms. As did the lecturer in my Cert ECC course. I have used it several times and with real good results. Risk for short term use is minimal.

Mariette

RE: Intralipid uses and doses

Emily Rainbow — Tue, 17 Oct 2017 06:52:12 GMT

Can us Robaxin rectally if not conscious enough to pill!

RE: Intralipid uses and doses

Beats — Mon, 16 Oct 2017 19:35:11 GMT

From ASPCA: http://www.aspcapro.org/resource/shelter-health-poison-control/five-tips-treating-cat-permethrin-toxicosis

[quote user="Anthony Dennison"]Methocarbamol?[/quote]

doses eg https://www.cliniciansbrief.com/article/managing-exposure-permethrin

ASPCA: http://webcache.googleusercontent.com/search?q=cache:3FvZWOPSfdoJ:www.aspcapro.org/sites/pro/files/d-veccs_april00_0.pdf+&cd=8&hl=en&ct=clnk&gl=uk

availability in UK?

tablets fine... injection... errmmm... i think needs imported for uk i'm afraid. Is guaifenesin a useful substitute?

http://webinars.veteducation.com.au/wp-content/images/Insecticide-Toxicity-in-Cats-Lecture-Notes.pdf appears to say it is.

Anyway, the point's the same with most drugs - if the drug you're using to treat the toxicity is lipid soluble then intravenous lipids are as likely to counteract that as the toxin. Perhaps midazolam-treatment less likely to be affected then? I wouldn't be in a rush to give intravenous lipids to a cat with permethrin toxicity, though accept it may have a place in selected cases.

For local anaesthetic overdose and cardiac arrest... surely... but best just not to overdose in first place than stock lipid just in case you do? Avermectins in collies, I'd be sold on that use also I reckon.

RE: Intralipid uses and doses

Anthony Dennison — Mon, 16 Oct 2017 17:45:24 GMT

[quote user="Beats"] give more methocarbamol if not doing well[/quote]

Methocarbamol? How easy is it to get hold of? We've had a spate of cats getting dog flea products. Apparently owner stupidity is contagious...

RE: Intralipid uses and doses

Silvia Maldonado — Mon, 16 Oct 2017 17:39:54 GMT

[quote user="Michael Woodhouse"]

We just get it from the usual wholesaler with our order

[/quote]

Phewww! I had no idea from where we order it

RE: Intralipid uses and doses

Beats — Mon, 16 Oct 2017 15:12:58 GMT

[quote user="Silvia Maldonado"]

Hi, all,

We have ordered some intralipid in our practice, after some colleagues mentioned it worked quite well on some intoxications like permethrin or mushrooms. What is your experience with using it, and what's your best advice?

Cheers

[/quote]

No expereince, but...

permethrin problems -> give more methocarbamol if not doing well (and if "lipid-sink" model is true then you're going to suck out your useful drugs as well as toxin...)

In humans, you have to have cardiac arrested before you'll get given lipids as I understand it - not exactly a first-line therapy.

RE: Intralipid uses and doses

Michael Woodhouse — Mon, 16 Oct 2017 10:42:51 GMT

We just get it from the usual wholesaler with our order

RE: Intralipid uses and doses

Andrea Tarr — Mon, 16 Oct 2017 10:36:05 GMT

Hi Silvia

From where do you order Intralipid?

RE: Intralipid uses and doses

Elliot Kneba — Tue, 24 May 2016 16:27:23 GMT

http://www.ncbi.nlm.nih.gov/pubmed/21827588?dopt=Abstract

"Dosing recommendations for 20% ILE are: 1.5 mL/kg (IV, bolus over 1 min), followed by a CRI of 0.25 mL/kg/min (IV, for 30–60 min). The bolus dose can be repeated twice in 5-minute intervals if CPA (cardiopulmonary arrest) persists. If progressive hypotension is noticed, the CRI rate of administration can then be further increased to 0.5 mL/kg/min (IV). A total limit of 8 mL/kg/day has been suggested"

Interestingly, lipids are not generally used in human medicine unless a patient is arresting. We have used it recently for treatment of an unknown toxicoses in a cat with prolonged neurological signs non-responsive to traditional treatment.

RE: Intralipid uses and doses

Silvia Maldonado — Thu, 19 May 2016 21:57:04 GMT

Quite useful information, special mention to the article posted by Laura Kidd. I have gathered together a bit of all what I found so far:

It is known as a component of parenteral nutrition (ILE 30%)

It is also used as a carrier for lipid soluble drugs, such as propofol, etomidate and diazepam

The half-life has been reported between 5.34 minutes and 6.51 minutes

An ILE bolus provides an expanded intravascular lipid phase that sequesters lipid soluble compound from the target tissues, decreases free drug levels and thereby lessens toxic effects. The “lipid sink” effect is dependent on the lipophilicity of a drug. The higher the lipophilicity, the greater the effectiveness of ILE as an antidote is expected

ILE containing fatty acids, major substrate of cardiac myocytes, may augment cardiac muscle function by increasing myocardial mitochondrial adenosine triphosphate synthesis. ILE could also have a positive inotropic effect on hearts intoxicated by increasing contractility in cardiac myocytes via action on voltage-dependent calcium channels

ILE has been USED in treatment of lipophilic toxicities, such as intravenous local anesthetic overdose (bupivacaine, lidocaine), moxidectin toxicosis in dogs, and lidocaine toxicosis in cats. It is also used for poisoning with permethrin, avermectines, baclofen, lidocaine (overdose), phenobarbital and tremogenic compost mycotoxins, and mushrooms, clomipramine, tricyclic antidepressants (TCA), propranolol, buproprion (Wellbutrin®, Zyban®), muscle relaxants (baclofen, flexeril) , macrocyclic lactones (moxidectin, ivermectin)

In human medicine, severe toxicosis, which has been reported as potentially responsive to treatment with ILE, includes local anaesthetics, beta-blockers, calcium channel blockers, antidepressants, anti-psychotics, anti-epileptics, barbiturates, anti-malarial, cocaine and herbicides

Faster recovery time has another advantage for pet owners beyond seeing their pet return to normal, reducing the time spent in the veterinary clinic

the use of ILE is considered extra-label and informed consent is needed before its use

ILE is NOT suitable for lipophilic compounds, such as vitamin D compounds and anticoagulant rodenticides

Adverse effects of ILE are uncommon, and most are due to long-term use as parenteral nutrition. These may include hyperlipidemia, icterus, seizures, hemolytic anemia, and thrombocytopenia

Rapid ILE infusion induces fat overload syndrome, characterised by sudden elevations in serum triglycerides, dyspnoea, fever, respiratory distress, hepatic function and coagulation disturbances, seizures and coma. Pancreatitis can occur if a patient has received multiple doses or a prolonged infusion of ILE. Lung injury has also been reported. ILE interferes with laboratory measurements (such as albumin, amylase, bilirubin, creatine kinase and glucose). Centrifugation (1,200rpm to 1,500rpm for 10 minutes) of blood samples reduces laboratory interferences
Administration of an initial ILE 20 per cent IV bolus 1.5ml/kg over one minute, followed by a continuous rate infusion of 0.25ml/kg/min for the next 30 to 60 minutes. In non-responsive patients, additional intermittent bolus can be given IV slowly at up to 8ml/kg-day (do not exceed that dose). If clinical signs do not improve after 24 hours, discontinue ILE.
As parenteral nutrition ILE 20% contains 2Kcal/ml.

RE: Intralipid uses and doses

Laura Kidd — Thu, 19 May 2016 19:46:02 GMT

There is a recent 2016 vettimes article that discusses this http://www.vettimes.co.uk/article/role-of-iv-lipid-emulsion-antidote/

RE: Intralipid uses and doses

Anthony Dennison — Thu, 19 May 2016 09:40:20 GMT

My practice has some in and we have used it once, can't remember what the poisoning was, but it was very succesful.

RE: Intralipid uses and doses

Michael Woodhouse — Wed, 18 May 2016 22:35:09 GMT

No idea about mushrooms - it will help with anything dissolved in lipid.

There are lots of different doses spoken about. We generally will let the drip run for a short while initially then aim to give something like 10ml/kg over 30-60 minutes and then let the rest of the bag drip until gone at 1-2 drips per second.

We have used it exclusively for avermectin toxicity.

Warn re pancreatitis, but not seen it myself.

RE: Intralipid uses and doses

mariette asselbergs — Wed, 18 May 2016 22:32:01 GMT

We just had discussion about it on my ECC cert course forum. The BSAVA formulary says give a bolus of 1.5-4 ml/kg iv over 15 minutes, followed by 15 - 30 ml/kg/hr for 1-2 hours. It then says that you can give 30 ml/kg/hr for a maximum of 24 hrs.

If you think of it, you are then giving 6-7x maintenance dose of lipid/fluid for 24 hours to an animal that is not necessarily hypovolaemic, and often a cat (after permethrin poisoning). That seemed to me insanely risky in terms of fluid overload. It is also a lot more than the guidelines for giving lipids in a parenteral feeding set up.

But it seems that this is what people who use it as a treatment for lipophillic toxins do and it doesn't seem to be high risk for complications.

It is used for poisoning with permethrin, avermectines, baclofen, lidocaine, phenobarbital and tremogenic compost mycotoxins, and mushrooms.

Mariette