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Self-Nanoemulsification of Healthy Oils to Enhance the Solubility of Lipophilic Drugs
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Lipid emulsion use precluding renal replacement therapy
Betzaida Rodríguez1, Andrew Wilhelm2, Kenneth E Kokko1
1Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi.
The Journal of Emergency Medicine
|October 2, 2014
Summary
Intralipid emulsion (ILE) can cause severe complications like filter obstruction during continuous venovenous hemofiltration (CVVHF) in overdose cases. Emergency physicians must be aware of these risks when using ILE as a potential antidote.
Area of Science:
- Toxicology
- Critical Care Medicine
- Nephrology
Background:
- Intralipid emulsion (ILE) is a nutritional fatty acid supplement investigated for treating lipophilic medication intoxications.
- Potential complications include pulmonary edema and severe lipemia.
- Its use as an antidote is still under investigation.
Observation:
- A patient with multiple medication overdoses developed hypotension and bradycardia unresponsive to standard treatments.
- ILE was administered, initially improving heart rate but later associated with acute respiratory and renal failure.
- Continuous venovenous hemofiltration (CVVHF) was initiated but the filter became obstructed by lipemic blood.
Findings:
- ILE administration in a medication overdose led to severe lipemia.
- Lipemic blood caused complete obstruction of the CVVHF filter, preventing its use for volume removal and metabolic correction.
- Despite plasmapheresis and maximal support, the patient expired.
Implications:
- This case highlights a critical complication of ILE therapy, specifically filter obstruction during CVVHF.
- Emergency physicians must consider the risk of severe lipemia and its consequences when using ILE in overdose management.
- Awareness of ILE's potential adverse effects is crucial for patient safety and effective treatment strategies.
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